OBJECT DRUGS
PRECIPITANT DRUGS
NSAIDs:
- Diclofenac (Voltaren, etc.)
- Diflunisal (Dolobid)
- Etodolac (Lodine)
- Fenoprofen (Nalfon)
- Flurbiprofen (Ansaid, etc.)
- Ibuprofen (Motrin, etc.)
- Indomethacin (Indocin, etc.)
- Ketoprofen (Orudis)
- Ketorolac (Toradol, etc.)
- Meclofenamate
- Mefenamic acid
- Meloxicam (Mobic)
- Nabumetone (Relafen)
- Naproxen (Aleve, etc.)
- Oxaprozin (Daypro)
- Piroxicam (Feldene)
- Sulindac (Clinoril)
- Tolmetin (Tolectin)
Comment:
NSAIDs can potentiate the effects of desmopressin, and severe hyponatremia with coma and seizures has been reported when NSAIDs were added to desmopressin therapy in patients with central diabetes insipidus or von Willebrand's disease. Desmopressin is also used for nocturia in the elderly, and it is not unusual for such patients to take NSAIDs concurrently. It is not known how often combined use of desmopressin and NSAIDs causes hyponatremia, but it may occur primarily in predisposed patients. Many diseases can predispose to hyponatremia, as can a number of drugs (eg, ACE inhibitors, antineoplastics, antipsychotics, SSRIs, diuretics, etc.)
Class 2: Use Only if Benefit Felt to Outweigh Risk
- Use Alternative:
- NSAIDs: In patients taking desmopressin, it would be prudent to use alternative to NSAIDs when possible. Consider using acetaminophen if the NSAID is being used as an analgesic or antipyretic. It is not known if COX-2 inhibitors such celecoxib would be less likely than regular NSAIDs to interact with desmopressin, but there have been isolated cases of hyponatremia with desmopressin combined with celecoxib or other COX-2 inhibitors.
- Monitor: If NSAIDs are used with desmopressin, monitor carefully for evidence of hyponatremia. Early signs are relatively nonspecific, including weakness, dizziness, headache, confusion, disorientation, nausea, vomiting, and muscle cramps. If hyponatremia is severe, it can lead to seizures, coma and death. In predisposed patients such as elderly women it may be prudent to measure baseline serum sodium and again after the second drug is started. Symptomatic hyponatremia can occur within a day or two of adding an NSAID to desmopressin therapy.