Safe desmopressin administration
Disclosed is a family of intranasal spray dispensers for administering uniform low doses of desmopressin so as to achieve safe antidiuresis in human patients. The dispensers of the invention may be used in the treatment of nocturia, primary nocturnal enuresis, incontinence, urinary frequency, diabetes insipidus, or any disease or syndrome where desmopressin therapy is useful or where safe temporary suppression of urine production may lead to beneficial health effects or increased convenience in voiding control.
1. An intranasal spray device for consistently achieving a low desmopressin blood concentration thereby to produce safe antidiuresis in a human patient suffering from nocturia and to minimize the likelihood that the patient will suffer from hyponatremia, the device comprising:
a reservoir having disposed therein a composition comprising desmopressin, and
an outlet in communication with the reservoir comprising a nozzle which dispenses a desmopressin dose in the form of a plume ejected over a time interval, the plume comprising a volume of moving droplets together defining a conical volume having a central axis and an apex at the nozzle of the spray device, wherein the droplet density (number of droplets per unit volume) within the conical volume increases in a direction normal to the axis, the droplets together comprising between about 0.05 μg and 5.0 μg desmopressin, the plume serving to increase contact of the droplets with intranasal luminal mucosal surfaces.
2. The device of claim 1 , wherein said droplets comprise an oil-in-water emulsion.
3. The device of claim 1 , wherein an axial cross section of the conical volume at a surface about 3 cm or less from its apex describes an annular disk of droplets.
4. The device of claim 1 , wherein the plume is effective to deliver transmucosally to the bloodstream of a patient weighing 70 kg sufficient desmopressin to produce a desmopressin blood concentration no greater than 15+/−3 pg/ml.
5. The device of claim 4 , wherein the plume is effective to produce a desmopressin blood concentration no greater than 10+/−3 pg/ml.
6. The device of claim 1 , wherein the droplets together comprise between about 0.05 μg and 1.0 μg desmopressin.
7. The device of claim 1 , wherein the droplets together comprise about 1.5 μg desmopressin.
8. The device of claim 1 , wherein the droplets together comprise about 0.75 μg desmopressin.
9. A method of treating nocturia in an adult patient, the method comprising intranasally administering to the patient a composition comprising an intranasal desmopressin dose in the form of a plume ejected over a time interval from the nozzle of a metered dose spray device, the plume comprising a volume of moving droplets together defining a conical volume having a central axis and an apex at the nozzle of the spray device, wherein the droplet density (number of droplets per unit volume) within the conical volume increases in a direction normal to the axis, the droplets together comprising between about 0.05 μg and 5.0 μg desmopressin, the plume serving to increase contact of the droplets with intranasal luminal mucosal surfaces.
10. The method of claim 9 , wherein the administration produces a desmopressin concentration no greater than 15+/−3 pg/ml in the bloodstream of the patient.
11. The method of claim 9 , wherein the administration induces antidiuresis for less than about six hours.
12. The composition of claim 10 , wherein the plume is effective to produce a desmopressin blood concentration no greater than 10+/−3 pg/ml.
13. The method of claim 9 , wherein the droplets further comprise a permeation enhancer.
14. The method of claim 13 , wherein the permeation enhancer comprises cyclopentadecanolide.
15. The method of claim 14 , wherein the droplets together comprise about 1.5 μg desmopressin.
16. The method of claim 14 , wherein the droplets together comprise about 0.75 μg desmopressin.
17. The method of claim 14 , wherein the droplets together comprise 1.5 μg desmopressin.
18. The method of claim 14 , wherein the droplets together comprise 0.75 μg desmopressin.
19. The method of claim 9 , wherein the droplets together comprise about 1.5 μg desmopressin.
20. The method of claim 9 , wherein the droplets together comprise about 0.75 μg desmopressin.
21. The method of claim 9 , wherein the droplets together comprise 1.5 μg desmopressin.
22. The method of claim 9 , wherein the droplets together comprise 0.75 μg desmopressin.
23. The device of claim 1 , wherein the droplets together comprise about 1.5 μg desmopressin.
24. The device of claim 1 , wherein the droplets together comprise about 0.75 μg desmopressin.
25. The method of claim 2 , wherein the droplets together comprise 1.5 μg desmopressin.
26. The method of claim 2 , wherein the droplets together comprise 0.75 μg desmopressin.