Formulary
Desmopressin: Indications, Dosing, Side Effects and Interactions
Desmopressin is an analogue of vasopressin.
MedNext Academy | 10 min read
Desmopressin: Indications, Dosing, Side Effects and Interactions
Desmopressin is an analogue of vasopressin.
Drug action
Desmopressin is an analogue of vasopressin.
Indications and dose
**Diabetes insipidus, treatment**
- **Child** (By Mouth): 12-17 years Initially 10-20 micrograms 1-2 times a day, adjusted according to response.
- **Adult** (By Mouth): 10-40 micrograms daily in 1-2 divided doses.
- **Adult** (By Subcutaneous Injection, Or By Intravenous Injection, Or By Intramuscular Injection): 1-4 micrograms daily.
**Primary nocturnal enuresis**
- **Child** (By Mouth Using Tablets): 5-17 years 200 micrograms once daily, increased if necessary to 400 micrograms once daily, dose to be taken at bedtime, limit fluid intake from 1 hour before to 8 hours after administration, dose to be increased only if lower dose not effective, reassess after 3 months by withdrawing treatment for at least 1 week.
- **Adult** (By Mouth Using Tablets): 18-65 years 200 micrograms once daily, increased if necessary to 400 micrograms once daily, dose to be taken at bedtime, limit fluid intake from 1 hour before to 8 hours after administration, dose to be increased only if lower dose not effective, reassess after 3 months by withdrawing treatment for at least 1 week.
- **Child** (By Mouth Using Oral Solution): 5-17 years 120 micrograms once daily, increased if necessary to 240 micrograms once daily, dose to be taken at bedtime, limit fluid intake from 1 hour before to 8 hours after administration, dose to be increased only if lower dose not effective, reassess after 3 months by withdrawing treatment for at least 1 week.
- **Adult** (By Mouth Using Oral Solution): 18-65 years 120 micrograms once daily, increased if necessary to 240 micrograms once daily, dose to be taken at bedtime, limit fluid intake from 1 hour before to 8 hours after administration, dose to be increased only if lower dose not effective, reassess after 3 months by withdrawing treatment for at least 1 week.
**Polyuria or polydipsia after hypophysectomy**
- **Adult** (By Mouth Using Tablets): 18-65 years Dose to be adjusted according to urine osmolality.
**Diabetes insipidus, diagnosis (water deprivation test)**
- **Adult** (By Intramuscular Injection, Or By Subcutaneous Injection): By intranasal administration 20 micrograms, limit fluid intake to 500 mL from 1 hour before to 8 hours after administration. 2 micrograms for 1 dose, limit fluid intake to 500 mL from 1 hour before to 8 hours after administration.
**Renal function testing**
- **Adult** (By Subcutaneous Injection, Or By Intramuscular Injection): By intranasal administration 40 micrograms, empty bladder at time of administration and limit fluid intake to 500 mL from 1 hour before until 8 hours after administration to avoid fluid overload. 2 micrograms, empty bladder at time of administration and restrict fluid intake to 500 mL from 1 hour before until 8 hours after administration to avoid fluid overload.
**Mild to moderate haemophilia and von Willebrand's disease**
- **Adult** (By Intravenous Infusion, Or By Subcutaneous Injection): By intranasal administration 300 micrograms every 12 hours if required, one 150 microgram spray into each nostril, 30 minutes before surgery or when bleeding, dose may alternatively be repeated at intervals of at least 3 days, if self-administered. 300 nanograms/kg for 1 dose, to be administered immediately before surgery or after trauma; may be repeated at intervals of 12 hours.
**Fibrinolytic response testing**
- **Adult** (By Intravenous Infusion, Or By Subcutaneous Injection): By intranasal administration 300 micrograms, blood to be sampled after 1 hour for fibrinolytic activity, one 150 microgram spray to be administered into each nostril. 300 nanograms/kg for 1 dose, blood to be sampled after 20 minutes for fibrinolytic activity.
**Lumbar-puncture-associated headache**
- **Adult** (By Intramuscular Injection, Or By Subcutaneous Injection): (consult product literature).
**Diabetes insipidus, treatment for desmopressin**
- **Neonate** (By mouth): Initially 1-4 micrograms 2-3 times a day, adjusted according to response.
- **Child 1-23 months** (By mouth): Initially 10 micrograms 2-3 times a day, adjusted according to response; usual dose 30-150 micrograms daily.
- **Child 2-11 years** (By mouth): Initially 50 micrograms 2-3 times a day, adjusted according to response; usual dose 100-800 micrograms daily.
- **Child 12-17 years** (By mouth): Initially 100 micrograms 2-3 times a day, adjusted according to response; usual dose 0.2-1.2 mg daily.
