Desmopressin and Breastfeeding

Summary of use during lactation

Desmopressin from a nasal spray is excreted in negligible amounts into milk and is poorly absorbed orally by the infant, so it appears acceptable to use during breastfeeding. There is no published experience with sublingual desmopressin during breastfeeding. Until more data become available, sublingual desmopressin should be used with caution during breastfeeding, especially while nursing a newborn or preterm infant.

Drug levels in milk and infant serum

Maternal Levels. In a patient who was using intranasal desmopressin 10 mcg twice daily for diabetes insipidus, serum and milk levels of arginine vasopressin were measured after a dose.[1] Milk levels gradually increased from the background level of 1 ng/L to about 1.5 ng/L over the 4-hour observation period. Infant Levels. Relevant published information was not found as of the revision date.

Effects in breastfed infants

Relevant published information was not found as of the revision date.

Effects on lactation and breastmilk

Several cases have been reported of mothers with diabetes insipidus using desmopressin and breastfeeding their infants.[2-4] In one case, the mother discontinued nursing after 2 weeks because of a low milk supply, but this was not clearly drug related.[3] Lactation sometimes improves diabetes insipidus and reduces desmopressin requirements.[2,3]

References

1. BurrowGN WassenaarW RobertsonGL DDAVP treatment of diabetes insipidus during pregnacy and the post-partum period. Acta Endocrinol (Copenh) 1981 97 23 5 7223315 PubMed
2. HadiHA MashiniIS DevoeLD Diabetes insipidus during pregnancy complicated by preeclampsia. A case report. J Reprod Med 1985 30 206 8 3999072 PubMed
3. HimeMC RichardsonJA Diabetes insipidus and pregnancy. Case report, incidence and review of literature. Obstet Gynecol Surv 1978 33 375 9 652196
4. WalliaA BizhanovaA HuangW Acute diabetes insipidus mediated by vasopressinase after placental abruption. J Clin Endocrinol Metab 2013 98 881 6 23393172 PubMed