Desmopressin

Desmopressin is a prescription medication used to treat Diabetes Insipidus, Hemophilia A, Von Willebrand Disease (Type 1), Nocturnal Enuresis, Nocturia, Uremic Bleeding in Acute or Chronic Renal Failure.

• Desmopressin is available under the following different brand names: DDAVP, Stimate, Minirin, Noctiva, Nocdurna.

Dosages of Desmopressin:

Adult and pediatric dosage

Injectable Solution (DDAVP)

• 4mcg/mL

Tablet (DDAVP)

• 0.1mg
• 0.2mg

Nasal spray (DDAVP, DDAVP Rhinal Tube)

• 0.1mg/mL (5mL): Delivers 10mcg/spray

Nasal spray (Stimate)

• 1.5mg/ML (2.5mL): Delivers 150mcg/spray

Preservative-free nasal spray (Noctiva)

• 0.83 mcg of desmopressin acetate/0.1mL (equivalent to 0.75 mcg desmopressin)
• 1.66 mcg of desmopressin acetate/0.1mL (equivalent to 1.5 mcg desmopressin)

Tablet, sublingual (Nocdurna)

• 27.7mcg of desmopressin acetate (equivalent to 25 mcg of desmopressin)
• 55.3mcg of desmopressin acetate (equivalent to 50 mcg of desmopressin)

Diabetes Insipidus

Adult dosage

Intranasal (DDAVP)

• 10-40 mcg (0.1-0.4 mL) once daily, either as a single dose or divided into 2 or 3 doses; the usual dose is 20 mcg (0.2 mL) once daily in 2 divided doses

Orally 

• Initial: 0.05 mg every 12 hours
• Effective range: 0.1-1.2 mg divided every 8-12 hours
• If switching to orally from intranasal, start oral treatment at least 12 hours after the last intranasal dose

IV/SC

• 2-4 mcg/day divided every 12 hours or one-tenth the maintenance of intranasal dose

Pediatric dosage

• Children younger than 3 months of age: safety and efficacy not established
• Children 3 months of age-12 years of age: Usual dosage range is 5-30 mcg (0.05-0.3 mL) once daily, either as a single dose or divided into 2 doses
• Children 12 years of age or older: 10-40 mcg (0.1-0.4 mL) once daily, either as a single dose or divided into 2 or 3 doses; usual dose is 20 mcg (0.2 mL) once daily in 2 divided doses

Hemophilia A

Adult dosage

IV

• 0.3 mcg/kg IV over 15-30 minutes (for pre-op, 30 minutes before the procedure)

Intranasal (Stimate)

• less than 50 kg: 150 mcg; for pre-op, give 2 hours before the procedure
• more than 50 kg: 300 mcg; for pre-op, give 2 hours before the procedure

Pediatric dosage

IV

• Infants 3 months of age, children, and adolescents: 0.3 mcg/kg IV, give 30 minutes before the procedure

Intranasal (Stimate)

• Infants 11 months or older, children and adolescents: 
• Children weighing less than 50 kg: 150 mcg intranasally
• Children weighing 50 kg or more: 300 mcg intranasally if used preoperatively, administer 2 hours before the procedure

Von Willebrand Disease (Type 1)

Adult dosage 

IV

• 0.3 mcg/kg IV over 15-30 minutes (for pre-op, 30 minutes before the procedure)

Intranasal (Stimate)

• less than 50 kg: 150 mcg; for pre-op, give 2 hours before the procedure
• more than 50 kg: 300 mcg; for pre-op, give 2 hours before the procedure

Pediatric dosage

• Infants 3 months of age, children, and adolescents: 0.3 mcg/kg IV, give 30 minutes before the procedure

Intranasal (Stimate)

• Infants 11 months or older, children and adolescents: 
• Children weighing less than 50 kg: 150 mcg intranasally
• Children weighing 50 kg or more: 300 mcg intranasally if used preoperatively, administer 2 hours before the procedure

Nocturnal Enuresis

Adult dosage

• 0.2 orally before bedtime (up to 0.6 mg per day)

Pediatric dosage

• Children older than 6 years of age: 0.2 mg orally before bedtime (up to 0.6 mg/day)

Nocturia

Adult dosage

• Preservative-free nasal spray (Noctiva)
• Adults 50 years of age to 65 years of age: 1 spray of 1.66 mcg in either nostril nightly ~30 minutes before going to bed
• Adults 65 years or older: 0.83 mcg in either nostril nightly ~30 minutes before going to bed; 0.83 mcg dose may have a lower risk of hyponatremia; may be increased to 1 spray of 1.66 mcg after at least 7 days, if needed, provided serum sodium has remained normal

Sublingual tablets (Nocdurna)

• Women: 27.7 mcg sublingually once daily, 1 hour before bedtime, administered sublingually without water
• Men: 55.3 mcg sublingually once daily, 1 hour before bedtime, administered sublingually without water

Uremic Bleeding in Acute or Chronic Renal Failure

• 0.4 mcg/kg IV over 10 minutes

Dosage Considerations – Should be Given as Follows: 

• See “Dosages”.

