Monday, January 24, 2011

How Do We Make Desmopressin Dose Adjustments in Dogs or Cats with Diabetes Insipidus?

Once a diagnosis of diabetes insipidus has been confirmed, the next step to start replacement treatment with desmopressin.

Initial treatment with desmopressin

Recommended initial doses of desmopressin vary depending on the route it is being administered. In most cats and smaller dogs, 1 to 2 drops of the intranasal preparation administered once or twice daily are sufficient to control polyuria and polydipsia (see Table below).  Larger dogs may require up to 4 to 5 drops twice daily. Use of a tuberculin or insulin syringe allows for more accurate dosing. Application of desmopressin into the conjunctival sac may cause local irritation, as the solution is acidic. Some animals may object to the daily eye drops, making this route of administration ineffective.

With the subcutaneous route of administration, the initial recommended dose is 1.0 to 5.0 μg once or twice daily, depending on the size of the animals. If the nasal solution (100 µg /ml) were used for this purpose, one would inject only 0.01 to 0.05 ml (or 1 to 5 U with a U-100 insulin syringe). With the oral tablets, a starting dose of 0.05 mg to 0.2 mg (50 to 100 µg) once or twice daily is initiated.

Desmopressin dose adjustments

In dogs and cats with central diabetes insipidus, daily administration of desmopressin may completely eliminate polyuria and polydipsia. However, because of individual differences in absorption and metabolism, the dose required to achieve complete, around-the-clock control varies from patient to patient. The maximal effect of desmopressin occurs from 2 to 8 hours after administration, and the duration of action varies form 8 to 24 hours. Larger doses of the drug appear to both increase its antidiuretic effects and prolong its duration of action; however, expense can become a limiting factor for some owners.

No matter what route of administration is used, the daily dose should be gradually adjusted as needed to control signs of polydipsia and polyuria. The morning and evening doses can be adjusted separately if needed.

Adverse effects of desmopressin 

Desmopressin is relatively safe for use in animals with central diabetes insipidus. Adverse effects of desmopressin are uncommon, but overdosage can lead to fluid retention, hyponatremia, and decreased plasma osmolality. Although extremely rare, fluid intoxication associated with desmopressin overdosage can lead to CNS disturbances including depression, increased salivation, vomiting, ataxia, muscle tremors, coma and convulsions. In such instances, furosemide can be given to induce diuresis.

To avoid the potential problem of overdosage, it is recommended that animals not be allowed free access to water immediately after each dose of desmopressin, especially if severe polydipsia and polyuria have redeveloped. Without such short-term (1 to 2 hours) water restriction, the cat many consume excessive amounts of water that cannot be subsequently excreted, as the desmopressin is absorbed and has its peak antidiuretic effects on the renal tubules.

Cost of desmopressin

The principle drawback with the use of any of the desmopressin preparations in the treatment of central diabetes insipidus is the drug’s considerable expense.  The oral route of administration is the most expensive, while the subcutaneous route of administration (using the sterilized nasal solutions) is generally the most cost-effective.


Click on Table to enlarge.

79 comments:

Carol Jackson said...

You state that "In most cats and smaller dogs, 1 to 2 drops of the intranasal preparation administered once or twice daily are sufficient to control polyuria and polydipsia (see Table below). Larger dogs may require up to 4 to 5 drops twice daily."

I was under the understanding that it was not size or weight dependent but solely on their Specific Gravity of the urine.
I have cared for 2 dogs in our rescue with CDI. for both, we tweeked their DDAVP based on SPGr not their weight or size.

Carol Jackson RN

Dr. Mark E. Peterson said...

You are correct in saying that there is not an exact dose to give. Some small dogs need a larger-than-expected dose, whereas other large dogs need a smaller dose. That said, larger dogs almost always need a larger dose than smaller dogs do.

Finally, I don't adjust the dose based upon the specific gravity alone... I adjust it based on the water consumption and degree of urination.

swanson vets said...

When using the tablets, is it best to give with food or without food for maximum absorption? Or does it make no difference?

Dr. Mark E. Peterson said...

It doesn't appear to make a difference.

Robin said...

Is there a great dropper that can be purchased? We take a Systane eye drop bottle and put the Desmopressin in there. But lately, that dropper is not holding the drop well. I think our fridge keeps them too cold. Can they be left out? Or can you recommend a good eye dropper system that holds the drop in the bottle more securely? Thanks in advance. I have a small 8 lb. Tabby cat with diabetes insipidus.

Dr. Mark E. Peterson said...

Yes, your vet or pharmacist should be able to order an eye dropper and vial for you. The solution should be kept refrigerated.

I've had much better luck in cats injecting the desmopressin. Most cats don't seem to respond well to eye drops and they don't like them!

Lauren Lawton said...

I have been advised to give the drops in the eye, however after years of use the eyes now appear to be becoming cloudy. The dog tolerates the solution being given nasally well, is this an effective route in dogs and can DDAVP cause clouding of the eyes?

