DESMODA
Clinical safety rating: caution
Comprehensive clinical and safety monograph for DESMODA (DESMODA).
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. |
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 | Consult provider |
| 2nd trimester | Consult provider |
| 3rd trimester | Consult provider |
Clinical note
Comprehensive clinical and safety monograph for DESMODA (DESMODA).
| Breastfeeding | Excreted in breast milk. M/P ratio not established. Avoid breastfeeding due to potential for serious adverse reactions (e.g., folate deficiency, kernicterus) in the infant. |
| 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 |
■ FDA Black Box Warning
No FDA black box warning.
| Serious Effects |
["Hypersensitivity to desmopressin or any component","Moderate to severe renal impairment (CrCl <50 mL/min)","Hyponatremia or history of hyponatremia","Primary polydipsia","Patients on diuretics or other drugs that increase risk of hyponatremia"]
| 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"] |
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| 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. |