Drug Action
Desmopressin is an analogue of vasopressin.
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Drug reference
Desmopressin is an analogue of vasopressin.
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Endocrine system Diabetes insipidus, treatment ▶BY MOUTH ▶Child 1–23 months: Initially 10 micrograms 2–3 times a day, adjusted according to response; usual dose 30–150 micrograms daily ▶Child 2–11 years: Initially 50 micrograms 2–3 times a day, adjusted according to response; usual dose 100–800 micrograms daily ▶Child 12–17 years: Initially 100 micrograms 2–3 times a day, adjusted according to response; usual dose 0.2–1.2 mg daily ▶Adult: Initially 100 micrograms 3 times a day; maintenance 100–200 micrograms 3 times a day; usual dose 0.2–1.2 mg daily ▶BY SUBLINGUAL ADMINISTRATION ▶Child 2–17 years: Initially 60 micrograms 3 times a day, adjusted according to response; usual dose 40–240 micrograms 3 times a day ▶Adult: Initially 60 micrograms 3 times a day, adjusted according to response; usual dose 40–240 micrograms 3 times a day ▶BY INTRANASAL ADMINISTRATION ▶Child 1–23 months: Initially 2.5–5 micrograms 1–2 times a day, adjusted according to response ▶Child 2–11 years: Initially 5–20 micrograms 1–2 times a day, adjusted according to response ▶Child 12–17 years: Initially 10–20 micrograms 1–2 times a day, adjusted according to response ▶Adult: 10–40 micrograms daily in 1–2 divided doses ▶BY SUBCUTANEOUS INJECTION, OR BY INTRAVENOUS INJECTION, OR BY INTRAMUSCULAR INJECTION ▶Adult: 1–4 micrograms daily Primary nocturnal enuresis ▶BY MOUTH ▶Child 5–17 years: 200 micrograms once daily, only increased to 400 micrograms if lower dose not effective; withdraw for at least 1 week for reassessment after 3 months, dose to be taken at bedtime, limit fluid intake from 1 hour before to 8 hours after administration ▶Adult 18–65 years: 200 micrograms once daily, only increased to 400 micrograms if lower dose not effective; withdraw for at least 1 week for reassessment after 3 months, dose to be taken at bedtime, limit fluid intake from 1 hour before to 8 hours after administration ▶BY SUBLINGUAL ADMINISTRATION ▶Child 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 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 Postoperative polyuria or polydipsia ▶BY MOUTH ▶Adult: Dose to be adjusted according to urine osmolality Polyuria or polydipsia after hypophysectomy ▶BY SUBLINGUAL ADMINISTRATION ▶Adult: Dose to be adjusted according to urine osmolality Idiopathic nocturnal polyuria in females ▶BY SUBLINGUAL ADMINISTRATION ▶Adult: 25 micrograms daily, to be taken 1 hour before bedtime Idiopathic nocturnal polyuria in males ▶BY SUBLINGUAL ADMINISTRATION ▶Adult: 50 micrograms daily, to be taken 1 hour before bedtime Diabetes insipidus, diagnosis (water deprivation test) ▶BY INTRANASAL ADMINISTRATION ▶Adult: 20 micrograms, limit fluid intake to 500 mL from 1 hour before to 8 hours after administration ▶BY INTRAMUSCULAR INJECTION, OR BY SUBCUTANEOUS INJECTION ▶Adult: 2 micrograms for 1 dose, limit fluid intake to 500 mL from 1 hour before to 8 hours after administration Nocturia associated with multiple sclerosis (when other treatments have failed) ▶BY INTRANASAL ADMINISTRATION ▶Adult 18–65 years: 10–20 micrograms once daily, to be taken at bedtime, dose not to be repeated within 24 hours, limit fluid intake from 1 hour before to 8 hours after administration Renal function testing ▶BY INTRANASAL ADMINISTRATION ▶Adult: 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 ▶BY SUBCUTANEOUS INJECTION, OR BY INTRAMUSCULAR INJECTION ▶Adult: 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 ▶BY INTRANASAL ADMINISTRATION ▶Adult: 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 ▶BY INTRAVENOUS INFUSION, OR BY SUBCUTANEOUS INJECTION ▶Adult: 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 ▶BY INTRANASAL ADMINISTRATION ▶Adult: 300 micrograms, blood to be sampled after 1 hour for fibrinolytic activity, one 150 microgram spray to be administered into each nostril ▶BY SUBCUTANEOUS INJECTION, OR BY INTRAVENOUS INJECTION ▶Adult: 300 nanograms/kg for 1 dose, blood to be sampled after 20 minutes for fibrinolytic activity Lumbar-puncture-associated headache ▶BY INTRAMUSCULAR INJECTION, OR BY SUBCUTANEOUS INJECTION ▶Adult: (consult product literature) l UNLICENSED USE ▶In children Consult product literature for individual preparations. Oral use of DDAVP intravenous injection is not licensed.