Dr. Mark E. Peterson said...

I have very little experience using desmopressin intranasally - usually dogs don't tolerate intranasal administration, and they just sneeze it out. That's why we use the intranasal human preparation as an ocular/conjunctival drop...but having said that, it should work very well intranasally.

I have never had an owner or veterinarian comment on clouding of the eyes after long term administration, although some dogs find the drops irritating to their eyes. You might want to check out Wedgewood Pharmacy - they prepares a desmopressin ophthalmic solution that is pH-adjusted and sterile which theoretically should be kinder to the eyes.

TJ Miller said...

Our cat has had polydipsia and polyuria since we found him 4 years ago. He has had poor appetite, weight loss and intermittent vomiting. He has had mild renal insufficiency in the past. When we took him to the vet he was clearly dehydrated but he had dilute urine (SG 1.015) along with elevated serum osmolality. The calculated osmolality was 344.6 (based on Na 152, BUN 98 Glu 102) Cr was 4.7. Is the dx of diabetes insipidus possible in this situation of dehydration, hyperosmolality of the serum and dilute urine? Or is this due to his apparent chronic renal insufficiency? After hydration his BUN dropped into the 40's but Cr only went down to 4.3. He has 2 plus proteinuria and mild anemia.
I had suggested the dx of DI to our vet based on his long history of profound polydipsia and polyuria along with the numbers at his latest presentation to the vets office. But is the dx of DI possible in the face of only upper normal serum sodium in this case?
I am an MD. THANKS

Dr. Mark E. Peterson said...

Cats with chronic renal disease have nephrogenic DI, which is at least partially responsible for the polyuria.

Your cat is in IRIS stage 4 CKD, however, so it's unlikely that desmopressin would make much difference. It may decrease the polyuria and polydipsia, but wouldn't increase long-term survival.

M. A. Mullaney said...

Your article was a great help to me in researching this topic. My 7yo pit mix was diagnosed with pituitary based cushings a year and a half ago, and diagosed with DI a few months ago. We first tried pills that had no effect at all. But once her vet changed to injections, she went from drinking 36 cups of water a day to 14 cups a day in 24hrs...it was amazingly effective. She started with 5 units 2x, then down to 4 units 3 days later. Still drinking normal amounts. The plan is to keep dropping her down to find the optimal dosage. Based on your experience, do you think it is possible to get her down to a once a day injection that will still be effective? Thank you.

Dr. Mark E. Peterson said...

You probably need to inject the desmopressin twice a day to control the thirst throughout the day.

However, many people only give the injection at night, so the dog won't have to urinate overnight. Of course, this also allows you to get some sleep!

M. A. Mullaney said...

Thanks for your reply, Doctor. With the Desmopressin injections being so effective, and her water intake back to normal, do I have to worry about the effectiveness of the injections masking the effectiveness of the Vetoryl and the possible need to adjust that medication? She started Vetoryl at 30mg 2x in September of 2012 and we've tested her since (last time was July) and she was right where she needed to be, so we've been with the 30mg 2x for over a year now. Her vet said we don't need to test as often as most because we measure her water every day. I just want to make sure that the Desmopressin isn't hiding the possibility that her Vetoryl may need to be adjusted. What are your thoughts on this? Thanks so much for your opinion and insight.

Dr. Mark E. Peterson said...

I would still recommend that you monitor your dog's cortisol levels every 3 months while on Vetoryl.

Monitoring thirst isn't going to help overdosage, and it's not uncommon for the dose to decrease with time on the Vetoryl.

M. A. Mullaney said...

Thank you very much.

jaf said...

My daughter's 7 year old black lab was diagnosed with DI about 7 months ago, after ruling out other possibilities. He has always displayed the signs of excessive drinking and urination, but never really had any problems associated with these, had never had an accident in the house. He started showing some aggressive behaviors and in the process of doing some evaluations the DI was diagnosed. He was started on desmopressin, one drop in each eye twice a day and seemed to show improvement. After several months he started urinating in his sleep. The dosage was increased to 2 drops in each eye twice a day. This seemed to take care of the problem until about a week ago when he had difficulty holding his urine after 4-5 hours, and again urinated in his sleep. Any ideas of what's happening here?

Dr. Mark E. Peterson said...

Based on the information provided, I certainly can't confirm the diagnosis, but it sounds like primary diabetes insipidus isn't the underlying problem. Central DI that first developed at age 7 years would be highly unlikely, unless the dog had a large pituitary tumor that had destroyed the neurons that secrete vasopressin. That would be very rare, however. There are many, many problems that can cause increased thirst and urination, and many of them will respond, at least temporarily, to treatment with desmopressin

I'd recommend that you talk to your vet about continuing the workup. You might need a referral to a specialist to figure out this problem.

jaf said...

