Desmopressin Zentiva
Sublingual tablet – Synthetic vasopressin analogue for diabetes insipidus, bedwetting, and nocturia
Desmopressin Zentiva is a prescription sublingual tablet containing desmopressin, a synthetic analogue of the natural hormone vasopressin (antidiuretic hormone). It is used to treat central diabetes insipidus, primary nocturnal enuresis (bedwetting) in children aged 5 and older, and nocturia (nighttime urination) in adults under 65. The tablet is placed under the tongue where it dissolves without water. Fluid intake must be carefully restricted during treatment to prevent potentially dangerous water retention and low sodium levels.
Quick Facts
Key Takeaways
- Desmopressin Zentiva is a synthetic vasopressin analogue that helps the kidneys concentrate urine, reducing excessive urination in conditions like central diabetes insipidus, bedwetting, and nocturia.
- The sublingual tablet dissolves under the tongue without water and must always be taken at the same time of day for optimal effectiveness.
- Fluid intake must be strictly limited from 1 hour before to 8 hours after taking the tablet to prevent water retention and dangerously low blood sodium (hyponatremia).
- This medication is not suitable for adults over 65 years for nocturia, children under 5 for bedwetting, or people with heart failure, moderate-to-severe kidney disease, or low blood sodium levels.
- Several drug classes including antidepressants (SSRIs, tricyclics), anticonvulsants (carbamazepine), and NSAIDs can increase the risk of water retention when taken with desmopressin.
What Is Desmopressin Zentiva and What Is It Used For?
Desmopressin Zentiva contains the active substance desmopressin, which is a synthetic analogue of vasopressin — also known as antidiuretic hormone (ADH). This naturally occurring hormone is produced by the hypothalamus and released from the posterior pituitary gland. Its primary function is to regulate the kidneys' ability to reabsorb water, thereby controlling urine concentration and output. When the body does not produce enough vasopressin, or when the kidneys do not respond properly to it, excessive urination and dehydration can result.
Desmopressin works by binding to V2 receptors on the basolateral membrane of the collecting duct cells in the kidneys. This activates a cascade of intracellular signaling that leads to the insertion of aquaporin-2 water channels into the apical membrane, allowing water to be reabsorbed from the urine back into the bloodstream. The result is more concentrated urine and reduced urine volume. Unlike natural vasopressin, desmopressin has minimal effect on blood vessel constriction (V1 receptors), making it safer for therapeutic use.
Desmopressin Zentiva is approved and used for the treatment of three distinct conditions:
Central Diabetes Insipidus
Central diabetes insipidus (CDI) is a condition caused by insufficient production or release of vasopressin from the pituitary gland. This leads to the kidneys being unable to concentrate urine properly, resulting in the excretion of large volumes of dilute, pale urine (polyuria) and intense thirst (polydipsia). Patients may produce anywhere from 3 to 20 liters of urine per day. CDI can be caused by head trauma, neurosurgery, tumors affecting the hypothalamic-pituitary region, autoimmune conditions, or genetic factors. Desmopressin effectively replaces the missing hormone and is the standard treatment recommended by international endocrinology guidelines.
Primary Nocturnal Enuresis (Bedwetting)
Primary nocturnal enuresis is involuntary urination during sleep in children who have never achieved consistent nighttime dryness. Desmopressin Zentiva is indicated for children aged 5 years and older who have a normal ability to concentrate urine but produce excessive amounts of urine at night. The International Children's Continence Society (ICCS) and NICE guidelines recommend that treatment should begin with lifestyle measures and bedwetting alarms. If these interventions are insufficient or medication is needed, desmopressin may be prescribed. The medication reduces nighttime urine production, allowing the child to remain dry.
Nocturia in Adults
Nocturia is a condition where adults wake frequently during the night to urinate, significantly disrupting sleep quality and overall well-being. Desmopressin Zentiva is indicated for nocturia treatment in adults under 65 years of age. By reducing urine production during the night, desmopressin allows for longer uninterrupted sleep. For patients over 65 years, the risk of hyponatremia (low blood sodium) is considered too high, and desmopressin is not recommended for this indication in this age group.
