DDAVP
Clinical safety rating
cautionComprehensive clinical and safety monograph for DDAVP (DDAVP).
Comprehensive clinical and safety monograph for DDAVP (DDAVP).
Central diabetes insipidusNocturnal enuresisHemophilia Avon Willebrand disease (type I)
Synthetic analog of vasopressin; primarily activates V2 receptors in renal collecting ducts, increasing water reabsorption and concentrating urine.
| Metabolism | Not significantly metabolized; primarily renal excretion. |
| Excretion | Primarily renal (unchanged drug); >90% eliminated by kidneys. |
| Half-life | Terminal elimination half-life: 2-3 hours (intravenous); 3.4-4.4 hours (oral); clinical context: antidiuretic effect persists longer (6-20 hours) due to receptor binding. |
| Protein binding | 50%; binding proteins: predominantly albumin. |
| Volume of Distribution | 0.3 L/kg; indicates distribution primarily in extracellular fluid. |
| Bioavailability | Intranasal: 10-20%; oral: 0.1-0.5% (sublingual tablets); subcutaneous: 100% (absolute bioavailability). |
| Onset of Action | Intranasal: 15-30 minutes; intravenous: 15-30 minutes; oral: 30-60 minutes; subcutaneous: 15-30 minutes. |
| Duration of Action | Dose-dependent; antidiuretic effect: 6-20 hours for intranasal, 6-12 hours for intravenous, 8-12 hours for oral; hemostatic effect: 4-8 hours for intravenous or high-dose intranasal. |
| Molecular Weight | 1069.2 |
Central diabetes insipidus: 0.1-0.4 mg orally every 12-24 hours or 0.5-1 mcg subcutaneously/intranasally every 12-24 hours. Nocturnal enuresis: 0.2-0.4 mg orally at bedtime. Hemophilia A/von Willebrand disease: 0.3 mcg/kg intravenous over 15-30 minutes or 300 mcg subcutaneously or 150 mcg intranasally (for >50 kg).
| Dosage form | TABLET |
| Renal impairment | Not recommended if GFR <50 mL/min; use with caution if GFR 50-90 mL/min. No standard dose adjustment available; risk of water intoxication increases in renal impairment. |
| Liver impairment | No dose adjustment recommended based on Child-Pugh class. Use with caution in severe hepatic impairment due to potential for fluid overload. |
| Pediatric use | Central diabetes insipidus: 0.05-0.1 mg orally every 12-24 hours (titrate). Nocturnal enuresis: 0.2-0.4 mg orally at bedtime (age ≥6 years). Hemophilia A/vWD: 0.3 mcg/kg intravenous over 15-30 minutes; intranasal dose: 150 mcg (if ≤50 kg) or 300 mcg (if >50 kg); subcutaneous: 0.3 mcg/kg. |
| Geriatric use | Start at lower end of dosing range (e.g., 0.1 mg orally once daily). Monitor serum sodium and fluid balance closely due to increased risk of hyponatremia and renal impairment. |
| 1st trimester | Use only if clearly needed. No well-controlled studies in humans; some animal studies show adverse effects at high doses. Avoid in women with preeclampsia due to risk of water intoxication. |
| 2nd trimester | Caution advised; may cause uterine contractions at high doses. Use only if potential benefit justifies risk. |
| 3rd trimester | Contraindicated in preeclampsia and during labor due to risk of water intoxication and hyponatremia. May cause neonatal hyponatremia if used near term. |
Clinical note
Comprehensive clinical and safety monograph for DDAVP (DDAVP).
| Placental transfer | Limited placental transfer; small amounts cross the placenta. Fetal exposure is minimal at therapeutic doses. |
| Breastfeeding | Desmopressin is excreted into breast milk in minimal amounts and is not expected to cause adverse effects in nursing infants. Use with caution, especially if high maternal fluid intake is required. |
| Lactation Rating | L1 (Compatible) |
| Teratogenic Risk | Category B: No evidence of teratogenicity in animal studies. Insufficient human data for first trimester; risk cannot be excluded. Second and third trimester: No reported fetal harm, but avoid in preeclampsia due to antidiuretic effect. |
| Fetal Monitoring | Monitor serum sodium, urine output, and blood pressure. In pregnancy, assess for uterine contractions (oxytocic effect at high doses) and fetal heart rate if used for diabetes insipidus. |
| Fertility Effects | No known adverse effects on fertility. May be used in women with central diabetes insipidus without impairing reproductive function. |
■ FDA Black Box Warning
None
| Serious Effects |
HyponatremiaModerate to severe renal impairment (CrCl <50 mL/min)PreeclampsiaActive labor (risk of water intoxication)Known hypersensitivity to desmopressin
| Precautions | Risk of hyponatremia, Fluid intake restriction to avoid water intoxication, Seizures in severe hyponatremia, Cardiovascular disease caution (hypertension, coronary artery disease) |
| Food/Dietary | Avoid excessive water intake while on DDAVP. Do not consume grapefruit or grapefruit juice, as it may affect drug metabolism. Limit caffeine intake due to diuretic effects that could counteract DDAVP. Avoid high-sodium foods that may increase thirst and fluid intake. |
| Clinical Pearls | DDAVP (desmopressin) is a synthetic analog of vasopressin with selective V2 receptor activity, minimizing vasoconstrictor effects. Administer intranasally for central diabetes insipidus; IV for hemophilia A and von Willebrand disease (type I). Monitor serum sodium closely, especially in elderly and young children, due to risk of hyponatremia and water intoxication. Avoid in patients with habitual psychogenic polydipsia. Can be used for nocturnal enuresis, but restrict fluid intake 1 hour before and 8 hours after dose to prevent hyponatremia. |
| Patient Advice | Take DDAVP exactly as prescribed; do not increase dose without consulting your doctor. · Limit fluid intake while using DDAVP to avoid severe low sodium levels (hyponatremia). · Monitor for symptoms of hyponatremia: headache, nausea, vomiting, confusion, lethargy, muscle cramps. · For nasal spray, do not blow nose for 30 minutes after administration. · Report any weight gain, persistent headache, or change in urination pattern to your healthcare provider. · Do not drink alcohol, as it may increase the risk of hyponatremia. · Store at room temperature; protect from light and moisture. |
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