Thanks. The thing about this is that this dog has had increased thirst and urination since he was a puppy but it never caused any problems and was never looked into specifically. It was only when he was having another problem about 9 months ago that more testing was done and in the process this was diagnosed. Apparantly regular diabetes, thyroid, liver and kidney failure, cushings and addisons testing all came out normal. I believe he is going back to the vet today since he had those couple accidents last week, although the past few days have been fine.

Dr. Mark E. Peterson said...

DI isn't a progressive disease. Most puppies need treatment to make reasonable pets unless they can live outside with access to tons of water.

So your dog didn't need treatment, and now all of a sudden he does, and it's not working?? Something else is probably going on here. Again, you need to talk to your vet about this and continue the workup.

jaf said...

Thanks so much for your input. We will likely be consulting a specialist to figure out the problem.

Merrick Wolfe said...

Thanks for your great blog, Dr. Peterson, and this page in particular. My 13yo Lab/Chow was diagnosed with DI (by process of elimination) a few months ago. Initially I tried the eyedrops but I actually found that method to be a bit messy at times, the effectiveness questionable, and I did have some worry about the effect of the acid solution on the eye. I just switched to injectable and instantaneously the water consumption has gone down and she now sleeps through the night.

However... one thing that happened with the eyedrops that is also happening with the injection: maybe about 2 or 3 hours after the injection, when I take her out, she has trouble peeing. Eventually the peeing goes back to normal -- although today lasted a bit longer and she seems to be able to only dribble out.

She's never had a problem urinating before and through the process of determining diagnosis she was tested for everything including UTI and had urine checked recently and all came out negative.

Also, it seems like when she's excited or when we're walking she's panting a bit harder than usual -- although when she's resting at home, laying down, there's no panting, it's normal.

Have you heard of these symptoms related to the Desmo before? I wonder if my telling you the dosage if that would make any difference. Rx says: "Give 0.1cc subq 1x/day. Desmo 50mcg." And my vet wrote: 0.1cc = 10 units, u-100

My dog is 70lbs. Do you feel this is normal dosage?

I'm going to check in with the vet on Friday, but I believe this is his very first case of DI he's treated (as seems to be the case with many vets) -- he said he had to do research on it when we narrowed down the diagnosis to DI, plus he initially didn't think the subq format was necessary, but has since found it's more accurate, as you've said (maybe he read your blog?) -- and so getting a second opinion, especially from you, would be highly appreciated. Thank you.

Dr. Mark E. Peterson said...

The signs that you describe should not be related to the desmopressin -- it sounds more like a UTI. I know that the urine culture was negative, but you dog would still have an occult bladder infection or have other pathology of the bladder going on.

If you haven't already done so, you might want to do an antibiotic trial to see if the symptoms improve. The recommended antibiotics would be either Clavimox (12.5 mg/kg) or Baytril (10 mg/kg once daily); in larger dogs, generic ciprofloxacin would be a cheaper alternative than Baytril (enrofloxacin), The dose of enteric ciprofloxacin is 1.5-2X greater than Baytril because of intestinal absorption issues. Treatment is recommended for a minimum of 1 week or a maximum of 2 weeks

Merrick Wolfe said...

Further responding to the above: it turns out my vet is not back until Monday, but on a hunch I decided to decrease the dosage from .1cc to .05cc -- and, lo & behold, she had no problem urinating thereafter and, at the same time, the PU/PD symptoms had not returned.

I administered this reduction in dosage still only 1x/day -- and a few hours prior to her next dosage (about 22 hours) she was back to excessive peeing which is leading me to wonder: .05cc, 2x's/day...?

I'm wondering: could this possibly be that .1cc is akin to a slight overdose in her situation, despite her 70 lb. body weight, and what she was experiencing was water retention? Or, perhaps, the .1cc was correct and this could have been psychological -- her thinking she had more to give, the transition period in getting used to peeing as normal prior to acquiring the PU/PD.

I will certainly be consulting further on Monday with our vet on these issues as well and will bring your recommendation to further address possible bladder issues -- with my thanks.

Dr. Mark E. Peterson said...

It is never a problem to decrease the dose. We don't want to ever INCREASE the dose too much because the dogs can develop serious side effects (neurological signs from water intoxication).

Mark Brennan said...

One one my cats has just been diagnosed with DI (after wrongly being diagnosed and treated by my previous vet with CRD) my vet has told me to give my cat 0.05ml DDAVP nasally per day using a 1ml syringe . I am finding this very difficult to manage and am wasting more of the drug than I am using. I am going to show this article to my vet, but wondered if 1 or 2 drops was closer to the prescribed dose. I tried to contact Ferring UK to ask if they knew how much one drop contained but was unable to speak to anyone there.

Thanks.

Dr. Mark E. Peterson said...

First of all, DI is an extremely rare disorder in cats, especially adult cats. Obviously, I don't know your cat's history or the testing done, but most cats that I see who have been diagnosed with DI do not have the disease.

