desmopressin iv to po conversion

Barnabei A, Corsello A, Paragliola RM, Iannantuono GM, Falzone L, Corsello SM, Torino F. Cancers (Basel). Gasthuys E, Dossche L, Michelet R, Nrgaard JP, Devreese M, Croubels S, Vermeulen A, Van Bocxlaer J, Walle JV. This site complies with the HONcode standard for trust- worthy health information: verify here. 1 After the original clinical study performed in Italy, desmopressin was used in Caution should be used when coadministering these agents. Wash the rhinal tube in water and shake well, until no water is left in the tube.To avoid the spread of infection, do not use the container for more than 1 person.For 2.5 mL bottles, discard after 25 sprays (doses) because the amount delivered thereafter per spray may be substantially less than the recommended dose. Conversion of IV Midazolam. Metolazone: (Moderate) Monitor serum sodium more frequently during concomitant desmopressin and thiazide diuretic use due to increased risk of water intoxication with hyponatremia. Demonstration of an adequate improvement in coagulation profile after administration is recommended prior to any surgical procedures. 1 spray (150 mcg) per nostril (300 mcg total dose) if >12 years of age or >50 kg body weight. After at least 7 days of treatment, the dose may be increased to 1.66 mcg, if needed, provided the serum sodium is within the normal range during treatment with the 0.83 mcg dose. stream Articaine; Epinephrine: (Minor) The antidiuretic response to desmopressin may be reduced in patients receiving high doses of epinephrine concomitantly. Desmopressin can be started or resumed 3 days or 5 half-lives after the corticosteroid is discontinued, whichever is longer. Particular attention should be paid to the possibility of the rare occurrence of an extreme decrease in plasma osmolality that may result in seizures which could lead to coma. The study had an open, randomised, four-way cross-over design. Subscribe to Drugs.com newsletters for the latest medication news, new drug approvals, alerts and updates. A woman who took both desmopressin and ibuprofen was found in a comatose state. Although the manufacturer states that nasal congestion does not affect the absorption of intranasal desmopressin, some clinicians recommend a higher dose. government site. Caution should be used when coadministering these agents. Amlodipine; Celecoxib: (Major) Additive hyponatremic effects may be seen in patients treated with desmopressin and drugs associated with hyponatremia including NSAIDs. Indications: Hemophilia (increases factor VIII levels): 0.3 mcg/kg in 50ml normal saline over 15-30 minutes. Aliskiren; Hydrochlorothiazide, HCTZ: (Moderate) Monitor serum sodium more frequently during concomitant desmopressin and thiazide diuretic use due to increased risk of water intoxication with hyponatremia. Desmopressin is contraindicated in patients with moderate to severe renal impairment (e.g., CrCl less than 50 mL/minute or eGFR less than 50 mL/minute/1.73 m2). Drug class: Antidiuretic hormones. In infants, doses less than 5 mcg (0.05 mL) may be necessary. Available for Android and iOS devices. This site needs JavaScript to work properly. 0.1 to 0.4 mL via rhinal tube intranasally twice a day. As of 2007 in response to a FDA request for removal of the indication, the intranasal formulation is no longer indicated for the treatment of primary nocturnal enuresis secondary to post-marketing reports of hyponatremic-related seizures, which most often occurred in pediatric patients. Would you like email updates of new search results? If the patient was previously receiving desmopressin tablets, dose titration is required because intranasal desmopressin is approximately 10 to 40 fold more potent than oral (tablet) desmopressin. Fluid restriction should be observed, and fluid intake should be limited to a minimum from 1 hour before administration, until the next morning, or at least 8 hours after administration. Caution should be used when coadministering these agents. Prolonged experience with desmopressin in pregnant women over several decades, based on the available published literature and case reports, have not identified a drug associated risk of major birth defects, miscarriage or other adverse maternal or fetal outcomes. Desmopressin is not recommended for use in persons with increased intracranial pressure or those with a history of urinary retention. Tolvaptan is a V2 receptor antagonist and may interfere with the V2 agonist activity of DDAVP. 