- **Child 2-17 years** (By sublingual administration): Initially 60 micrograms 3 times a day, adjusted according to response; usual dose 40-240 micrograms 3 times a day.
- **Neonate** (By intranasal administration): Initially 100-500 nanograms, adjusted according to response; usual dose 1.25-10 micrograms daily in 1-2 divided doses.
- **Child 1-23 months** (By intranasal administration): Initially 2.5-5 micrograms 1-2 times a day, adjusted according to response.
- **Child 2-11 years** (By intranasal administration): Initially 5-20 micrograms 1-2 times a day, adjusted according to response.
- **Child 12-17 years** (By intranasal administration): Initially 10-20 micrograms 1-2 times a day, adjusted according to response.
- **Neonate** (By intramuscular injection): Initially 100 nanograms once daily, adjusted according to response.
- **Child 1 month-11 years** (By subcutaneous injection, or by intramuscular injection): Initially 400 nanograms once daily, adjusted according to response.
- **Child 12-17 years** (By subcutaneous injection, or by intramuscular injection): Initially 1-4 micrograms once daily, adjusted according to response.
**Primary nocturnal enuresis for desmopressin**
- **Child 5-17 years** (By mouth using tablets): 200 micrograms once daily, increased if necessary to 400 micrograms once daily, dose to be taken at bedtime, limit fluid intake from 1 hour before to 8 hours after administration, dose to be increased only if lower dose not effective, reassess after 3 months by withdrawing treatment for at least 1 week.
- **Child 5-17 years** (By mouth using oral solution): 180 micrograms once daily, increased if necessary to 360 micrograms once daily, dose to be taken at bedtime, limit fluid intake from 1 hour before to 8 hours after administration, dose to be increased only if lower dose not effective, reassess after 3 months by withdrawing treatment for at least 1 week.
- **Child 5-17 years** (By sublingual administration): 120 micrograms once daily, increased if necessary to 240 micrograms once daily, dose to be taken at bedtime, limit fluid intake from 1 hour before to 8 hours after administration, dose to be increased only if lower dose not effective, reassess after 3 months by withdrawing treatment for at least 1 week.
**Diabetes insipidus, diagnosis (water deprivation test) for desmopressin**
- **Neonate** (By intranasal administration): Not recommended, use trial of treatment.
- **Child 1-23 months** (By intranasal administration): 5-10 micrograms for 1 dose, manage fluid input carefully to avoid hyponatraemia, not usually recommended.
- **Child 2-11 years** (By intranasal administration): 10-20 micrograms for 1 dose, manage fluid input carefully to avoid hyponatraemia.
- **Child 12-17 years** (By intranasal administration): 20 micrograms for 1 dose, manage fluid input carefully to avoid hyponatraemia.
- **Neonate** (By intramuscular injection, or by subcutaneous injection): Not recommended, use trial of treatment.
- **Child 1-23 months** (By intramuscular injection, or by subcutaneous injection): 400 nanograms for 1 dose, manage fluid input carefully to avoid hyponatraemia, not usually recommended.
- **Child 2-11 years** (By intramuscular injection, or by subcutaneous injection): 0.5-1 microgram for 1 dose, manage fluid input carefully to avoid hyponatraemia.
- **Child 12-17 years** (By intramuscular injection, or by subcutaneous injection): 1-2 micrograms for 1 dose, manage fluid input carefully to avoid hyponatraemia.
**Renal function testing for desmopressin**
- **Child 1-11 months** (By intranasal administration): 10 micrograms, empty bladder at time of administration and restrict fluid intake to 50% at next 2 feeds to avoid fluid overload.
- **Child 1-14 years** (By intranasal administration): 20 micrograms, empty bladder at time of administration and restrict fluid intake to 500 mL from 1 hour before until 8 hours after administration to avoid fluid overload.
- **Child 15-17 years** (By intranasal administration): 40 micrograms, empty bladder at time of administration and limit fluid intake to 500 mL from 1 hour before until 8 hours after administration to avoid fluid overload.
- **Child 1-11 months** (By subcutaneous injection, or by intramuscular injection): 400 nanograms, empty bladder at time of administration and restrict fluid intake to 50% at next 2 feeds to avoid fluid overload.
- **Child 1-17 years** (By subcutaneous injection, or by intramuscular injection): 2 micrograms, empty bladder at time of administration and restrict fluid intake to 500 mL from 1 hour before until 8 hours after administration to avoid fluid overload.
**Mild to moderate haemophilia and von Willebrand's disease for desmopressin**
- **Child 1-17 years** (By intranasal administration): 4 micrograms/kg for 1 dose, for pre-operative use give 2 hours before procedure.