If we are going to use desmopressin in cats, I certainly wouldn't give it intranasally! We can use eye drops, oral pills, and subcutaneous injections, but in cats the injections are by far the best way to control the increased thirst and urination.

You can buy sterilized desmopressin that is meant to give by injection from a veterinary compounding pharmacy relatively cheaply (eg, Wedgewood pharmacy).

Robin said...

Hi Dr. Peterson, I have a little tabby, Kate, who's had DI for several years now. We've been doing the eye drop and all seems to be okay. However, she was just diagnosed with Hypotropic Cardiomyopathy. I'm wondering if the bp elevation that results from the Desmopressin caused it. Would hate to think that. Any thoughts? Thanks in advance, Robin Hardy

Robin said...

Also, by the way, I saw your comment on the eye dropper. Thank you. She is an absolute angel about the eye drops, though, just leans back and holds her eye open. But I would say, there are days (most days) where the drops don't seem to be limiting her urination that much. There are large (!) clumps of urine in the kitty box.

Dr. Mark E. Peterson said...

Desmopressin has little effect on blood pressure (this is not true for natural vasopressin). So the drug should not have caused either hypertension or the heart disease.

jerseygirl said...

Thanks for the great posts to help we folks with DI pets. Our 14.5 yr old Cardigan Welsh Corgi was diagnosed with DI last April. Water monitoring pre-treatment showed 7 - 9 cups per day (Duncan is 40 #'s). Twenty-four hours after starting Desmopressin eye drops, consumption dropped to 3.5 - 4 cups. He's been relatively stable since then although some creep in water consumption caused us to increase from 2 drops to 3 drops twice a day.

Based on blood test results and repetitive hot spots over the past year, he started on Soloxine .3mg twice a day on 1/29/14. Almost exactly one month later, he started eating his poop. With abandoned. Never in his life was this an issue. His kibbles and biscuits are all ones that we've used for years. Also, his water consumption has ramped up even more. His 24 hour test today showed 8.75 cups consumed. Because of this, we had a fairly large leakage issue today. He has been on Metacam liquid and Tamadol (1/2 of 50mg twice a day) for several years due to arthritis pain. He takes Pepcid AC 10mg due to stomach issues with the Tramadol. One other item which was unexpected is that he started showing signs of stomach distress shortly after starting the Soloxine. This was alleviated by giving him a small biscuit with the pill (I'm aware of the empty stomach instructions).

Since the introduction of the Soloxine, he's initiated more engagement with us, mostly to acquire more treats. Also he has lost some inhibition about just grabbing for something he wants to eat (our treats, not his).

We are waiting for a call from our Vet. Duncan is due for thyroid tests and I expect she will want other blood tests too as well as SG. Meanwhile your opinion on two items would be appreciated.

First, could the Soloxine have caused this sudden coprophagia? If so, would you expect a dosage reduction to correct it or would a different thyroid med be in order?

Second, do you think giving Duncan a trial on the injectable Desmopressin would be worth our while? He is great with the eye drops and with his pill meds, he even opens his mouth for me to pop them down his throat.

He is an alert, engaging, companion and, while mostly deaf, he is still in very good shape. We watch for gait problems on the assumption of a tumor causing the DI but all I see is weakness caused by his arthritis pain. When we can fit in a 3d 1/2 pill he ambulation is better. Thanks for your consideration.

Dr. Mark E. Peterson said...

Thyroid medication should not cause a dog to eat his or her stool.

If your dog is doing well on the current treatment with desmopressin, there is absolutely no reason to switch to the injections.

andysalm said...

We have just started (this morning) a trial of Desmospressin with my elderly dog. Luckily I was able to convince my vet to use a trial of Desmospressin instead of a water deprivation test, and to use the compounding pharmacy that you recommend. However, my vet has little or no experience with DI and thus I have no advice on the protocol used with this drug. More than anything I am concerned with the timing of dosage and water consumption. Can my dog drink water before or after the eye drops, or should I withhold water?
Sandra

Dr. Mark E. Peterson said...

No, you should NOT withhold water. This could lead to serious problem, depending on the underlying cause of the increased thirst and urination.

jerseygirl said...

Just a comment on Andysalm's post, our Duncan was 13.5 at diagnosis and I also refused to have him given a water deprivation test. Testing for suspected DI by a trial of Desmopressin eye drops worked like magic. Letting a DI dog run out of water starts a spiraling stress situation. Not knowing Duncan was DI, this happened to us and it took about 5 hours for him to get back to normal (he did have his normal bowl of water in his cage but the undiagnosed DI caused him to run out). He was beside himself and had pooped & peed in his cage. He then drank about a pint, threw it up, then drank every 10 minutes for close to an hour. He wouldn't eat for close to 2 hours and then finally got back to normal by bedtime. Ergo when the vet said water deprivation, I said no. We actually have a water bowl in the bedroom, in the kitchen, and in his cage. For an older dog, it's good to cage him in the bedroom at night, with water. If he starts whining, then he needs to go out.

