Makindo Medical Notes

📖 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