What Should You Know Before Taking Desmopressin Zentiva?
Contraindications
There are several conditions in which Desmopressin Zentiva must not be used. Your doctor will assess your individual suitability for this medication before prescribing it. Do not take Desmopressin Zentiva if any of the following apply:
- Allergy: You are allergic to desmopressin or any of the other ingredients (including lactose monohydrate, maize starch, citric acid, croscarmellose sodium, or magnesium stearate).
- Polydipsia: You have habitual or psychogenic polydipsia (an abnormally large fluid intake, typically more than 3 liters per day).
- Heart failure: You have cardiac insufficiency or other conditions that require treatment with diuretic medications.
- Kidney disease: You have moderate or severe renal impairment (estimated GFR less than 50 mL/min).
- Hyponatremia: You have known low sodium levels in your blood (serum sodium below 135 mmol/L).
- Fluid restriction non-compliance: You are unable to follow the required fluid intake restrictions.
- SIADH: You have the syndrome of inappropriate antidiuretic hormone secretion.
- Age restrictions: Adults over 65 years for nocturia treatment, or children under 5 years for bedwetting.
Warnings and Precautions
Before taking Desmopressin Zentiva, inform your doctor if you have any of the following conditions, as they may require special monitoring or dose adjustments:
- Coronary artery disease or hypertension: Desmopressin may affect fluid balance, which could place additional strain on the cardiovascular system.
- Thyroid or adrenal disorders: Conditions affecting the thyroid gland or adrenal glands can influence the body's fluid and electrolyte balance.
- Risk of increased intracranial pressure: Fluid retention could theoretically worsen conditions associated with raised intracranial pressure.
- Disturbed fluid balance: Any acute illness causing vomiting, diarrhea, or fever can disrupt fluid and electrolyte balance and requires careful monitoring.
If you develop headache, decreased appetite, nausea, vomiting, weight gain, confusion (difficulty understanding words or concentrating), or seizures (violent involuntary muscle contractions), these may be signs of hyponatremia (dangerously low blood sodium). Stop taking the medication immediately and contact your doctor. For diabetes insipidus: reduce fluid intake and contact your doctor, who will reduce the dose or suspend treatment. For bedwetting or nocturia: stop treatment, reduce fluid intake, and contact your doctor immediately.
For bedwetting and nocturia treatment, fluid intake must be limited to the minimum necessary to quench thirst during the period from 1 hour before to 8 hours after taking the tablet. This restriction is critical to prevent water retention and hyponatremia. In children, administration must always be supervised by an adult.
Pregnancy and Breastfeeding
If you are pregnant, think you may be pregnant, or are planning to have a baby, consult your doctor or pharmacist before using Desmopressin Zentiva. Clinical experience with desmopressin use during pregnancy is limited, and the decision to use it should be made on a case-by-case basis by your healthcare provider, weighing the potential benefits against any possible risks.
Desmopressin does pass into breast milk, but at therapeutic doses it is unlikely to affect the breastfed infant. Studies have shown that the amount of desmopressin transferred through breast milk is considerably less than the dose that would be needed to produce a pharmacological effect in the infant. However, you should still discuss breastfeeding with your doctor while taking this medication.
Driving and Operating Machinery
Desmopressin Zentiva has no or negligible effect on the ability to drive and use machines. However, you should be aware of all potential side effects, including dizziness and headache, which could affect your ability to perform these activities safely. If you experience such effects, avoid driving until they resolve.
Important Information About Excipients
Desmopressin Zentiva contains lactose monohydrate. If you have been told by your doctor that you have an intolerance to some sugars, contact your doctor before taking this medicine. The tablets also contain sodium, but less than 1 mmol (23 mg) per sublingual tablet, meaning they are essentially sodium-free.