Hdale said...

I am still confused on what this Desmonpressin is suppose to do for my dog. I have a 7 year old german sheperd-great dane mix. He started urinating alot more and can't control it. He has had several accidents in the house. When he drinks water he acts like he's been without for days but that is not the case. Then when he urinates is twice as much as he took in and he has to go frequently. I'm also concerned on how much water he should be drinking and what this medicine is suppose to do for him.

Dr. Mark E. Peterson said...

Desmopressin is a treatment for diabetes insipidus (remember that this blog is written for veterinarians and vet technicians). It doesn't sound like you have a diagnosis. This is not a drug to use indiscriminately.

Talk to your veterinarian about what workup is needed and what to do.

Lyanna Stark said...

Dr. Peterson, thank you for taking time out of your busy day to respond to these questions.

We have a 14 year old retreiver that has been treated with desmopressin (5 units of .01% inj SQ BID) successfully for two years now.

Approximately 6 months ago, the dog was started on carpofen for join pain/stiffness (100mg BID).

Recently, we have observed a modest increase in thirst, decreased appetite, and panting/rapid breathing.

We stopped both the carprofen and desmopressin immediately, but made water readily available. Of course the thirst/urination increased, however the panting/rapid breathing stopped and the dog's appetite returned.

I'm taking her back to the clinic for urinalysis and blood work today, however I welcome any thoughts/suggestions you may have regarding this case.

Thank you again!

Dr. Mark E. Peterson said...

I'm happy to hear that you have an appointment. You definitely need to monitor your dog with periodic blood and urine tests, especially at 14-years of age.

skearns said...

We have been giving our dog (28 lb
terrier mix) Desmopressin
the 10 microgram spray, but we
spray into his upper lip,
holding his lip out and spraying
between the gums and lip.

This works great, doesn't bother
him at all. We know it works by
comparing his water drinkage when
on and off.

Recently, some online pharmacies
have stopped carrying it, and we
have been forced to get it from
CVS for $178 / 5mg bottle. ouch.

Since he has a doggy door but
gets caged at nite, we only give
it to him at nite and this seems
to work ok.

Janni C. said...

check CVS and ask them to run some of the "free" discount cards - like goodRx, etc - I am paying about $100 for the vial and the folks were really helpful in finding the "free" discount cards that can be applied - esp if you tell them it's for a dog. ;-)

Houdini said...

My dog was diagnosed with DI and I have been treating him with 1 drop of desmopressin acetate in the occular conjuctive sac twice daily with great success. Unfortunately I stuck the bottle in my pocket after administering it and it fell out in the car and spent the day there in the heat. Since it's suppose to be kept refrigerated, is it ruined and/or would it harm my dog to continue to administer it or would it just be less effective?

Dr. Mark E. Peterson said...

The heat likely damaged the desmopression, but I don't see how the drug could hurt your dog. If it's lost all it's potency, it just won't be effective anymore. You will know within a day or so if you need a new bottle.

jono10-43 said...

I am not sure what is meant by "sterilised" nasal spray? I have a patient that I would like to explore cheaper Rx options for - currently using the human Minirin melts 120ugs - effective but costly. Thank you Dr Peterson for any comment. Kind regards, Jonathan Hale MRCVS

Dr. Mark E. Peterson said...

You don't want to put regular nasal drops/nasal spray into a dog's conjunctival space. We sterilize the solution by passing it through a Millipore filter. A pharmacy may be able to help you with that, or you can buy desmopressin that is meant for ocular use.

jono10-43 said...

Thank you Dr Peterson, I was actually thinking of creating a solution for subcutaneous injection (as per your chart the least expensive soln. I guess same technique as for the conjunctival route applies. Hadn't heard of Millipore filters till now. Thanks for enlightening me. Jonathan

Dr. Mark E. Peterson said...

Yes, the filter sterilization is even more important for SC injections!

ALISON COZZOLINO said...

My vet and I have decided to start desmopressin on my 10 yr old dalmatian. He is prescribing the ocular route. I have read in your article it can be given SC as a means of cost savings. Am I to understand that the nasal form can be given SC directly from bottle or does further filtering have to be preformed. This is based on the question from jono10-43 of Aug 11, 2014 and your response mentioning "filtering with Millipore filters and how the filter sterilization is even more important for SC injections"

Dr. Mark E. Peterson said...

The ocular form of desmopressin is not sterilized for the parenteral (Subcutaneous) route. What I generally recommend is to buy it from a compounding pharmacy and let them do the filtering/sterilization.