1.5-2 mg IM/SC = 6-7 mg PO. Use desmopressin nasal spray for nocturia with caution and monitoring of blood volume status in persons with New York Heart Association Class I congestive heart failure. Desmopressin intranasal formulations are no longer indicated for the treatment of primary nocturnal enuresis due to the risk for developing severe hyponatremia that can result in seizures and death. Intermittent intravenous infusionFor adults and children weighing greater than 10 kg, dilute dose in 50 mL of 0.9% Sodium Chloride for injection. As her serum sodium concentration was 121 mmol/L, and her plasma osmolality was low in the presence of a high-normal urine osmolality and normal sodium excretion, she was treated with fluid restriction. x}n y)Zn91Iv l38Y8bIkYbX$=x:9\>?}st_~xOo^\~dt&&=\~o~g/}~y%;]V|s{h+j/~\f'iqriwZgI~IOk[b,n6'K+%Y{Y?k{]U4{H}mWRa |3}ktz_>iCy>VbZ{SZ(_!> _~{pz.5'Kxo'wW0P*okGa? Use combination with caution, and monitor patients for signs and symptoms of hyponatremia. Q@xtt/ Use combination with caution, and monitor patients for signs and symptoms of hyponatremia. Following oral administration, the bioavailability of desmopressin is about 5% and 0.16% compared to intranasal and intravenous administration, respectively. The recommended maintenance dose is 10 mcg/day to 40 mcg/day intranasally (0.1 mL/day to 0.4 mL/day) in 1 to 3 divided doses. What is the difference in Nocdurna dosage between men and women. Peak plasma concentration (Cmax) was 6.2 (5.1-7.5) pg/ml at night and 6.6 (5.5-7.9) pg/ml in the daytime. Prior to treatment with DDAVP, assess serum sodium, urine volume and osmolality. Use combination with caution, and monitor patients for signs and symptoms of hyponatremia. Rapid IV bolus DOSAGE AND ADMINISTRATION Hemophilia A and von Willebrand's Disease (Type I): Desmopressin Acetate Injection 4 mcg/mL is administered as an intravenous infusion at a dose of 0.3 mcg desmopressin acetate/kg body weight diluted in sterile physiological saline and infused slowly over 15 to 30 minutes. David McAuley, Pharm.D. Desmopressin acts similarly to native vasopressin. See Table 1 for volume of diluent to use. DDAVP Rhinal TubeDDAVP Rhinal tube is used to administer desmopressin doses less than 10 mcg (less than 0.1 mL).Break the seal on the bottle and remove cap. 1/10 of intranasal dose . Determine need for repeat dosage based on laboratory response and patient's clinical condition. DDAVP will also stop bleeding in hemophilia A patients with episodes of spontaneous or trauma-induced injuries such as hemarthroses, intramuscular hematomas or mucosal bleeding. Antidiuretic effects usually occur within 15 to 60 minutes, with peak effects evident 1 to 5 hours after nasal administration. 2022 Mar 8;7(1):e000852. [33605], Initially, 10 mcg (0.1 mL) intranasally into 1 nostril, may increase to 30 mcg until the patient can sleep for an adequate period of time without incidence of polyuria. The woman had previously received desmopressin without the development of clinical symptoms of hyponatremia Diphenhydramine; Phenylephrine: (Moderate) Although the pressor activity of desmopressin is very low compared to its antidiuretic activity, large doses of desmopressin should be used with other pressor agents like phenylephrine only with careful patient monitoring. ADH activity : Pressor activity [DDAVP: 2000-4000: 1 Vasopressin: 1:1]. A woman who took both desmopressin and ibuprofen was found in a comatose state. Scand J Urol Nephrol Suppl. Tilt bottle so that the tube inside the bottle draws from the deepest portion of the medication.To avoid the spread of infection, do not use the container for more than 1 person.For 5 mL bottles, discard after 50 sprays (doses), and for 2.5 mL bottles, discard after 25 sprays (doses) because the amount delivered thereafter per spray may be substantially less than the recommended dose. 1. Her serum sodium concentration was 124 mmol/L within a day and was 135 mmol/L by the second day. Chlorpheniramine; Dihydrocodeine; Phenylephrine: (Moderate) Although the pressor activity of desmopressin is very low compared to its antidiuretic activity, large doses of desmopressin should be used with other pressor agents like phenylephrine only with careful patient monitoring. If there is no response, the medication will be stopped. A woman who took both desmopressin and ibuprofen was found in a comatose state. If the patient was previously receiving desmopressin injection, administer 10 times the amount of desmopressin acetate, rounding down to the nearest 10 mcg. IV injection due to hypotension, bradycardia, and arrhythmias. -, BJU Int. Repeat administration should be determined by laboratory response and clinical condition of the patient. Losartan; Hydrochlorothiazide, HCTZ: (Moderate) Monitor serum sodium more frequently during concomitant desmopressin and thiazide diuretic use due to increased risk of water intoxication with hyponatremia. Desmopressin can be started or resumed 3 days or 5 half-lives after the corticosteroid is discontinued, whichever is longer. 