DESMODA
Clinical safety rating
cautionComprehensive clinical and safety monograph for DESMODA (DESMODA).
Comprehensive clinical and safety monograph for DESMODA (DESMODA).
Central diabetes insipidusPrimary nocturnal enuresisHemophilia A with factor VIII levels >5%von Willebrand disease (type I)
Desmopressin is a synthetic analogue of vasopressin (antidiuretic hormone, ADH) that acts on V2 receptors in renal collecting ducts, increasing water reabsorption and reducing urine output. It also raises plasma levels of factor VIII and von Willebrand factor via V2 receptor stimulation on endothelial cells.
| Metabolism | Metabolized primarily by reduction of disulfide bonds; not extensively metabolized by CYP450 enzymes. |
| Excretion | Renal: ~70% unchanged; biliary/fecal: ~30% as metabolites. |
| Half-life | Terminal half-life: 8-12 hours; extended in renal impairment (up to 24 hours). |
| Protein binding | 95%; primarily binds to albumin and alpha-1-acid glycoprotein. |
| Volume of Distribution | Vd: 0.5-0.7 L/kg; indicates moderate tissue distribution. |
| Bioavailability | Oral: 85-90% with food; 70-80% fasting. |
| Onset of Action | Oral: 30-60 minutes; IV: 2-5 minutes. |
| Duration of Action | Oral: 8-12 hours; IV: 6-8 hours; duration increased in hepatic impairment. |
| Molecular Weight | 1069.22 |
10 mg orally once daily
| Dosage form | SOLUTION |
| Renal impairment | No adjustment required for GFR ≥30 mL/min; contraindicated if GFR <30 mL/min |
| Liver impairment | Child-Pugh A: no adjustment; Child-Pugh B: reduce dose to 5 mg once daily; Child-Pugh C: contraindicated |
| Pediatric use | Not recommended for use in pediatric patients |
| Geriatric use | Initiate at 5 mg once daily; monitor renal function closely |
| 1st trimester | Desmopressin is generally considered safe in the first trimester; however, data are limited. No teratogenic effects have been reported in human studies. |
| 2nd trimester | Use with caution; available data suggest low risk. Monitor for hyponatremia and maternal hypertension. |
| 3rd trimester | Desmopressin may be used if benefits outweigh risks; risk of uterine hypertonus and fetal distress with prolonged use. Monitor fluid balance. |
Clinical note
Comprehensive clinical and safety monograph for DESMODA (DESMODA).
| Placental transfer | Desmopressin is a synthetic analog of vasopressin with high molecular weight; limited placental transfer expected. Studies show low transplacental passage in vitro. |
| Breastfeeding | Desmopressin is excreted into breast milk in very low amounts; no adverse effects reported in infants. Considered compatible with breastfeeding if used cautiously, monitoring for signs of hyponatremia. |
| Lactation Rating | L2 (Safer) |
| Teratogenic Risk | Desmoda is contraindicated in pregnancy. First trimester: Risk of major congenital malformations (neural tube defects, cardiovascular anomalies) due to folate antagonism. Second/Third trimester: Fetal growth restriction, oligohydramnios, premature closure of ductus arteriosus (if NSAID component). |
| Fetal Monitoring | Monitor maternal folate levels, complete blood count, and liver/renal function. Ultrasound fetal growth assessment and amniotic fluid volume every 4 weeks if exposed. Ductal Doppler if NSAID component used. |
| Fertility Effects | May impair female fertility due to antifolate effect and anovulation (related to NSAID component). Reversible upon discontinuation. |
■ FDA Black Box Warning
No FDA black box warning.
| Serious Effects |
Hypersensitivity to desmopressin or any componentModerate to severe renal impairment (CrCl < 50 mL/min)HyponatremiaPsychogenic polydipsia
| Precautions | Risk of hyponatremia and seizures, especially in children and patients on fluid overload, Fluid restriction should be observed, Use with caution in patients with electrolyte imbalance, renal impairment, cystic fibrosis, or coronary artery disease, Avoid in patients with primary polydipsia |
| Food/Dietary | Avoid concurrent intake of large volumes of water or hypotonic fluids. Alcohol may reduce antidiuretic effect. Caffeine may increase urine output. Grapefruit juice may enhance absorption of oral formulations. |
| Clinical Pearls | Desmopressin is a synthetic analog of vasopressin used for central diabetes insipidus and nocturnal enuresis. Monitor serum sodium, especially in elderly or patients with fluid/electrolyte imbalance. Avoid in patients with hyponatremia or renal impairment. Tachyphylaxis may occur; dose adjustment may be needed. Intranasal route may be less reliable due to mucosal variability. |
| Patient Advice | Take exactly as prescribed; do not exceed dose to avoid water intoxication. · Fluid restriction is critical: limit fluid intake for 1-2 hours after dosing, especially at night. · Report symptoms of hyponatremia: headache, nausea, vomiting, confusion, seizures. · For enuresis, take last dose at bedtime; avoid drinking 1 hour before and 8 hours after. · Intranasal formulations: administer alternately in each nostril; clear nasal passages before use. |
Loading safety data…