Heidi Schluter said...

we are currently using drops .1mg each eye twice a day. 160.00 for each refill. I just found I can get the tablets for $58 for 30 days. This is with a AAA discount. tablets are .1mg is 1/2 twice a day suffiecnt? or does it need to be every 8 hrs. Ihave been getting conflicting information and thought you input would help.

Heidi

Dr. Mark E. Peterson said...

Most owners give the pills twice daily, which adequately controls the urination.

Horse Mom said...

Our dog was diagnosed with DI as a pup early in 2006 by his prior owner's veterinarian. They couldn't keep him in their RV traveling across the countryside, so we took him since we live on land and have a dog door and access to tons of water (a horse water trough). Initially we tried the DDVAP in his eye, but it was a big mess and he hated it and I never noticed a difference, so wondered at the time if it was psychogenic or possibly nephrogenic DI or if I just never got it dosed correctly.

Sadly, I didn't even think to look for a veterinary endocrinologist at the time to help us figure out what was really wrong with him, but kept bouncing around from vet to vet for help. Then gave-up on a solution.

A few vets I encountered said it was extremely rare to have a case of DI and even if he had it, for his 40 lb weight we should limit his water usage to no more than some small amount daily, I tried for 1/2 day when I realized the vet just didn't understand what it was like to live with a dog so thirsty that he'd dig out the backyard looking for more water. I wanted to try and give DDAVP subcutaneous since in his eye I wasn't getting it administered correctly, it was going everywhere but in his eyes. For some reason, the vets I encountered, it was met with resistance for me to give it to him subcutaneously; even though as a horse trainer I give IM, subq, and IV injections routinely as prescribed by my client's veterinarians for their horses.

This dog recently had an incident where he started vomiting bad from getting into canola oil and rather quickly went into shock from being dehydrated since he couldn't keep down his water and it didn't help that he was guzzling it down out of pure panic. The ER clinic helped stabilize him with IV fluids. The incident then made me determined to help find a solution and answer if it was central DI vs nephrogenic DI. Thankfully I found a vet near us willing to prescribe the desmopressin acetate tablets, because there was no way I was going to put him through a water deprivation test that other vets wanted us to first do. The vet did first do a sterile urine culture to ensure he didn't have a UTI. Another reason I wanted to start him back on desmopressin is he just isn't getting good sleep (neither are we) and is up every 3 hours at night to go out the dog door and I worry as he gets older, he just won't be able to hold it as well as he does now with the gigantic bladder he has developed to cope with his issue.

Yesterday, we started our 40 lb dog on 0.1 mg of desmopressin acetate 3 times a day, as per the vet instructions. So far it seems to be working!

I found the best deal to buy is using GoodRx.com to get the 0.2mg tables and split them in half. It cost $116.00 at my local pharmacy for 100 of the 0.2mg tablets that accepted the GoodRx coupon. I was dubious if the GoodRx would work and it does! I am hoping the desmopressin tablets keep working and he can sleep peacefully in his twilight years and not be so anxious about water.

I notice you mention that twice a day is ok to give vs. 3 times a day. I spoke to our vet that in all likelihood, two times a day is more realistic, but he wanted me to be diligent in the first month of getting home to give it to him 3 times a day spaced 8 hours apart, then go to a twice-a-day.

What issues can he encounter if I only give it to him with is PM dinner and then AM breakfast? I'm assuming it if only lasts 8 hours, he'd just have to go to the bathroom and drink more during the later part of the day or am I missing something? I'm not quite clear what I'm proving by making sure it is strictly on an 8-hour schedule this first month.

Dr. Mark E. Peterson said...

The desmopressin can be given 1-3 times a day. I have many clients that just give it at bedtime, so the dog will sleep through the night without having to urinate.

Heidi Schluter said...

Dr. Peterson I am struggling with what dose and how often for the oral tablets, I have found them fairly inexpensive wit a AAA discount.

I am being told to give every 8 hours which is impossible due to my work schedule. My dog weighs 38 pounds and I am currently giving her 1-1/4 of 1mg tablet 2 times a day.

Specific gravity of her urine was just 1.007. Consuming lots of water but less than before and getting me up 1-2 times a night for either water or to go out.

What are your thoughts as to what our next steps should be?

Dr. Mark E. Peterson said...

We rarely give desmopressin 3 times a day. Both the subcutaneous or ocular routes of administration tend to work better than the oral pills. The drug just isn't absorbed all that great orally.

So you can either increase the oral dose or try another route of administration. Talk to your veterinarian.

Tricia said...

My 13 yr old Yorkie was diagnosed with DI a couple years ago...we inject 1 unit twice a day....he has shown evidence of dehydration at blood tests and recently started drinking more ...he hardly drank anything until the desmopressin wore off which I thought was odd....he now is dumping 5 times the normal protein into his urine and has been diagnosed with glomerular disease. We were never told to withhold water directly after the injections and he often has drank a lot right after or right before the injection. My question is could this be causing the renal tube deterioration and could he have had early kidney disease all along rather than DI. The most he ever drank during DI testing was 3 times normal amount for a 9 lb dog. I feel like this drug is doing more harm for his kidneys now than good. His specific gravity tested 1.035 after 12 hours overnight sine he had the desmopressin. The vet says he has two problems and he has also been put on enalapril, fish oil and aspirin for the glomerular disease. I read no desmopressin if subject to blood clots but he is on that and now 4 mg aspirin a day to guard against clots....does this make sense?