Common side effects of Desmopressin include:

• headache, 
• dizziness, 
• dry mouth, 
• nausea, and 
• mild stomach pain

Serious side effects of Desmopressin include:

• hives, 
• difficulty breathing, 
• swelling of the face, lips, tongue, or throat, 
• headache, 
• confusion, 
• hallucinations, 
• muscle cramps, 
• severe weakness, 
• vomiting, 
• loss of coordination, 
• restlessness,
• feeling unsteady, 
• flushing (sudden warmth, redness, or tingly feeling), 
• swelling, 
• weight gain, 
• seizure, 
• weak or shallow breathing, and
• lightheadedness

Rare side effects of Desmopressin include:

• none 

If your medical doctor is using this medicine to treat your pain, your doctor or pharmacist may already be aware of any possible drug interactions and may be monitoring you for them.  Do not start, stop, or change the dosage of any medicine before checking with your doctor, health care provider, or pharmacist first

• Desmopressin has severe interactions with the following drugs:
  • mometasone, intranasal
• Desmopressin has serious interactions with the following drugs:
  • mometasone, inhaled
• Desmopressin has moderate interactions with no other drugs.
• Desmopressin has minor interactions with at least 27 other drugs.

This information does not contain all possible interactions or adverse effects. Visit the RxList Drug Interaction Checker for any drugs interactions. Therefore, before using this product, tell your doctor or pharmacist of all the products you use.  Keep a list of all your medications with you, and share this information with your doctor and pharmacist.  Check with your health care professional or doctor for additional medical advice, or if you have health questions, concerns.

Contraindications

• Hypersensitivity
• Hyponatremia or history of hyponatremia
• Moderate to severe renal impairment (CrCl over 50 mL/min)

Intranasal preservative-free (Noctiva) and sublingual tablets

• Polydipsia
• Primary nocturnal enuresis
• Concomitant use with loop diuretics or systemic or inhaled glucocorticoids
• Estimated glomerular filtration rate below 50 mL/min/1.73 m²
• Syndrome of inappropriate antidiuretic hormone secretion (SIADH)
• Uncontrolled hypertension
• During illnesses that can cause fluid or electrolyte imbalance
• Noctiva only: New York Heart Association (NYHA) class II-IV congestive heart failure
• Nocdurna only: Heart failure

Effects of drug abuse

• None

Short-Term Effects

• See “What Are Side Effects Associated with Using Desmopressin?”

Long-Term Effects

• See “What Are Side Effects Associated with Using Desmopressin?”

Cautions

• Factor VIII levels over 5% or presence of factor VIII antibodies
• Avoid use in Type IIB von Willebrand disease
• Therapeutic effect has not been observed in patients who have been febrile or stressed for several days; monitor for efficacy if necessary
• Use caution in patients with habitual or psychogenic polydipsia (increased risk of hypnatremia)
• The risk of potentially fatal hyponatremia/seizures; may occur with any route of administration
• Anaphylactic reactions reported (rare) with IV and intranasal administration
• Use an alternative route of administration if changes in the nasal mucosa resulting from edema or scarring occur
• Rapid IV infusions may result in severe hypotension
• Interrupt therapy if patient perform activities associated with an increase in water consumption or with acute illness including fever or recurrent vomiting or diarrhea
• Use with caution in patients predisposed to thrombus formation; acute myocardial infarction and cerebrovascular thrombosis reported with desmopressin injection
• Therapy can cause fluid retention, which can worsen underlying conditions that are susceptible to volume status, including congestive heart failure (see Contraindications)
• In children and the elderly adjust fluid intake downward to decrease the possibility of water intoxication and hyponatremia