How Does Desmopressin Zentiva Interact with Other Drugs?
Tell your doctor or pharmacist if you are taking, have recently taken, or might take any other medicines. Certain medications can alter the effect of desmopressin, either increasing the risk of water retention (and consequently hyponatremia) or reducing its therapeutic effectiveness. Understanding these interactions is essential for safe treatment.
Medications That Increase Desmopressin's Effect
The following medications can enhance the antidiuretic effect of desmopressin, meaning that more water is retained by the body. This increases the risk of hyponatremia, which can be a serious and potentially life-threatening condition. Your doctor may need to adjust your desmopressin dose, monitor your sodium levels more frequently, or avoid combining these medications:
| Drug Class | Examples | Interaction Type | Clinical Significance |
|---|---|---|---|
| Tricyclic antidepressants | Amitriptyline, imipramine, clomipramine | Increases antidiuretic effect | Major – increased hyponatremia risk |
| SSRIs | Fluoxetine, sertraline, paroxetine, citalopram | Increases antidiuretic effect | Major – increased hyponatremia risk |
| Antipsychotics | Chlorpromazine | Increases antidiuretic effect | Major – increased hyponatremia risk |
| Anticonvulsants | Carbamazepine | Increases antidiuretic effect | Major – increased hyponatremia risk |
| NSAIDs | Ibuprofen, naproxen, diclofenac | Increases antidiuretic effect | Major – increased hyponatremia risk |
| Sulfonylureas | Chlorpropamide, glibenclamide | Increases antidiuretic effect | Moderate – monitor sodium |
| Antidiarrheals | Loperamide | Increases antidiuretic effect | Moderate – monitor sodium |
Medications That Decrease Desmopressin's Effect
Some medications can reduce the therapeutic effectiveness of desmopressin, potentially leading to inadequate urine concentration and a return of symptoms:
- Dimethicone (simethicone): This agent, commonly used to treat gas and bloating, may reduce the absorption or effectiveness of sublingual desmopressin. If you need to take simethicone, discuss the timing of administration with your doctor or pharmacist to minimize this interaction.
If you are taking Desmopressin Zentiva for bedwetting or nocturia, you must restrict your fluid intake from 1 hour before taking the tablet to 8 hours after. This includes all beverages, soups, and water-rich foods. Failing to restrict fluids can lead to water retention and hyponatremia. For diabetes insipidus treatment, your doctor will provide individualized fluid intake guidance.
What Is the Correct Dosage of Desmopressin Zentiva?
Always take this medicine exactly as your doctor has told you. The dose is individually adjusted based on your condition, response to treatment, and other factors. Desmopressin Zentiva sublingual tablets should be placed under the tongue, where they dissolve without water. The tablets should always be taken at the same time each day to ensure consistent therapeutic effect.
| Indication | Patient Group | Usual Dose | Frequency | Special Instructions |
|---|---|---|---|---|
| Central Diabetes Insipidus | Adults and children | 60–120 mcg (1–2 tablets of 60 mcg) | 3 times daily | Dose individually adjusted; same dose for children and adults |
| Bedwetting (nocturnal enuresis) | Children ≥ 5 years | 120–240 mcg (1–2 tablets of 120 mcg) | Once daily at bedtime | Restrict fluids 1 hr before to 8 hrs after; review every 3 months |
| Nocturia | Adults < 65 years | 60 mcg (1 tablet of 60 mcg) | Once daily at bedtime | Restrict fluids 1 hr before to 8 hrs after |
Adults
For central diabetes insipidus in adults, the recommended starting dose is 60 mcg (one 60-mcg sublingual tablet) taken three times daily. Your doctor will adjust the dose based on your response, with typical doses ranging from 60 to 120 mcg three times daily. For nocturia in adults under 65 years, the dose is one 60-mcg sublingual tablet taken at bedtime. The tablet should be placed under the tongue and allowed to dissolve without water. You must restrict fluid intake from 1 hour before to 8 hours after the dose.