1997;183:53-4. Captopril; Hydrochlorothiazide, HCTZ: (Moderate) Monitor serum sodium more frequently during concomitant desmopressin and thiazide diuretic use due to increased risk of water intoxication with hyponatremia. The use of desmopressin for nocturia is not recommended in pregnant women; nocturia is usually related to normal, physiologic changes during pregnancy that do not require treatment with desmopressin. Budesonide; Formoterol: (Major) Desmopressin is contraindicated with concomitant inhaled or systemic corticosteroid use due to an increased risk of hyponatremia. desmopressin (des-moe-pres-sin) DDAVP, DDAVP Rhinal Tube, DDAVP Rhinyle Drops, Octostim, Stimate. . CAREFULLY BEFORE ACCESSING OR USING THIS SITE. Other evaluations have indicated that the terminal half-life for desmopressin is approximately 3 hours. The https:// ensures that you are connecting to the Her serum sodium concentration was 124 mmol/L within a day and was 135 mmol/L by the second day. Enalapril; Hydrochlorothiazide, HCTZ: (Moderate) Monitor serum sodium more frequently during concomitant desmopressin and thiazide diuretic use due to increased risk of water intoxication with hyponatremia. Use combination with caution, and monitor patients for signs and symptoms of hyponatremia. During the initial titration period and continued therapy, observe and monitor closely. Desmopressin is contraindicated in patients with moderate to severe renal impairment (defined as a creatinine clearance below 50 mL/min). Desmopressin, sold under the trade name DDAVP among others, is a medication used to treat diabetes insipidus, bedwetting, hemophilia A, von Willebrand disease, and high blood urea levels. 1996 Sep;42(3):379-85 Children younger than 12 years of ageUse and dose must be determined by your doctor. Budesonide: (Major) Desmopressin is contraindicated with concomitant inhaled or systemic corticosteroid use due to an increased risk of hyponatremia. It acts on the kidneys to reduce the flow of urine. The initial response is reproducible if DDAVP is administered every 2 to 3 days. BJU Int. Repeat administration should be determined by laboratory response and clinical condition of the patient. The volume of diluent is weight-based. Desmopressin has been used safely in many women during pregnancy, including those with bleeding disorders and diabetes insipidus. It may be given in the nose, by injection into a vein, by mouth, or under the tongue. Limit fluid intake to a minimum 1 hour before and 8 hours after administration. dose conversion. Hougaard C, Matthiesen TB, Rittig S, Djurhuus JC. Her serum sodium concentration was 124 mmol/L within a day and was 135 mmol/L by the second day. [61810], 2 to 4 mcg IV or subcutaneously given in 1 to 2 divided doses daily. The site is secure. The woman had previously received desmopressin without the development of clinical symptoms of hyponatremia Celecoxib; Tramadol: (Major) Additive hyponatremic effects may be seen in patients treated with desmopressin and drugs associated with hyponatremia including NSAIDs. Her serum sodium concentration was 124 mmol/L within a day and was 135 mmol/L by the second day. <>/Metadata 2732 0 R/ViewerPreferences 2733 0 R>> DOSAGE AND ADMINISTRATION Hemophilia A and von Willebrand's Disease (Type I): Desmopressin Acetate Injection 4 mcg/mL is administered as an intravenous infusion at a dose of 0.3 mcg desmopressin acetate/kg body weight diluted in sterile physiological saline and infused slowly over 15 to 30 minutes. You may require 10 to 20 times a greater dose of desmopressin with the tablet oral formulations than with the nasal formulations. 8-10 mg IV = 40 mg PO. Alternatively, if the patient was previously receiving intranasal therapy, the usual dose is one-tenth (1/10) of the intranasal maintenance dose. . 