Desmopressin (DDAVP)
📖 About
Always check the BNF link here before prescribing.
- 💉 Desmopressin (DDAVP) is a synthetic analogue of ADH (vasopressin).
- 🫗 Promotes water reabsorption in renal collecting ducts → reduces urine output.
- 🩸 Has additional haemostatic effects by ↑ release of Factor VIII and von Willebrand factor (vWF).
⚙️ Mode of Action
- Acts on renal collecting duct V2 receptors → ↑ aquaporin-2 channel insertion → ↑ water retention.
- Stimulates endothelial release of Factor VIII and vWF → improves haemostasis.
📋 Indications
- 💧 Cranial Diabetes Insipidus (DI).
- 🛏️ Primary nocturnal enuresis in children/adolescents.
- 🩸 Haemophilia A (if baseline Factor VIII >5%).
- 🧬 Von Willebrand disease (types 1 and some type 2 variants).
- Perioperative haemostatic support in mild bleeding disorders.
💊 Dose (examples – check BNF/local guidelines)
- Subcutaneous (S/C): 1–2 mcg every 12–24 h.
- Nasal spray: 10–20 mcg BD–TDS (bottle = 50 sprays of 10 mcg).
- Oral: 100–400 mcg BD–TDS.
💡 Dose varies with indication and formulation – always confirm in the BNF.
🔄 Interactions
- 📉 Hyponatraemia risk ↑ with SSRIs, TCAs, NSAIDs, and carbamazepine (all enhance ADH effect).
- ⚠️ Avoid concomitant excessive fluid intake → worsens hyponatraemia risk.
⛔ Contraindications
- Creatinine clearance <50 mL/min (renal impairment).
- Existing hyponatraemia.
- Psychogenic polydipsia (risk of severe water intoxication).
⚠️ Side Effects
- 💧 Hyponatraemia (water intoxication) – rare but potentially life-threatening (confusion, seizures).
- 🧠 Headache, flushing, mild abdominal pain, nausea.
- 🌙 Nasal congestion or rhinitis (with spray formulation).
📝 Clinical Pearls
- Always restrict fluid intake (avoid overhydration) when on desmopressin.
- Monitor serum sodium, especially in elderly patients or those on interacting drugs.
- Used in perioperative settings for patients with mild haemophilia A or vWD undergoing minor surgery.
- Children on desmopressin for enuresis should be advised to avoid evening fluids.
📚 Refer