Dr. Mark E. Peterson said...

Most dogs with primary DI are puppies, not older dogs. So it makes a lot more sense that your dog had kidney disease all along that has now progressed. Remember that renal disease, in itself, causes a secondary type of DI, but that type of DI is not generally very responsive to desmopressin as the kidney disease gets worse. You may want to see a kidney expert to verify the diagnosis and ensure that the treatment is the best. Talk to your vet.

Beth P said...

I rescued my Abigail after I found her lying in the middle of the road (at 3 mths) hit by a car. Since that time, within her first year she has been diagnosed with Cushing’s disease, and now Diabetes Insipidus. Her levels that contributed to Cushing’s is under control. The medication for Cushing’s showed the cortisol levels are managed, but her physical appearance, thirst, and constant urination remained, hence the diagnosis of DI. I am limited financially, and both medications are extremely expensive. If I had to cease one of the medications, which one would that be? In my observation of Abigail, I feel the DI is the most threatening and detrimental to her life. Please advise.

Dr. Mark E. Peterson said...

Idiopathic DI by itself is not life threatening as long as water is freely available. Cushing's, on the other hand, carries a guarded prognosis if not treated.

That said, the combination of Cushing's and true DI is extremely rare. Talk to your vet about the diagnosis.. why would they diagnose both disorders when Cushing's could cause severe PUPD by itself? You may want to get another opinion with a specialist.

jono10-43 said...

Can Cushings occur within the first year of life? Not sure if Abigail is a small or large breed dog but I thought small breed and assuming pituitary that's it's an adenoma and therefore needs time to develop or grow to a point where its produces clinical signs. So usually middle to older age dogs?

Dr. Mark E. Peterson said...

Highly unlikely that a 1 year old dog would develop Cushing's.

Nicole said...

Hi Dr. Peterson. I have read through all your articles and have found them incredibly helpful. My 10 year old cattle dog was recently diagnosed with central DI. We have had the desmopressin compounded but I have had a couple questions. She is currently prescribed desmopressin acetate 0.01%. Instructions were originally to give her 0.005ml (0.5mcg) every 12 hours. However, this was impossible to measure on the syringe. So our vet recommended giving her 1 unit every 12 hours. Prior to medication, her water consumption would occur in bursts and she self-abstained from water at night and showed no need to go out until early morning. So originally I began giving her 1 unit in the morning only. I have started giving her 1 unit every 12 hours now because first thing in the morning she would consume a lot of water. I pick up her water from the time I inject until about 2 hours after her injection for fear that water intoxication would become an issue. My question is how do I know if this dose is too much for her? What symptoms would I notice? Should I let her drink right after her injection even if it is a lot of water? Thanks!

Dr. Mark E. Peterson said...

We dose the desmopressin to control (normalize) the water intake and urination. It sounds like you need to increase the dose. You don't have to give the same amount in the morning and night. You aren't going to see water intoxication unless you greatly overdose the drug.

There is no dose that will work for all dogs. Most dogs and cats (especially at 10 years) do not have primary DI but a secondary form. So your vet should always continue to look for commonly underlying causes (kidney disease and Cushing's).

Unknown said...

My dog developed DI a couple of years ago (I think he was about 6).
He was drinking constantly and urinating in his sleep without being aware.
He was being investigated by the vet and lost 1kg in a week (he's only a cocker and was slim to start).
He's much better now (my purse isn't!!), are there any other health problems that can occur down the line as a direct result of DI?

Dr. Mark E. Peterson said...

Only if your dog has a pituitary tumor causing the DI. If it's idiopathic, then they can live a normal life as long as they have unlimited access to water.

Sarah said...

Thank you so much for your blog..very helpful to me and my vet. My vet is ordering the compounded formula from Wedgewood for SQ use in my boxer. Do I need to ask them to put this in a sterile vial to be able to draw into the syringe.

Thank you in advance for your time.

Sarah

Dr. Mark E. Peterson said...

If you order injectable desmopressin, it will already come in a sterile vial.

Sarah said...

Thank you very much. We ordered from Wedgewood and I started my girl on the injections this weekend. My only problem is they do not deliver to my state and I have to drive and hour and a half one way to pick it up at another vets office across the state line. But that is fine...if it helps my girl. Thank you again.

Alisa Shamosh said...

