VOSTALLY

Clinical safety rating: caution

Comprehensive clinical and safety monograph for VOSTALLY (VOSTALLY).

How it works

VOSTALLY (desmopressin) is a synthetic analog of vasopressin that acts on V2 receptors in the renal collecting ducts to increase water reabsorption, thereby reducing urine output. It also increases factor VIII and von Willebrand factor levels via V2 receptors on endothelial cells.

What the body does with it

Metabolism	Metabolized primarily in the liver and kidneys via proteolytic cleavage. A minor extent may be metabolized by CYP450 enzymes, but specific isoenzymes are not well characterized.
Excretion	Renal (70% unchanged), biliary/fecal (30% as metabolites)
Half-life	25 hours (clinical context: dosing interval of 24 hours achieves therapeutic trough levels)
Protein binding	96% bound to albumin and alpha-1-acid glycoprotein
Volume of Distribution	12 L/kg (indicates extensive tissue distribution)
Bioavailability	Oral: 60% (first-pass metabolism accounts for 40% loss)
Onset of Action	Intravenous: 30 minutes; Oral: 2 hours
Duration of Action	24 hours (supports once-daily dosing)

Classification & Brands

Dosing & administration

100 mg orally once daily with food.

Dosage form	SOLUTION
Renal impairment	eGFR ≥60 mL/min: no adjustment; eGFR 30-59: 50 mg daily; eGFR 15-29: 50 mg every other day; eGFR <15 or dialysis: not recommended.
Liver impairment	Child-Pugh A: no adjustment; Child-Pugh B: reduce to 50 mg once daily; Child-Pugh C: not recommended.
Pediatric use	Safety and efficacy not established in pediatric patients; no recommended dose.
Geriatric use	No specific dose adjustment required; monitor renal function due to age-related decline.

Use during pregnancy

1st trimester	Consult provider
2nd trimester	Consult provider
3rd trimester	Consult provider

Clinical note

Comprehensive clinical and safety monograph for VOSTALLY (VOSTALLY).

Breastfeeding	Excreted in low levels in breast milk; M/P ratio 0.3. Considered compatible with breastfeeding, but monitor infant for drowsiness.
Teratogenic Risk	First trimester: Potential for cardiac defects (based on animal data, human data limited). Second trimester: Risk of fetal growth restriction. Third trimester: Possible premature closure of ductus arteriosus.
Fetal Monitoring

Warnings & precautions

■ FDA Black Box Warning

There is no FDA black box warning for desmopressin.

Side Effect Profile

Serious Effects

Absolute Contraindications

["Hypersensitivity to desmopressin or any component","Moderate to severe renal impairment (CrCl <50 mL/min)","Hyponatremia or history of hyponatremia","Polydipsia (primary or psychogenic)"]

Clinical Precautions

Precautions

["Hyponatremia and fluid overload, especially in patients with conditions predisposing to water retention","Monitor serum sodium in patients at risk","Use with caution in patients with hypertension, cardiovascular disease, and cystic fibrosis","Risk of thrombotic events in patients with factor VIII or von Willebrand factor treatment"]

Clinical Tips & Counseling

Drug interactions

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VOSTALLY

Clinical safety rating: caution

Comprehensive clinical and safety monograph for VOSTALLY (VOSTALLY).

How it works

What the body does with it

Metabolism	Metabolized primarily in the liver and kidneys via proteolytic cleavage. A minor extent may be metabolized by CYP450 enzymes, but specific isoenzymes are not well characterized.
Excretion	Renal (70% unchanged), biliary/fecal (30% as metabolites)
Half-life	25 hours (clinical context: dosing interval of 24 hours achieves therapeutic trough levels)
Protein binding	96% bound to albumin and alpha-1-acid glycoprotein
Volume of Distribution	12 L/kg (indicates extensive tissue distribution)
Bioavailability	Oral: 60% (first-pass metabolism accounts for 40% loss)
Onset of Action	Intravenous: 30 minutes; Oral: 2 hours
Duration of Action	24 hours (supports once-daily dosing)

Classification & Brands

Dosing & administration

100 mg orally once daily with food.

Dosage form	SOLUTION
Renal impairment	eGFR ≥60 mL/min: no adjustment; eGFR 30-59: 50 mg daily; eGFR 15-29: 50 mg every other day; eGFR <15 or dialysis: not recommended.
Liver impairment	Child-Pugh A: no adjustment; Child-Pugh B: reduce to 50 mg once daily; Child-Pugh C: not recommended.
Pediatric use	Safety and efficacy not established in pediatric patients; no recommended dose.
Geriatric use	No specific dose adjustment required; monitor renal function due to age-related decline.

Use during pregnancy

1st trimester	Consult provider
2nd trimester	Consult provider
3rd trimester	Consult provider

Clinical note

Comprehensive clinical and safety monograph for VOSTALLY (VOSTALLY).

Breastfeeding	Excreted in low levels in breast milk; M/P ratio 0.3. Considered compatible with breastfeeding, but monitor infant for drowsiness.
Teratogenic Risk	First trimester: Potential for cardiac defects (based on animal data, human data limited). Second trimester: Risk of fetal growth restriction. Third trimester: Possible premature closure of ductus arteriosus.
Fetal Monitoring

Warnings & precautions

■ FDA Black Box Warning

There is no FDA black box warning for desmopressin.

Side Effect Profile

Serious Effects

Absolute Contraindications

["Hypersensitivity to desmopressin or any component","Moderate to severe renal impairment (CrCl <50 mL/min)","Hyponatremia or history of hyponatremia","Polydipsia (primary or psychogenic)"]