Children
For central diabetes insipidus, the dosage in children is the same as for adults: 60–120 mcg three times daily, individually adjusted by the treating physician. For bedwetting in children aged 5 years and older, the usual dose is 120 mcg (one 120-mcg sublingual tablet) at bedtime. The dose may be increased to 240 mcg if the lower dose is not sufficiently effective. Fluid intake must be restricted, and administration must always be supervised by an adult. Desmopressin Zentiva must not be given to children under 5 years of age for bedwetting.
Every three months, the doctor should assess whether treatment should continue. A treatment-free period of at least one week may be recommended to evaluate whether the child still requires medication.
Elderly Patients
Desmopressin Zentiva is not recommended for nocturia treatment in patients over 65 years of age due to an increased risk of hyponatremia in this population. For central diabetes insipidus, elderly patients may use desmopressin under close medical supervision with regular monitoring of serum sodium levels. The doctor will carefully consider the benefit-risk ratio and may use lower doses.
Missed Dose
If you forget to take a dose of Desmopressin Zentiva, take it as soon as you remember unless it is nearly time for your next dose. Do not take a double dose to make up for a forgotten tablet. If you are unsure what to do, contact your doctor or pharmacist for guidance.
Overdose
Taking too much Desmopressin Zentiva may prolong the effect of the medication and increase the risk of water retention and hyponatremia (dangerously low blood sodium). Symptoms of severe water retention include seizures and loss of consciousness. If you suspect an overdose, or if a child has accidentally ingested the medication, contact your local poison control center or seek emergency medical attention immediately.
What Are the Side Effects of Desmopressin Zentiva?
Like all medicines, Desmopressin Zentiva can cause side effects, although not everyone will experience them. The most important risk associated with desmopressin therapy is hyponatremia (low blood sodium), which can occur if fluid intake is not restricted as recommended. This risk is particularly relevant for bedwetting and nocturia treatment, where the medication is taken at night.
If you experience headache, stomach pain, nausea or vomiting, weight gain, dizziness, confusion, general feeling of illness, vertigo, or in severe cases seizures and coma, these may indicate significant water retention. These symptoms usually occur at higher doses and resolve when the dose is reduced. Stop taking the medication and contact your doctor immediately if you experience these symptoms.
Side Effects in Adults
Very Common
- Headache
Common
- Hyponatremia (low blood sodium)
- Dizziness
- High blood pressure
- Abdominal pain
- Nausea
- Diarrhea
- Constipation
- Vomiting
- Bladder and urethral discomfort
- Swelling in hands, arms, feet, or legs (peripheral edema)
- Fatigue
Uncommon
- Sleep difficulties (insomnia)
- Drowsiness
- Tingling or prickling sensations (paresthesia)
- Visual disturbances
- Vertigo
- Palpitations
- Low blood pressure when standing (orthostatic hypotension)
- Shortness of breath (dyspnea)
- Indigestion, flatulence, bloating
- Excessive sweating
- Itching, rash, or hives (urticaria)
- Muscle spasms and muscle pain
- Chest pain
- Flu-like symptoms
- Weight gain
- Elevated liver enzymes
- Low potassium levels (hypokalemia)
Rare
- Confusion
- Allergic skin inflammation (dermatitis)
Frequency Not Known
- Anaphylactic reaction (severe allergic reaction)
- Dehydration
- Hypernatremia (high blood sodium)
- Seizures
- Asthenia (weakness)
- Coma
Side Effects in Children
Common
- Headache
Uncommon
- Rapidly changing emotions (emotional lability)
- Aggression
- Nausea
- Abdominal pain
- Vomiting
- Diarrhea
- Bladder and urethral discomfort
- Swollen hands and feet
- Fatigue
Rare
- Anxiety symptoms
- Nightmares
- Mood swings
- Drowsiness
- High blood pressure
- Irritability
Frequency Not Known
- Anaphylactic reaction
- Hyponatremia (low blood sodium)
- Abnormal behavior
- Emotional disturbances
- Depression
- Hallucinations
- Attention disorders
- Increased muscle movement (hyperkinesia)
- Seizures
- Nosebleeds
- Rash, allergic dermatitis
- Excessive sweating
- Hives (urticaria)
If you experience any side effects, talk to your doctor, pharmacist, or nurse. This includes any possible side effects not listed here. You can also report side effects directly to your national medicines regulatory authority. By reporting side effects, you can help provide more information on the safety of this medicine.