Thank you for your blog. My dog was diagnosed with DI after going through a tough battle of pneumonia. I was skeptical that the Clavamox and Baytril caused this but it wasn't that case. He has been off his meds now for 3 1/2 weeks and still is drinking lots of water and having some accidents in the house.
I started the drops a week ago tomorrow and have seen a little improvement with the peeing. I don't know that he is drinking less water. My question is how long does it take for the Desmopressin to work? Could it take a while before the problems is under control? It seems like most blogs I read say that the problem gets batter right away. Because there isn't a test for DI and it is rare, I am concerned this is not what my dog has. Thank you for your help!

Dr. Mark E. Peterson said...

Should get better within a week at most. Look for UTI and renal diseaase.

m.e.l.i.s.s.a. said...

I have a question about using the 0.01% nasal solution as an injectable... How can you safely draw up the injection from the nasal spray bottle? I've called compounding pharmacies in my state and none will transfer the nasal spray from its original bottle to a sterile vial. My vet and I have dosed out the sub q dose to be given but I'm not sure how to safely do this. I've planned on using insulin syringes but was wondering how others have gotten around this problem. We had a similar problem when we started to give the nasal spray as drops in his eyes. My husband sterilized an amber dropper bottle and transfered it over using a clean syringe. We've been thinking about doing that again for the injections of we have to but want to see what others have done? The most important thing is that we do what's safest for our pet.

Dr. Mark E. Peterson said...

I've had the injectable made up by Wedgewood compounding pharmacy. I would contact them to do it.

Benjamin Bram said...

HI Dr. Peterson, Thank you for publishing this article. My Pit Mix was diagnosed with DI about a month ago. We first started with Desmopressin via eye drops but that did not seem to help and was difficult to administer so we have since changed to the injections which seem to really help the symptoms. My concern is that since going on Desmopressin, his appetite has decreased and he becomes somewhat lethargic after we administer the injection. Is this normal? The decreased appetite might be because he has irritable bowel syndrome as well and his tummy has been off since we began the injections. Currently, he is eating about a cup and half of kibble as opposed to the cup and half twice a day. Any guidance or advice would be greatly appreciated! Thanks!

Dr. Mark E. Peterson said...

No, this is not from the desmopressin. Remember that renal disease or large pituitary tumors can cause forms of diabetes insipidus. Talk to your vet and continue the workup.

Kevin Bresler said...

Thank you for your blog Dr. Peterson - it provided us much information when our 2 year old Golden Retriever was diagnosed with DI a year ago. He is currently receiving 0.2 mg Desmopressin orally 3 times a day. We tried twice daily but the Desmopressin seemed to lose its effectiveness after approximately 11 hours. My questions are: can Webster overdose on Desmopressin? If we forget a dose, how closely can 2 doses be given? For example would a 6pm dose and then an 11pm dose before bed be too much? Thank you.

Dr. Mark E. Peterson said...

Of course overdose is possible. I wouldn't give more frequently than every 12 hours without close monitoring with blood testing.

Jenna Phillips said...

Hi Dr. Peterson,
Thank you for your blog and providing so much valuable information. My eight year old Aussie Shepherd/Corgi mix dog (Belle) started drinking a large amount of water approximately four weeks ago. I took her to the vet as I was constantly refilling her bowl and they ran a blood panel and urine culture which all came back excellent. Next we did an ultrasound which was also all clear. We started her on the Clavamox antibiotic (just in case) and then three days later we started a Desmopressin trial too. The Clavamox was for seven days and ended 12/09. For the Desmopressin trial, I'm currently putting 2-3 drops in her eye every 12 hours. I've noticed an improvement but I'm wondering if she should be back to normal levels already. The Desmopressin trial started on the night of December 6th. Here are her water intake levels for the past six days recorded in 24 hour increments starting 10:45pm to 10:45pm the following day.
Wednesday 12/07: 5.25 Liters
Thursday 12/08: 4.5 Liters
Friday 12/09: 4.28 Liters
Saturday 12/10: 3.6 Liters
Sunday 12/11: 4.28 Liters
Monday 12/12: 3.9 Liters
Is this a normal response to the Desmopressin or do you think something else might be behind her increased drinking? I would very much appreciate your insight.
Thank you,
Jenna Phillips

Dr. Mark E. Peterson said...

This doesn't look like the desmopressin is doing much of anything. If you don't see improvement in another week, I'd continue the workup (exclude Cushing's etc).

Jenna Phillips said...

Thank you for your help! If the Cushing's and Addison's tests come back negative they're saying that it is either Psychogenic Polydipsia or possibly a tumor in her head. They're recommending a CT scan and are offering one to me for free as the office just received a new CT machine and are training on the device. Would you recommend a CT scan? All of her blood work has come back excellent and I'm nervous to expose her to radiation and anesthesia if it's not necessary or highly unlikely. I appreciate your thoughts.

Dr. Mark E. Peterson said...

I'd jump at the chance to get a free CT scan. Go ahead and do it.