- **Child** (By intravenous infusion, or by subcutaneous injection): 300 nanograms/kg for 1 dose, to be administered immediately before surgery or after trauma; may be repeated at intervals of 12 hours if no tachycardia.
**Fibrinolytic response testing for desmopressin**
- **Child 2-17 years** (By intravenous infusion, or by subcutaneous injection): 300 nanograms/kg for 1 dose, blood to be sampled after 20 minutes for fibrinolytic activity.
**Assessment of antidiuretic hormone secretion (congenital deficiency suspected) (specialist use only) for desmopressin**
- **Child 1-23 months** (By intranasal administration): Initially 100-500 nanograms for 1 dose.
**Assessment of antidiuretic hormone secretion (congenital deficiency not suspected) (specialist use only) for desmopressin**
- **Child 1-23 months** (By intranasal administration): 1-5 micrograms for 1 dose.
Cautions
Avoid fluid overload; cardiovascular disease (not indicated for nocturia associated with multiple sclerosis); conditions which might be aggravated by water retention; cystic fibrosis; elderly (in adults); epilepsy; hypertension (not indicated for nocturia associated with multiple sclerosis); nocturia-limit fluid intake to minimum from 1 hour before dose until 8 hours afterwards; nocturnal enuresis-limit fluid intake to minimum from 1 hour before dose until 8 hours afterwards Cautions, further information Elderly In adults: Elderly patients are at increased risk of hyponatraemia and renal impairment-measure baseline serum sodium concentration, then monitor regularly during treatment; discontinue treatment if levels fall below the normal range. Review treatment if no therapeutic benefit after 3 months. M
Contraindications
Cardiac insufficiency; conditions treated with diuretics; history of hyponatraemia; polydipsia in alcohol dependence; psychogenic polydipsia; syndrome of inappropriate ADH secretion; von Willebrand's Disease Type IIB (may result in pseudothrombocytopenia)
Side effects
General side-effects: Common or very common Headache; hyponatraemia (frequency not known in children); nausea Rare or very rare Allergic dermatitis; emotional disorder Frequency not known Aggression (in children); fluid retention Specific side-effects: Common or very common With intranasal use Asthenia; conjunctivitis With oral use Abdominal pain With sublingual use Diarrhoea (in adults); dizziness (in adults); dry mouth (in adults) Uncommon With intranasal use Epistaxis; gastrointestinal discomfort; nasal congestion; rhinitis; vomiting With sublingual use Constipation (in adults); fatigue (in adults); gastrointestinal discomfort (frequency not known in children); peripheral oedema (in adults) Rare or very rare With intranasal use Brain oedema Frequency not known With intramuscular use Abdominal pain With intravenous use Abdominal pain; vasodilation With oral use Brain oedema (in children and young adults) With subcutaneous use Abdominal pain Side-effects, further information Treatment with desmopressin without restricting fluid intake may lead to fluid retention and/or hyponatraemia.
Interactions
**Other interactions (8):**
- The below listed drugs increase the vasopressin effect, leading to reduced renal electrolyte free water excretion and increase the risk of hospital acquired hyponatraemia following inappropriately...
- Others Clinical pharmacology interaction studies showed that co-administration of ticagrelor with heparin, enoxaparin and ASA or desmopressin did not have any effect on the pharmacokinetics of...
- Co-administration of ticagrelor with heparin, enoxaparin or desmopressin had no effect on activated partial thromboplastin time (aPTT), activated coagulation time (ACT) or factor Xa assays.
- Therefore, the effect of vasopressin analogues such as desmopressin may be attenuated in patients using such analogues to prevent or control bleeding when co- administered with tolvaptan.
- Concomitant treatment with oral desmopressin resulted in a 2-fold increase of desmopressin plasma concentrations, presumably due to slower gastrointestinal motility.
- Use in combination with other agents associated with hyponatremia (e.g.
Pregnancy
Small oxytocic effect in third trimester; increased risk of pre-eclampsia.
Breast feeding
Amount too small to be harmful.
Renal impairment
Caution with injection , nasal spray , and tablets (antidiuretic effect may be reduced). M Avoid oral lyophilisate , oral solution , and sublingual tablets in moderate or severe impairment. M
Medicinal forms
Capsule,Tablet,Tablet,Solution,Solution,Spray
Clinical governance
**Author:** MedNext Clinical Team. **Clinical reviewer:** Dr Shameer Deen, MBBS, MS, MRCS. **Sources:** BNF, Indian Pharmacopoeia, CIMS India. **Correction:** Report errors at support@mednext.academy.
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