0.3 mcg/kg/dose (Max: 20 mcg/dose) IV once. The morning and evening doses should be separately adjusted for an adequate diurnal rhythm of water turnover. Do Not Copy, Distribute or otherwise Disseminate without express permission. Initially, 10 mcg (0.1 mL) intranasally into 1 nostril, may increase to 40 mcg until the patient can sleep for an adequate period of time without incidence of polyuria. Her serum sodium concentration was 124 mmol/L within a day and was 135 mmol/L by the second day. In certain clinical situations, it may be justified to try DDAVP in patients with factor VIII levels between 2% to 5%; however, these patients should be carefully monitored. WARNINGS When Desmopressin Acetate Injection is administered to patients who do not have need of antidiuretic hormone for its antidiuretic effect, in particular in pediatric and geriatric patients, fluid intake should be adjusted downward to decrease the potential occurrence of water intoxication and hyponatremia with accompanying signs and symptoms (headache, nausea/vomiting, decreased serum sodium and weight gain). Eprosartan; Hydrochlorothiazide, HCTZ: (Moderate) Monitor serum sodium more frequently during concomitant desmopressin and thiazide diuretic use due to increased risk of water intoxication with hyponatremia. Desmopressin is a man-made form of vasopressin and is used to replace a low level of vasopressin. The pharmacodynamic effects of oral and intravenous desmopressin given in the daytime were similar during the first 6 h after dosing. 1. In general, desmopressin is contraindicated in persons with heart failure or uncontrolled hypertension because fluid retention increases the risk for worsening of underlying conditions that are susceptible to volume status. Idiopathic partial central diabetes insipidus. Desmopressin is contraindicated in persons with hyponatremia or a history of hyponatremia, polydipsia, concomitant loop diuretic or systemic or inhaled corticosteroid therapy, known or suspected syndrome of inappropriate antidiuretic hormone (SIADH) secretion, and other illnesses that can cause fluid and electrolyte imbalance, such as gastroenteritis, salt-wasting nephropathies, or systemic infection. Her serum sodium concentration was 124 mmol/L within a day and was 135 mmol/L by the second day. Acetaminophen; Dextromethorphan; Guaifenesin; Phenylephrine: (Moderate) Although the pressor activity of desmopressin is very low compared to its antidiuretic activity, large doses of desmopressin should be used with other pressor agents like phenylephrine only with careful patient monitoring. Adjust doses based on patient's diurnal pattern of response. Response to vasopressin is mediated through two receptors: the V1 receptor, which mediates smooth muscle contraction in the peripheral vasculature, and the V2 receptor, which regulates water resorption in the collecting ducts. A woman who took both desmopressin and ibuprofen was found in a comatose state. Infants 3 months of age to children 12 years of age: Desmopressin can be started or resumed 3 days or 5 half-lives after the corticosteroid is discontinued, whichever is longer. Management focuses on controlling symptoms with drug therapy. Her serum sodium concentration was 124 mmol/L within a day and was 135 mmol/L by the second day. 8600 Rockville Pike Use combination with caution, and monitor patients for signs and symptoms of hyponatremia. Fluid restriction was to be observed, with fluid intake was limited to a minimum from 1 hour before intranasal administration, until the next morning, or at least 8 hours after administration. Only start or resume therapy in patients with a normal serum sodium concentration. Dextromethorphan; Diphenhydramine; Phenylephrine: (Moderate) Although the pressor activity of desmopressin is very low compared to its antidiuretic activity, large doses of desmopressin should be used with other pressor agents like phenylephrine only with careful patient monitoring. Carbinoxamine; Phenylephrine: (Moderate) Although the pressor activity of desmopressin is very low compared to its antidiuretic activity, large doses of desmopressin should be used with other pressor agents like phenylephrine only with careful patient monitoring. During treatment with DDAVP Injection, assess serum sodium, bleeding time, factor VIII coagulant activity, ristocetin cofactor activity, and von Willebrand antigen to ensure that adequate levels are being achieved. Her serum sodium concentration was 124 mmol/L within a day and was 135 mmol/L by the second day. Oxaprozin: (Major) Additive hyponatremic effects may be seen in patients treated with desmopressin and drugs associated with hyponatremia including NSAIDs. Use combination with caution, and monitor patients for signs and symptoms of hyponatremia. Last updated on Sep 28, 2022. Decrease bleeding following cardiac bypass: 0.3 mcg/kg ivpb. The resultant increases in FVIII and vWF are similar to those seen with replacement therapy using blood products. 