Nasal spray

• Chronic administration nasal spray may result in changes to nasal mucosa; nasal mucosa abnormalities (such as scarring and edema) due to chronic administration, or due to other causes (nasal blockage, nasal mucosal atrophy, severe atrophic rhinitis, recent nasal surgery such as transsphenoidal hypophysectomy) may cause erratic, unreliable absorption; avoid the use of the nasal spray in such patients and consider the use of other formulations of desmopressin acetate given by other routes of administration
• Intranasal DDAVP at high dosage has infrequently produced a slight elevation of blood pressure, which disappeared with a reduced dose; exercise caution in patients with coronary artery insufficiency and/or hypertensive cardiovascular disease because of a possible rise in blood pressure
• Use with caution in patients predisposed to thrombus formation; acute myocardial infarction and cerebrovascular thrombosis reported with desmopressin injection

Noctiva only

• Before starting or resuming therapy, ensure that serum sodium concentration is normal; consider 0.83-mcg dose as starting dose for patients who may be at risk for hyponatremia
• Not recommended in patients at risk of increased intracranial pressure or history of urinary retention; monitor volume status in patients with NYHA Class I congestive heart failure
• Discontinue therapy in patients with concurrent nasal conditions that may increase systemic absorption (eg, atrophy of nasal mucosa, acute or chronic rhinitis), because increased absorption may increase the risk of hyponatremia; therapy can be resumed when conditions resolve
• When therapy is administered, fluid intake in the evening and nighttime hours should be moderated to decrease the risk of hyponatremia; monitor serum sodium concentration within 7 days and ~1 month of initiating therapy or increasing dose, and periodically thereafter; the frequency of serum sodium monitoring should be based on patient’s risk for hyponatremia

Hyponatremia

• Also see Administration, Black Box Warnings, and Dosing Considerations
• To decrease the risk of water intoxication with hyponatremia, fluid restriction is recommended; careful fluid intake restriction is particularly important in pediatric and geriatric patients because these patients are at greater risk of developing hyponatremia; more frequent monitoring of serum sodium levels is recommended in the following patients: those with conditions associated with fluid and electrolyte imbalance, such as cystic fibrosis, heart failure, renal disorders, habitual or psychogenic polydipsia or those taking concomitant drugs that may cause hyponatremia
• The nasal spray is not an indicated formulation for the treatment of primary nocturnal enuresis due to higher risk of hyponatremia and hyponatremic convulsions with the use of nasal spray formulation compared to desmopressin tablets seen in postmarketing reports
• Signs and symptoms associated with hyponatremia: Headache, nausea/vomiting, decreased serum sodium, weight gain, restlessness, fatigue, lethargy, disorientation, depressed reflexes, loss of appetite, irritability, muscle weakness, muscle spasms or cramps, and abnormal mental states such as hallucinations, decreased consciousness, and confusion
• Severe symptoms due to an extreme decrease in serum sodium and plasma osmolality may include one or a combination of the following: seizure, coma, and/or respiratory arrest

Drug interaction overview

• Concomitant use of desmopressin sublingual and loop diuretics or systemic or inhaled glucocorticoids is contraindicated because of the risk of severe hyponatremia; may be started or resumed 3 days or 5 half-lives after discontinuing glucocorticoid, whichever is longer
• Drugs (eg, tricyclic antidepressants, selective serotonin reuptake inhibitors, chlorpromazine, opiate analgesics, thiazide diuretics, carbamazepine, lamotrigine, sulfonylureas, particularly chlorpropamide, NSAIDs) may increase the risk of hyponatremia; monitor serum sodium more frequently in patients taking desmopressin concomitantly with these drugs and when doses of these drugs are increased
• Use of large doses of nasal spray with other vasoconstrictors may require reducing the dose

Pregnancy and Lactation

• Prolonged experience with desmopressin in pregnant women over several decades, based on available published data and case reports, did not identify a drug-associated risk of major birth defects, miscarriage, or adverse maternal or fetal outcomes; in addition, in vitro studies with human placenta demonstrate the poor placental transfer of desmopressin; no adverse developmental outcomes were observed in animal reproduction studies with administration of desmopressin during organogenesis to pregnant rats and rabbits at doses approximately less than 1 and 38 times, respectively, the maximum recommended human dose based on body surface area (mg/m²)
• Not recommended for treatment of nocturia in pregnant women; nocturia is usually related to normal, physiologic changes during pregnancy that does not require treatment
• Desmopressin is present in small amounts in human milk and is poorly absorbed orally by infant
• There is no information on the effects of desmopressin on the breastfed infant or milk production; development and health benefits of breastfeeding should be considered along with the mother’s clinical need for therapy and potential adverse effects on the breastfed infant from therapy or the underlying maternal condition