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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)
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GENERAL CAUTIONS Asthma. avoid fluid overload. cardiovascular disease (not indicated for nocturnal enuresis or nocturia). conditions which might be aggravated by water retention. cystic fibrosis. elderly (avoid for primary nocturnal enuresis and nocturia associated with multiple sclerosis in those over 65 years). epilepsy. heart failure. hypertension (not indicated for nocturnal enuresis or nocturia). migraine. 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 SPECIFIC CAUTIONS ▶With intranasal use should not be given intranasally for nocturnal enuresis due to an increased incidence of side- effects CAUTIONS, FURTHER INFORMATION Elderly patients are at increased risk of hyponatraemia and renal impairment— manufacturer advises 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.
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Oral, intranasal, intravenous, subcutaneous and intramuscular doses are expressed as desmopressin acetate; sublingual doses are expressed as desmopressin base. Children requiring an intranasal dose of less than 10 micrograms should be given DDAVP ® intranasal solution.
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Scottish Medicines Consortium (SMC) decisions SMC No. 1218/17 The Scottish Medicines Consortium has advised (August 2017) that desmopressin oral lyophilisate (Noqdirna ®) is accepted for restricted use within NHS Scotland for the symptomatic treatment of nocturia due to idiopathic nocturnal polyuria in patients aged 65 years and over. All Wales Medicines Strategy Group (AWMSG) decisions AWMSG No. 3282 The All Wales Medicines Strategy Group has advised (October 2017) that desmopressin acetate (Noqdirna ®) is recommended for restricted use within NHS Wales for idiopathic nocturnal polyuria in adults aged over 65 years, for whom treatment options are currently limited.
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→Appendix 1: desmopressin
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GENERAL SIDE-EFFECTS ▶Common or very common Hyponatraemia (on administration without restricting fluid intake). nausea ▶Frequency not known Abdominal pain. aggression (in children). allergic dermatitis. emotional disorder. fluid retention. headache. hyponatraemic seizure. vomiting. weight increased SPECIFIC SIDE-EFFECTS ▶With intranasal use Epistaxis. nasal congestion. rhinitis ▶With intravenous use Vasodilation SIDE-EFFECTS, FURTHER INFORMATION Manufacturer advises avoiding concomitant use of drugs which increase secretion of vasopressin (e.g. tricyclic antidepressants)— increases risk of hyponatraemia.
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Small oxytocic effect in third trimester; increased risk of pre-eclampsia.
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Amount too small to be harmful.
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Use with caution; antidiuretic effect may be reduced.
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In nocturia, periodic blood pressure and weight checks are needed to monitor for fluid overload.
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DDAVP ® and Desmotabs ® tablets may be crushed. DDAVP ® intranasal solution may be diluted with Sodium Chloride 0.9% to a concentration of 10 micrograms/mL. DDAVP ® injection may be administered orally. Desmopressin oral lyophilisates are for sublingual administration. ▶With intravenous use For intravenous infusion (DDAVP ®, Octim ®), give intermittently in Sodium chloride 0.9%; dilute with 50 mL and give over 20 minutes.
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There can be variation in the licensing of different medicines containing the same drug. Forms available from special-order manufacturers include: capsule, oral suspension, oral solution, spray, nasal drops Tablet ▶Desmopressin (Non-proprietary) Desmopressin acetate 100 microgram Desmopressin 100microgram tablets | 90 tablet P £76.62 DT = £63.09 Desmopressin acetate 200 microgram Desmopressin 200microgram tablets | 30 tablet P £28.50 DT = £23.52 ▶DDAVP (Ferring Pharmaceuticals Ltd) Desmopressin acetate 100 microgram DDAVP 0.1mg tablets | 90 tablet P £44.12 DT = £63.09 Desmopressin acetate 200 microgram DDAVP 0.2mg tablets | 90 tablet P £88.23 ▶Desmotabs (Ferring Pharmaceuticals Ltd) Desmopressin acetate 200 microgram Desmotabs 0.2mg tablets | 30 tablet P £29.43 DT = £23.52 Solution for injection ▶DDAVP (Ferring Pharmaceuticals Ltd) Desmopressin acetate 4 microgram per 1 ml DDAVP 4micrograms/1ml solution for injection ampoules | 10 ampoule P £13.16 DT = £13.16 ▶Octim (Ferring Pharmaceuticals Ltd) Desmopressin acetate 15 microgram per 1 ml Octim 15micrograms/1ml solution for injection ampoules | 10 ampoule P £192.20 Spray ▶Desmopressin (Non-proprietary) Desmopressin acetate 10 microgram per 1 dose Desmopressin 10micrograms/dose nasal spray | 60 dose P £23.04 DT = £17.85 ▶Desmospray (Ferring Pharmaceuticals Ltd) Desmopressin acetate 2.5 microgram per 1 dose Desmospray 2.5micrograms/dose nasal spray | 50 dose s Desmopressin acetate 10 microgram per 1 dose Desmospray 10micrograms/dose nasal spray | 60 dose P £25.02 DT = £17.85 ▶Octim (Ferring Pharmaceuticals Ltd) Desmopressin acetate 150 microgram per 1 dose Octim 150micrograms/dose nasal spray | 25 dose P £576.60 DT = £576.60 Oral lyophilisate CAUTIONARY AND ADVISORY LABELS 26 ▶DDAVP Melt (Ferring Pharmaceuticals Ltd) Desmopressin (as Desmopressin acetate) 60 microgram DDAVP Melt 60microgram oral lyophilisates sugar-free | 100 tablet P £50.53 DT = £50.53 Desmopressin (as Desmopressin acetate) 120 microgram DDAVP Melt 120microgram oral lyophilisates sugar-free | 100 tablet P £101.07 DT = £101.07 Desmopressin (as Desmopressin acetate) 240 microgram DDAVP Melt 240microgram oral lyophilisates sugar-free | 100 tablet P Endocrine system £202.14 ▶DesmoMelt (Ferring Pharmaceuticals Ltd) Desmopressin (as Desmopressin acetate) 120 microgram DesmoMelt 120microgram oral lyophilisates sugar- free | 30 tablet P £30.34 DT = £30.34 Desmopressin (as Desmopressin acetate) 240 microgram DesmoMelt 240microgram oral lyophilisates sugar- free | 30 tablet P £60.68 DT = £60.68 ▶Noqdirna (Ferring Pharmaceuticals Ltd) Desmopressin (as Desmopressin acetate) 25 microgram Noqdirna 25microgram oral lyophilisates sugar-free | 30 tablet P £15.16 DT = £15.16 Desmopressin (as Desmopressin acetate) 50 microgram Noqdirna 50microgram oral lyophilisates sugar-free | 30 tablet P £15.16 DT = £15.16 Nasal drops ▶DDAVP (Ferring Pharmaceuticals Ltd) Desmopressin acetate 100 microgram per 1 ml DDAVP 100micrograms/ml intranasal solution | 2.5 ml P £9.72 DT = £9.72