How Should You Store Desmopressin Zentiva?
Proper storage of Desmopressin Zentiva is important to ensure the medication remains effective and safe throughout its shelf life. Desmopressin is sensitive to moisture, so storage conditions must be followed carefully.
Blister Pack Storage
- Store in the original blister packaging to protect from moisture
- No special temperature storage requirements
- Keep out of the sight and reach of children
- Do not use after the expiry date printed on the blister and carton
Bottle Storage
- Store in the original container
- Keep the bottle tightly closed to protect from moisture
- Store below 30°C
- Keep out of the sight and reach of children
Do not dispose of medicines via wastewater or household waste. Ask your pharmacist how to dispose of medicines you no longer use. These measures will help to protect the environment.
What Does Desmopressin Zentiva Contain?
Active Substance
The active substance is desmopressin, present as desmopressin acetate:
- 60 mcg tablets: Each tablet contains 60 micrograms of desmopressin (as desmopressin acetate). Round, biconvex white tablet marked "I" on one side, 6.5 mm diameter.
- 120 mcg tablets: Each tablet contains 120 micrograms of desmopressin (as desmopressin acetate). Octagonal, biconvex white tablet marked "II" on one side, 6.5 mm length/width.
- 240 mcg tablets: Each tablet contains 240 micrograms of desmopressin (as desmopressin acetate). Square, biconvex white tablet marked "III" on one side, 6.5 mm length/width.
Inactive Ingredients (Excipients)
| Excipient | E Number | Function |
|---|---|---|
| Lactose monohydrate | — | Filler/diluent |
| Maize starch | — | Binder/disintegrant |
| Citric acid | E330 | pH adjustment |
| Croscarmellose sodium | E468 | Disintegrant |
| Magnesium stearate | E470b | Lubricant |
Packaging
Desmopressin Zentiva is available in OPA/Al/PVC/PE-Al blister packs with integrated desiccant in pack sizes of 10, 20, 30, 50, 60, 90, or 100 sublingual tablets. It is also available in perforated unit-dose blisters (10×1, 20×1, 30×1, 50×1, 60×1, 90×1, and 100×1) or in HDPE bottles with PP caps and integrated desiccant containing 30 or 100 tablets. Not all pack sizes may be marketed in all countries.
Frequently Asked Questions About Desmopressin Zentiva
Desmopressin Zentiva is a prescription sublingual tablet used to treat three main conditions: (1) central diabetes insipidus, a hormonal disorder where the pituitary gland does not produce enough vasopressin, causing excessive thirst and large volumes of dilute urine; (2) primary nocturnal enuresis (bedwetting) in children aged 5 years and older who have normal urine concentrating ability; and (3) nocturia (frequent nighttime urination) in adults under 65 years of age. The active ingredient desmopressin works by mimicking the natural hormone vasopressin, helping the kidneys concentrate urine and reduce urine output.
Place the sublingual tablet under your tongue and let it dissolve completely without water. Do not swallow or chew it. Take the tablet at the same time each day. For bedwetting and nocturia, take it at bedtime and restrict fluid intake from 1 hour before to 8 hours after administration. Children should always be supervised by an adult during administration. The dose is individualized by your doctor based on your specific condition and response to treatment.
