The treatment for Central Diabetes Insipidus (CDI) that most veterinarians were taught and that is referenced in most veterinary text books is to use DDAVP (brand name) or desmopressin acetate (generic name) as eye drops. Newer texts reference using subcutaneous injection of the same drug. We have treated our cat, Puff, both ways and have found some very major advantages to administering the drug by subcutaneous injection.
- First, the drug is more effective when injected.
- Second, the duration of action is longer when injected.
- Third, less drug is needed and thus cost is reduced when injected.
- Fourth, Puff prefers the injections over the eye drops. She used to run from eye drops; she does not notice injections.
We started treating Puff by subcutaneous injection because we found a vet textbook that suggested it. By the time we came across the reference, we were already using the DDAVP as eye drops and Puff hated it and it was really expensive! We took the reference to our vet who read it, and then contacted the author (didn't hurt that he knew the author personally, I'm sure!)
Because your vet will be much more interested in veterinary literature references than in our antecdotal reports of doing subcutaneous administration of DDAVP/desmopressin, we have compiled the references that we have found for you to print out and take to your veterinarian. Our experiences and the info we have collected from others are reported just to reassure you and your vet that the text books are right.
Because this is copyrighted material, I will quote only very small sections of the texts. Your veterinarian will need to look up the references. If they have any trouble finding them, please email me (click here to send me email) and I can send a hard copy via snail mail of the material they cannot find.
Text books and reference books:
"Textbook of Veterinary Internal Medicine - Diseases of the Dog and Cat"
by Stephen J. Ettinger and Edward C. Feldman
1995 (Fourth) edition ... the one with the RED cover ... published by W. B. Saunders Company
The monograph is Chapter 12, pp 1422-1436 (in volume 2)
"Pituitary-Hypothalamic Disease" by Rhett Nichols and Leland Thompson
THIS BOOK HAS SAVED US THOUSANDS OF DOLLARS! It is where we first read about using the nasal spray as injections. So, PLEASE, BUY THIS BOOK! (We have no commercial interest in this.)
** NOTE ** There is a later edition of the text book, but the monograph on pituitary problems was written by someone else and does not include this information.
Here is a short quote from the section on "Formulations of DDAVP":"The cost of parenteral DDAVP is 20 times higher per microgram than the intranasal preparation. The intranasal form of DDAVP, although not designed for parenteral use, has been given by injection with no adverse effect to both dogs and cats. Clinically, the intranasal and injectable preparations of DDAVP produce indistinguishable responses when administered intravenously or subcutaneously."And from the section on "Treatment of Central Diabetes Insipidus with DDAVP":"However, because of its short duration of action (8 to 24 hours), which would require repeated injections, and its high cost, the injectable form of DDAVP is not suitable for long-term management of central DI in veterinary medicine. As previously mentioned, if injectable administration of DDAVP is necessary or desired, the intranasal formulation can be administered safely parenterally. The parenteral dose of DDAVP is 0.5 to 2 mcg administered intravenously or subcutaneously once or twice daily."-------------
"The 5 minute Veterinary Consult, Canine and Feline"
by Larry P. Tilley and Francis W. K. Smith, Jr.
1997 edition, published by Williams & Wilkins
The monograph on Diabetes Insipidus (pp 514-515)
Here is what they say about drugs used for treatment:
"DRUGS OF CHOICE
- Central diabetes insipidus — DDAVP. (1–2 drops of the intranasal preparation in the conjunctival sac q12h–q24h to control polyuria and polydipsia). Alternatively, the intranasal preparation may be given subcutaneously (2 to 5 mcg q12h–q24h).
- Nephrogenic diabetes insipidus — chlorothiazide (10–40 mg/kg PO q12h)"
"Consultations in Feline Internal Medicine"
edited by John R. August
Vol 3, 1997, published by W.B. Saunders Company
The monograph is Chapter 19, Diabetes Insipidus, pp142-146 by Rhett Nichols
This is a good general reference on diabetes insipidus in cats as well as a reference for treatment via injection.
