DESMOPRESSIN ACETATE (NEEDS NO REFRIGERATION)
Clinical safety rating: safe
Other drugs that may increase the risk of water intoxication and hyponatremia Can cause hyponatremia and water intoxication monitor sodium levels.
Synthetic analog of vasopressin (antidiuretic hormone) that acts on V2 receptors in renal collecting ducts to increase water reabsorption, reducing urine output. Also transiently increases factor VIII and von Willebrand factor via V2 receptor activation on endothelium.
| Metabolism | Primarily metabolized by plasma and renal peptidases; <1% excreted unchanged in urine. |
| Excretion | Renal: >90% unchanged drug excreted in urine via glomerular filtration and tubular secretion. Fecal: negligible (<1%). |
| Half-life | Terminal elimination half-life: 2.8-3.6 hours (range 1.5-5 hours). Prolonged in renal impairment (up to 8-10 hours) and in infants. |
| Protein binding | Approximately 50% bound to plasma proteins (mainly albumin). |
| Volume of Distribution | 0.3-0.5 L/kg (adults); higher in neonates and children (up to 1.0 L/kg). Indicates distribution primarily in extracellular fluid. |
| Bioavailability | Oral: 0.16% (extremely low due to extensive gastrointestinal degradation); Intranasal: 3-5% (range 2-10%); Subcutaneous: 85-100%; Intravenous: 100%. |
| Onset of Action | Intravenous: 15-30 minutes; Intranasal: 30-60 minutes; Oral: 1-2 hours; Subcutaneous: 30-60 minutes. |
| Duration of Action | Intravenous: 6-8 hours; Intranasal: 8-12 hours (antidiuretic effect); Oral: 6-12 hours; Subcutaneous: 8-12 hours. Duration may be extended in renal impairment. |
Central diabetes insipidus: 0.1-0.4 mL (10-40 mcg) intranasally once or twice daily. Nocturnal enuresis: 20-40 mcg intranasally at bedtime. IV dosing for central diabetes insipidus: 2-4 mcg once daily subcutaneously or intravenously.
| Dosage form | SPRAY, METERED |
| Renal impairment | No specific dose adjustment for GFR 30-50 mL/min; caution. For GFR <30 mL/min: contraindicated or reduce dose by 50% and monitor for hyponatremia. Not recommended if eGFR <10 mL/min. |
| Liver impairment | No specific Child-Pugh based dose adjustment; use with caution due to possible fluid retention. No formal studies available. |
| Pediatric use | Nocturnal enuresis: 3-12 years: 10-20 mcg intranasally at bedtime; max 40 mcg. Weight-based: 0.2-2 mcg/kg/day orally divided 1-2 times. Central diabetes insipidus: 0.025-0.1 mL (2.5-10 mcg) intranasally once or twice; or IV 0.5-1 mcg/kg/day. |
| Geriatric use | Start at low end of dosing (e.g., 0.1 mL intranasally once daily) due to higher risk of hyponatremia; monitor serum sodium frequently. Avoid in patients with renal impairment or fluid overload. |
| 1st trimester | Consult provider |
| 2nd trimester | Consult provider |
| 3rd trimester | Consult provider |
Clinical note
Other drugs that may increase the risk of water intoxication and hyponatremia Can cause hyponatremia and water intoxication monitor sodium levels.
| FDA category | Animal |
| Breastfeeding | Present in breast milk in small amounts. Milk/plasma ratio not established. No adverse effects reported in infants. Compatible with breastfeeding; avoid excessive maternal doses. Monitor infant for water retention, hyponatremia. |
| Teratogenic Risk | FDA Category B. No evidence of teratogenicity in animal studies; limited human data. First trimester: no increased risk of major malformations from case series. Second/third trimester: use only for diabetes insipidus; associated with preterm contractions if used for enuresis. Avoid high doses near term due to possible uterine hyperstimulation. |
■ FDA Black Box Warning
No FDA black box warning.
| Common Effects | enuresis |
| Serious Effects |
["Hypersensitivity to desmopressin or any component","Moderate to severe renal impairment (eGFR <50 mL/min)","Hyponatremia or history of hyponatremia","Type IIB or platelet-type von Willebrand disease","Active coronary artery disease or hypertension requiring treatment"]
| Precautions | ["Avoid fluid overload, especially in patients at risk for hyponatremia or seizures","Use with caution in patients with coronary artery disease or hypertension due to vasopressor effects","Monitor serum sodium and fluid balance","May cause thrombotic events (rare)"] |
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| Fetal Monitoring | Monitor maternal serum sodium, urine output, urine specific gravity, and blood pressure weekly. Fetal growth ultrasound every 4 weeks if used for diabetes insipidus. Assess for uterine contractions if used near term. Neonatal monitoring for hyponatremia and fluid balance after delivery. |
| Fertility Effects | No known direct effects on fertility. Used for diabetes insipidus, which itself may impair fertility if untreated; treatment may restore normal fertility. No impact on spermatogenesis or ovulation. |