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Hyponatraemic convulsions Patients being treated for primary nocturnal enuresis should be warned to avoid fluid Endocrine system overload (including during swimming) and to stop taking desmopressin during an episode of vomiting or diarrhoea (until fluid balance normal). Medicines for Children leaflet: Desmopressin for bedwetting www.medicinesforchildren.org.uk/desmopressin-bedwetting-0
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Initially 10 micrograms 2–3 times a
First-line fragment. Read the complete Indications and Dose section above.
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Initially 50 micrograms 2–3 times a
First-line fragment. Read the complete Indications and Dose section above.
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Initially 100 micrograms 2–3 times a
First-line fragment. Read the complete Indications and Dose section above.
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Initially 100 micrograms 3 times a day;
First-line fragment. Read the complete Indications and Dose section above.
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Initially 60 micrograms 3 times a day,
First-line fragment. Read the complete Indications and Dose section above.
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Initially 60 micrograms 3 times a day, adjusted
First-line fragment. Read the complete Indications and Dose section above.
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Initially 2.5–5 micrograms 1–2 times
First-line fragment. Read the complete Indications and Dose section above.
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Initially 5–20 micrograms 1–2 times a
First-line fragment. Read the complete Indications and Dose section above.
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Initially 10–20 micrograms 1–2 times
First-line fragment. Read the complete Indications and Dose section above.
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10–40 micrograms daily in 1–2 divided doses
First-line fragment. Read the complete Indications and Dose section above.
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1–4 micrograms daily
First-line fragment. Read the complete Indications and Dose section above.
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200 micrograms once daily, only
First-line fragment. Read the complete Indications and Dose section above.
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200 micrograms once daily, only
First-line fragment. Read the complete Indications and Dose section above.
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120 micrograms once daily, increased
First-line fragment. Read the complete Indications and Dose section above.
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120 micrograms once daily, increased
First-line fragment. Read the complete Indications and Dose section above.
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Dose to be adjusted according to urine
First-line fragment. Read the complete Indications and Dose section above.
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Dose to be adjusted according to urine
First-line fragment. Read the complete Indications and Dose section above.
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25 micrograms daily, to be taken 1 hour before
First-line fragment. Read the complete Indications and Dose section above.
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50 micrograms daily, to be taken 1 hour before
First-line fragment. Read the complete Indications and Dose section above.
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20 micrograms, limit fluid intake to 500 mL from
First-line fragment. Read the complete Indications and Dose section above.
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2 micrograms for 1 dose, limit fluid intake to
First-line fragment. Read the complete Indications and Dose section above.
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10–20 micrograms once daily, to be
First-line fragment. Read the complete Indications and Dose section above.
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40 micrograms, empty bladder at time of
First-line fragment. Read the complete Indications and Dose section above.
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2 micrograms, empty bladder at time of
First-line fragment. Read the complete Indications and Dose section above.
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300 micrograms every 12 hours if required, one
First-line fragment. Read the complete Indications and Dose section above.
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300 nanograms/kg for 1 dose, to be administered
First-line fragment. Read the complete Indications and Dose section above.
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300 micrograms, blood to be sampled after
First-line fragment. Read the complete Indications and Dose section above.
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300 nanograms/kg for 1 dose, blood to be
First-line fragment. Read the complete Indications and Dose section above.
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(consult product literature)
First-line fragment. Read the complete Indications and Dose section above.
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