1/10 of intranasal dose; restrict fluid intake nocturnal enuresis Use combination with caution, and monitor patients for signs and symptoms of hyponatremia. Also known as antidiuretic hormone (ADH), vasopressin is secreted by the hypothalamus in response to hyperosmolarity, volume depletion, stress (emotional or physiological), certain drugs, and painful stimuli. DB00035. Diclofenac: (Major) Additive hyponatremic effects may be seen in patients treated with desmopressin and drugs associated with hyponatremia including NSAIDs. As her serum sodium concentration was 121 mmol/L, and her plasma osmolality was low in the presence of a high-normal urine osmolality and normal sodium excretion, she was treated with fluid restriction. Use combination with caution, and monitor patients for signs and symptoms of hyponatremia. Lisinopril; Hydrochlorothiazide, HCTZ: (Moderate) Monitor serum sodium more frequently during concomitant desmopressin and thiazide diuretic use due to increased risk of water intoxication with hyponatremia. Most patients respond to 1 to 2 doses; administer a second dose 8 to 24 hours after the first dose if needed. Use combination with caution, and monitor patients for signs and symptoms of hyponatremia. IV and subcutaneously: No definitive dosing available. News Article Holder This page will generate the the news article from the ID supplied in the URL. Select one or more newsletters to continue. Terminal half-life was longer at night than in the daytime, but the difference is considered too small to be of clinical importance. Gently breathe in through the nose and out through the mouth several times.Wipe the nasal applicator using a clean tissue and replace the cap on the bottle.To avoid the spread of infection, do not use the container for more than 1 person.Do not co-administer with other intranasal products.Discard nasal spray 60 days after opening. Missed Dose As her serum sodium concentration was 121 mmol/L, and her plasma osmolality was low in the presence of a high-normal urine osmolality and normal sodium excretion, she was treated with fluid restriction. Desmopressin can be started or resumed 3 days or 5 half-lives after the corticosteroid is discontinued, whichever is longer. As her serum sodium concentration was 121 mmol/L, and her plasma osmolality was low in the presence of a high-normal urine osmolality and normal sodium excretion, she was treated with fluid restriction. Persons with vWD subtype 1C, which is characterized by a shorted vWF half-life, may require alternative management in the setting of surgery. Lithium: (Moderate) The antidiuretic response to desmopressin may be reduced in patients receiving lithium concomitantly. As her serum sodium concentration was 121 mmol/L, and her plasma osmolality was low in the presence of a high-normal urine osmolality and normal sodium excretion, she was treated with fluid restriction. During the initial titration period and continued therapy, observe and monitor closely; treatment should be adjusted according to the diurnal pattern of response. For bleeding, desmopressin increases the blood levels of factor VIII and von Willebrand . Initially, 0.2 mg PO once daily at bedtime. When administered to patients with central diabetes insipidus, desmopressin exerts antidiuretic effects similar to those of vasopressin; a reduction in urine output with an accompanying increase in urine osmolality and a decrease in clinical symptoms of urinary frequency and nocturia are noted following desmopressin treatment. Generic name: DESMOPRESSIN ACETATE 4ug in 1mL Demonstration of an adequate improvement in coagulation profile after administration is recommended prior to any surgical procedures. 2 0 obj Careful fluid intake restrictions are required in pediatric patients to prevent hyponatremia and water intoxication. Bumetanide: (Contraindicated) Desmopressin is contraindicated with concomitant loop diuretic use due to an increased risk of hyponatremia. The initial and terminal half-lives for desmopressin are 7.8 and 75.5 minutes, respectively, resulting in a prompt onset of action with a long duration of action. The 0.83 mcg dose did not meet all prespecified efficacy endpoints in clinical trials, but may have a lower risk of hyponatremia. Use combination with caution, and monitor patients for signs and symptoms of hyponatremia. 