Here are a couple of quotes that relate to medicating via injection:"Because the cost of parenteral DDAVP is 20 times higher per microgram than the intranasal preparation, the intranasal form of DDAVP, although not designed for parenteral use, has been given by injection with no adverse effect to both dogs and cats. Clinically, the intranasal and injectable preparations of DDAVP produce indistinguishable responses when administered intravenously or subcutaneously."I would dispute both their cost estimates and the savings they quote. We estimate a monthly cost to treat via the more usual eye drop method at $140-$175 per month. We estimate a monthly cost to treat via the injection method of $35 per month. The cost is reduced to 25% or less of the eye drop method cost. Savings per year is over $1000!
"If injectable administration of DDAVP is necessary or desired, the intranasal formulation can be administered safely parenterally."
"DDAVP given at a dose of 2 to 5 mcg subcutaneously once or twice daily (using an insulin needle) has proved to be a satisfactory therapeutic alternative."
"The principal drawback with the use of DDAVP is the considerable expense ($65 to $80 per month for most cats), although if given parenterally, the monthly cost can often be reduced by over 50 per cent."
"Veterinary Drug Handbook"
by Donald C. Plumb, Pharm.D.
3rd Edition (1999) and 4th Edition (2002). Distributed by Iowa State University Press / Ames
Drug monograph for Desmopressin Acetate (3rd edition p 175; 4th edition I don't know the page number)
The section on "Doses" gives appropriate amounts for injections for dogs.
"Consultations in Feline Internal Medicine"
edited by John R. August
1991, published by W.B. Saunders Company (not designated as such, but this is Volume 1)
The monograph is Chapter 27, Polyuria and Polydipsia, pp 227-235 by David S. Bruyette
This paper does NOT mention treatment by injection, but is a good diagnostic overview including flow charts to help you see why various tests are/have been done. Since it is specifically about cats, some of the rule-outs and tests for dogs may have been omitted. Dr. Bruyette has seen our cat Puff, though he was not our vet when she was diagnosed. And, he was very helpful when we were trying to find out why Ziggy drank so much. He was quite gracious and did multiple phone consultations with our vet.
Where your vet can get more info or discuss your animal with the experts
VIN (online service - Veterinary Information Network for vets). If your vet is a member, Dr. Bruyette answers questions on the endocrinology board. If your vet posts there, he or she can find out what others are doing for treatment options. The last time I checked, many vets are still using nasal spray as eye drops. Believe me, you want to use it as injections! Your vet should ask specifically about injecting the nasal spray subcutaneously. Your vet can get a free month membership to VIN at www.vin.com if he has internet access.
One of the vets who wrote some of the above referenced materials which recommend injection as a treatment option is Rhett Nichols. He is a veterinary endocrinologist. I believe that he is currently a consultant with Antech. If your vet uses Antech as his lab, he may be able to talk directly with Dr. Nichols.
Diabetes Insipidus Topics
It all started with Puff ... DI Central home What is diabetes insipidus How is DI diagnosed What are the problems with the water deprivation test A safer way to determine if your pet has CDI If your pet has been diagnosed with nephrogenic diabetes insipidus Traditional treatments Treatment of central diabetes insipidus by subcutaneous injection of desmopressin References Where your vet can get more information and help How to treat by subcutaneous injection of desmopressin What you need How much to use Breaking into the bottle and transferring the drug Pictures to guide you the first time through What about using the pills? How to keep the cost down A cost comparison - eye/nose drops vs. injections Puff's opinion - Use the injections … here's why A picture gallery of pets with diabetes insipidus Puff's story You can email Puff for more information or to ask questions.
Click here to email Puff
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Information on these pages is the result of personal experience and study.
It was not written by a veterinarian and is not intended to be used as if it was.