Minirin Nasal Spray (desmopressin) is an anti-diuretic used for several purposes:

• Reduces excessive thirst and urination in diabetes insipidus
• Helps control bedwetting
• Helps with blood clotting in individuals who have hemophilia A or von Willebrand disease
• Treats polyuria and polydipsia following head trauma or surgery near the pituitary region of the brain

Minirin's active ingredient, desmopressin, is a synthetic version of the naturally-occurring hormone vasopressin. Vasopressin increases water permeability in renal tubular cells. In simple terms, when permeability is increased, the need for urination and excessive thirst decreases.

Minirin also stimulates release of clotting factor VIII from cells in blood vessels. Patients who have mild to moderate hemophilia A or von Willebrand disease may use Minirin prior to minor surgery, or in other situations in which bleeding is likely. It is not terribly effective in severe cases, however.

Nasal Spray Controversy

In the USA, the nasal spray version of Minirin is associated with low sodium levels, particularly in children, and it is no longer approved for use in children in the US. Elsewhere there are no such restrictions. Parents concerned about this should discuss use with a doctor, or use an orally-dissolving tablet version of the medication. Children often take orally-dissolving tablets more readily anyway, and orally-dissolving tablets, as well as regular tablets, are not as associated with low sodium levels.

All forms of Minirin can influence electrolyte and fluid balances, however. Patients prone to such imbalances may want to consider alternative products At a minimum discuss risks and warning signs with a doctor before use.

Patients taking any form of Minirin will need to regulate fluid intake.

Diabetes Insipidus

Diabetes insipidus is the most common use for this product. Note that it will not produce benefit in other types of diabetes.

Treatment is largely personalized according to patient response. Patients under age 13 will need modified doses. The goal is to get an adequate response---sufficient sleep (not needing to get up to urinate) and sufficient turnover of water, using the lowest possible dose.

In patients age 13 and up:

• Start with 10 mcg (one spray), administered in a single dose.
• Dosage may be increased up to 40 mcg (four sprays) three or four times per day according to patient response.
• The majority of patients find 20 mcg (two sprays) taken twice per day to be sufficient.

Treatment may continue indefinitely, provided the medication continues to produce results and no side effects develop.

Bedwetting

Minirin can inhibit bedwetting in patients age 6 and up, including the elderly, as long as other causes---such as physical deformities or injury---have been ruled out. Prior to 6 years old bedwetting is fairly common and it's usually not considered something that should be treated with medication.

Again use of the nasal spray version in children is controversial in the USA. USA clients may want to consider other options.

In patients age 6 and up:

• Start with 10 mcg (one spray) before bedtime.
• Dosage may be increased, if needed, up to 40 mcg (two sprays in each nostril, total of four sprays) before bedtime.
• Do not exceed 40 mcg in children. If it doesn't produce results at this dosage, alternatives should be considered.

Fluid intake should be minimized one hour prior to administering Minirin, and maintained for at least 8 hours after a dose has been administered.

Treatment typically does not exceed six consecutive months, and some patients---particularly children---may relapse when treatment ends. The medication can also be used as-needed, for example to keep a child dry during a sleepover, once an effective dose has been determined but the patient relapsed after treatment ended. Daily use should not exceed one week for as-needed use.

Polyuria & Polydipsia

Polyuria and polydipsia are medical terms for excessive urination and excessive thirst, both of which can occur---independently or together---following head trauma or surgery to certain regions of the brain. Treatment is often similar to that of diabetes insipidus, but can vary---doctor instructions should be followed.

Treatment will likely end periodically to see if it's still needed. Post-surgical or head trauma patients should attend regular doctor checkups, and a doctor will advise on dosage and duration of treatment.