The most serious risk is hyponatremia (dangerously low blood sodium), which can occur if fluid intake is not restricted as instructed. Symptoms include headache, nausea, vomiting, weight gain, confusion, and in severe cases seizures and coma. This risk is especially important for children treated for bedwetting and adults treated for nocturia. If you experience any of these symptoms, stop taking the medication and seek medical attention immediately. Regular monitoring of blood sodium levels is recommended, especially at the start of treatment.
No. Desmopressin Zentiva is not recommended for the treatment of nocturia in adults aged 65 years and older. This age group has a significantly higher risk of developing hyponatremia (low blood sodium), which can be a serious and potentially life-threatening condition. Elderly patients who need nocturia treatment should discuss alternative therapies with their healthcare provider. However, desmopressin may still be prescribed for central diabetes insipidus in older patients under careful medical supervision with regular sodium monitoring.
Sublingual desmopressin is typically absorbed quickly, with onset of action within 15 to 60 minutes after administration. The antidiuretic effect generally lasts 8 to 12 hours, depending on the dose and individual patient factors. For bedwetting, the effect should last through the night. For diabetes insipidus, the medication is usually taken three times daily to maintain consistent urine concentration throughout the day. Your doctor may adjust the dose and timing based on your individual response.
Desmopressin is available in several formulations including sublingual tablets (like Desmopressin Zentiva), nasal sprays, and oral tablets. The sublingual formulation dissolves under the tongue and is absorbed through the oral mucosa, offering more predictable absorption than nasal sprays, which can be affected by nasal congestion, colds, or rhinitis. Studies have shown that the sublingual route provides more consistent bioavailability. The doses differ between formulations — sublingual doses are not directly interchangeable with nasal or oral tablet doses. Your doctor will determine the appropriate dose for the specific formulation prescribed.
References
This article is based on the following peer-reviewed sources and international clinical guidelines. All medical claims have evidence level 1A, the highest quality of evidence based on systematic reviews and randomized controlled trials.
- European Medicines Agency (EMA). Summary of Product Characteristics – Desmopressin sublingual tablets. 2024. Available from: www.ema.europa.eu
- World Health Organization (WHO). WHO Model List of Essential Medicines, 23rd edition. Geneva: WHO; 2023.
- National Institute for Health and Care Excellence (NICE). Nocturnal enuresis: the management of bedwetting in children and young people (CG111). 2010 (updated 2024). Available from: www.nice.org.uk/guidance/cg111
- Christ-Crain M, Bichet DG, Fenske WK, et al. Diabetes insipidus. Nature Reviews Disease Primers. 2019;5(1):54. doi:10.1038/s41572-019-0103-2
- British National Formulary (BNF). Desmopressin monograph. 2024. Available from: bnf.nice.org.uk
- Juul KV, Klein BM, Sandstrom R, et al. Gender difference in antidiuretic response to desmopressin. American Journal of Physiology-Renal Physiology. 2011;300(5):F1116-F1122.
- Vande Walle J, Stockner M, Raes A, et al. Desmopressin 30 years in clinical use: a safety review. Current Drug Safety. 2007;2(3):232-238.
- International Children's Continence Society (ICCS). Management of nocturnal enuresis: practical consensus guidelines. 2020.
- U.S. Food and Drug Administration (FDA). Prescribing Information for Desmopressin Acetate. Available from: www.fda.gov
- Oelke M, De Wachter S, Drake MJ, et al. A practical approach to the management of nocturia. International Journal of Clinical Practice. 2017;71(11):e13027.
Editorial Team
Written by iMedic Medical Editorial Team – Specialists in endocrinology, urology, and clinical pharmacology.
Reviewed by iMedic Medical Review Board according to international clinical guidelines (WHO, EMA, NICE, FDA).
Level 1A evidence based on systematic reviews and meta-analyses of randomized controlled trials. GRADE evidence framework.
No pharmaceutical company funding or sponsorship. Independent medical editorial content with no conflicts of interest.