0.2 to 0.6 mg orally once daily before bedtime. The pump will stay primed for up to 1 week. Desmopressin is present in small amounts in human milk and is poorly absorbed by an infant. Then i-Vents acuity will now have a 10 to signify there is a open i-Vent. When switching between formulations, the below text is meant as guidance for starting dose. Usual Adult Dose for Diabetes Insipidus Initial dose: 0.05 mg orally twice a day or 1 to 2 mcg IV twice a day or 1 to 2 mcg subcutaneously twice a day or 5 to 40 mcg spray intranasally twice a day or 0.1 to 0.4 mL via rhinal tube intranasally twice a day. Subscribe to Drugs.com newsletters for the latest medication news, new drug approvals, alerts and updates. Dilute DDAVP Injection in sterile 0.9% Sodium Chloride Injection, USP and infuse slowly over 15 minutes to 30 minutes. Desmopressin Acetate Injection 4 mcg/mL dosage must be determined for each patient and adjusted according to the pattern of response. Hvistendahl GM, Riis A, Nrgaard JP, Djurhuus JC. The peak cerebrospinal fluid concentrations are 60% greater with IV administration than with PO and 87% greater with IV administration than with PR. Prior to treatment with DDAVP Injection, verify that factor VIII coagulant activity levels are >5% and exclude severe von Willebrand's disease (Type I) and presence of abnormal molecular form of factor VIII antigen. Main menu. The optimal dosage depends on the patient's response (duration of sleep and adequate, not excessive water turnover). Many persons with type 2 vWD do not respond to desmopressin and require alternate treatment; however, a desmopressin trial can help confirm diagnosis and may be useful in some instances of mild bleeding in persons with type 2 vWD. The hemostatic effects of desmopressin are mediated through V2 receptor agonist activity, as patients with nephrogenic diabetes insipidus, who lack this receptor, do not have a hemostatic response to desmopressin. The plasma levels given by the intravenous dose resulted in a duration of action of 12 h or more. Children more than 12 years of age: Desmopressin can be started or resumed 3 days or 5 half-lives after the corticosteroid is discontinued, whichever is longer. <> Dosing: Diabetes Insipidus Propranolol; Hydrochlorothiazide, HCTZ: (Moderate) Monitor serum sodium more frequently during concomitant desmopressin and thiazide diuretic use due to increased risk of water intoxication with hyponatremia. The nasal spray should not be used to treat patients with type IIB von Willebrand's disease since platelet aggregation may be induced. DDAVP (Desmopressin Acetate Tablets) may treat, side effects, dosage, drug interactions, warnings, patient labeling, reviews, and related medications including drug comparison and health resources. Please enable it to take advantage of the complete set of features! Withdraw the necessary volume of DDAVP Injection from the vial and dilute by adding to the infusion bag of 0.9% Sodium Chloride Injection, USP per Table 1. %f2fDWBRex1*s GZhlNx;hI>l!dKc:cmEg2&M*?*q$|sa[`ov#1q=[`0GP/==g5>dof?N~;1Y Infusion Pump Required. Desmopressin: Corticosteroids (Systemic) may enhance the hyponatremic . If no response after 3 days, the dose was adjusted upward to 40 mcg/day (20 mcg per nostril) intranasally at bedtime. The following pharmacist will check on these open i-Vents and close then when appropriate. No adverse developmental outcomes were observed in animal reproduction studies with administration of desmopressin during organogenesis to pregnant rats and rabbits at doses approximately less than 1 and 38 times, respectively, the maximum recommended human dose based on body surface area (mg/m2). Fluid restrictions should be observed. For All Patients Receiving Repeated Doses: Restrict free water intake and monitor for hyponatremia. Use combination with caution, and monitor patients for signs and symptoms of hyponatremia. In additio The morning and evening doses should be separately adjusted for an adequate diurnal rhythm of water turnover. Ther Drug Monit. The mechanism of action of desmopressin in Use this combination with caution, and monitor patients for signs and symptoms of hyponatremia. peak plasma concentration (Cmax) was 4 (+/- 3.85) pg/mL for the 0.83 mcg dose and 9.11 (+/- 6.90) pg/mL for the 1.66 mcg dose. 3 0 obj Less vasopressor activity. Serum concentrations of potassium, sodium, and creatinine do not change following the administration of desmopressin, and urinary excretion of potassium and sodium also remains the same. Administration of intranasal desmopressin may be compromised by nasal mucosa changes (e.g., nasal trauma, nasal surgery, nasal blockage, nasal mucosal atrophy, congestion, or severe atrophic rhinitis), cranial surgery, and nasal packing. The woman had previously received desmopressin without the development of clinical symptoms of hyponatremia Sumatriptan; Naproxen: (Major) Additive hyponatremic effects may be seen in patients treated with desmopressin and drugs associated with hyponatremia including NSAIDs. As her serum sodium concentration was 121 mmol/L, and her plasma osmolality was low in the presence of a high-normal urine osmolality and normal sodium excretion, she was treated with fluid restriction.