• Chronic intranasal use may cause tolerance or if administered more frequently than every 24–48 hr IV tachyphylaxis (short-term tolerance) may develop.

• Monitor frequency of enuresis throughout therapy. Use cautiously in patients at risk for water intoxication with hyponatremia.

• Do not intranasal form for nocturnal enuresis.

• Monitor urine and plasma osmolality and urine volume frequently. Assess patient for symptoms of dehydration (excessive thirst, dry skin and mucous membranes, tachycardia, poor skin turgor). Weigh patient daily and assess for edema.

• Monitor plasma factor VIII coagulant, factor VIII antigen, and ristocetin cofactor. May also assess activated partial thromboplastin time (aPTT) for hemophilia A and skin bleeding time for von Willebrand's disease. Assess patient for signs of bleeding.

» Monitor BP and pulse during IV infusion.

» Monitor intake and output and adjust fluid intake (especially in children and elderly) to avoid overhydration in patients receiving desmopressin for hemophilia.

• Signs and symptoms of water intoxication include confusion, drowsiness, headache, weight gain, difficulty urinating, seizures, and coma.

» Treatment of overdose includes decreasing dose and, if symptoms are severe, administration of furosemide.