Desmopressin

Summary

Desmopressin (DDAVP) is a synthetic analogue of arginine vasopressin with enhanced antidiuretic potency and minimal vasopressor activity. It is approved for central diabetes insipidus, primary nocturnal enuresis, nocturia, and hemostatic indications including mild hemophilia A and von Willebrand disease type 1. Available in multiple formulations including intranasal, oral, and injectable forms.

Mechanism of Action

Selectively binds V2 receptors in renal collecting ducts, increasing water reabsorption via aquaporin-2 upregulation; also binds V1b receptors (pituitary) and promotes release of von Willebrand factor and Factor VIII from endothelial cells via V2 receptor stimulation.

Routes of Administration

Goals & Uses

• Nocturia reduction in adultsUrologyHigh
• Hemostasis in mild hemophilia A / vWD type 1HematologyHigh
• Central diabetes insipidus managementEndocrine / RenalHigh
• Hemostatic agent in uremia-related platelet dysfunctionHematology / NephrologyModerate
• Primary nocturnal enuresis treatmentUrology / PediatricsHigh
• Cranial surgery/trauma-related polyuriaNeurosurgery / Critical CareModerate

Contraindications

• Syndrome of inappropriate antidiuretic hormone secretion (SIADH)EndocrineHigh
• von Willebrand disease type 2BHematologyHigh
• Hyponatremia or history of hyponatremiaElectrolyte DisorderHigh
• Polydipsia (primary or psychogenic)Psychiatric / BehavioralHigh
• Hypersensitivity to desmopressinAllergy / ImmunologyHigh
• Moderate to severe renal impairment (CrCl <50 mL/min)RenalHigh

Adverse Effects

• Injection site reactionsLocalUncommon
• HeadacheNeurologicCommonPain in the head or upper neck
• Flushing / Facial flushingDermatologicalUncommon
• NauseaGastrointestinalCommonFeeling of sickness or urge to vomit
• HyponatremiaElectrolyteUncommon
• Nasal congestion / rhinitisENTCommon

Drug Interactions

• Selective serotonin reuptake inhibitors (SSRIs)Moderate
• Tricyclic antidepressantsModerate
• CarbamazepineModerate
• NSAIDsModerateMay increase renal risk in susceptible patients
• Lamotrigine / ValproateLow
• Thiazide diureticsHigh

Population Constraints

• PregnancyReproductive SafetyRelative
• Cardiovascular disease / hypertensionCardiovascularRelative
• Children under 5 yearsPediatricRelative
• Cystic fibrosisPulmonary / GeneticRelative
• Elderly patients (≥65 years)Age RelatedRelative

Regulatory Status

• European UnionApprovedApproved: Central diabetes insipidus, Primary nocturnal enuresis, Nocturia, Haemophilia A (mild to moderate), von Willebrand disease type 1Multiple EMA-approved products including Minirin, Nocutil, and Nocdurna; sex-differentiated dosing for nocturia.
• United StatesApprovedApproved: Central diabetes insipidus, Primary nocturnal enuresis (children ≥5 years and adults), Nocturia in adults (Nocdurna oral lyophilisate, approved 2018), Hemostasis in mild hemophilia A, Hemostasis in von Willebrand disease type 1FDA-approved across multiple formulations: DDAVP nasal spray, DDAVP injection, DDAVP tablets, Stimate nasal spray, Nocdurna sublingual tablets.
• United KingdomApprovedApproved: Cranial diabetes insipidus, Primary nocturnal enuresis, Nocturia, Mild hemophilia A, von Willebrand disease type 1MHRA-approved; available as Desmotabs, DDAVP, Desmospray among others. NICE guidance supports use in nocturia.

FDA-approved for multiple indications; intranasal formulation for primary nocturnal enuresis in adults gained specific labeling. Oral lyophilisate (Nocdurna) approved by FDA in 2018 for nocturia in adults. EU EMA approval also in place for multiple indications. Risk of hyponatremia highlighted in labeling.

Evidence & Sources

No sources recorded yet.