ClinCalc Pro
Menu
Calculators Drugs Pathways AI Dx Donate Get the App
Haemostasis Pregnancy: Caution — desmopressin used in pregnancy for DI; hyponatraemia risk; consult haematology for vWD management in pregnancy

Desmopressin

Brand names: DDAVP, Octim, Stimate

Adult dose

Dose: 0.3 mcg/kg IV in 50 mL sodium chloride 0.9%
Route: IV (also intranasal 150–300 mcg, SC)
Frequency: Single dose; may repeat once at 12–24 hours (tachyphylaxis after 2nd dose)
Max: 20 mcg per dose
Infuse IV dose over 20–30 minutes. Intranasal: 150 mcg (1 spray) if under 50 kg, 300 mcg (2 sprays) if 50 kg and above. Restrict fluids for 24 hours after to prevent hyponatraemia

Paediatric dose

Dose: 0.3 mcg/kg mcg/kg
Route: IV or intranasal
Frequency: Single dose
Max: 20 mcg
Under 3 months: very high hyponatraemia risk — extreme caution; Central DI: 0.1–0.4 mcg/day IV in divided doses

Dose adjustments

Renal

eGFR under 30: use with extreme caution — risk of severe hyponatraemia; monitor sodium closely

Hepatic

No specific adjustment

Paediatric weight-based calculator

Under 3 months: very high hyponatraemia risk — extreme caution; Central DI: 0.1–0.4 mcg/day IV in divided doses

Clinical pearls

  • Mechanism: synthetic vasopressin analogue — V2 receptor agonist (renal tubular water reabsorption) + releases vWF and factor VIII from Weibel-Palade bodies in endothelial cells; minimal V1 (vascular) activity unlike vasopressin
  • Emergency haemostasis indications: mild haemophilia A (factor VIII above 5%), Type I vWD, uraemic bleeding (from platelet dysfunction), reversal of antiplatelet effect prior to urgent surgery
  • TACHYPHYLAXIS: vWF/factor VIII stores in endothelial cells are depleted after 1–2 doses — subsequent doses produce diminishing responses; wait 48–72 hours between treatments; if more doses needed, switch to factor concentrates
  • MHRA — HYPONATRAEMIA: fatal cases reported in children and elderly — MANDATORY fluid restriction for 24 hours after use; measure serum sodium at baseline and 4–8 hours after; avoid in patients who are polyuric or cannot restrict fluids
  • Uraemic bleeding: desmopressin 0.3 mcg/kg IV is standard pre-operative treatment — shortens bleeding time within 1 hour; effect lasts 4–8 hours; conjugated oestrogens are longer-acting alternative
  • Central DI: desmopressin replaces absent ADH — do NOT confuse doses: haemostasis dose (0.3 mcg/kg) vs DI dose (0.1–0.4 mcg/day) are very different

Contraindications

  • Type IIB or platelet-type von Willebrand disease (causes thrombocytopenia)
  • Cardiac failure
  • Psychogenic polydipsia (profound hyponatraemia risk)
  • Syndrome of inappropriate ADH secretion (SIADH)
  • Hyponatraemia

Side effects

  • Hyponatraemia — MOST IMPORTANT — can be severe and life-threatening, especially in children
  • Fluid retention
  • Headache
  • Flushing, vasodilation, hypotension
  • Tachyphylaxis after 2nd dose (factor VIII and vWF stores depleted)
  • Nausea

Interactions

  • NSAIDs and carbamazepine (increase antidiuretic effect — increase hyponatraemia risk)
  • Chlorpropamide (enhances antidiuretic effect)
  • Demeclocycline (antagonises desmopressin — used for SIADH treatment)

Monitoring

  • Serum sodium at baseline and 4–8 hours post-dose (hyponatraemia monitoring — mandatory)
  • Fluid intake and urine output
  • Factor VIII and vWF levels (haemostasis response)
  • Blood pressure (hypotension risk during IV infusion)
  • Platelet count (in vWD — confirm not type IIB before giving)

Reference: BNFc; BNF 90; UKHCDO Guidelines for vWD; MHRA DSU 2017 (hyponatraemia); BSH Guidelines on haemophilia. Verify against your local formulary and the latest BNF before prescribing.

Related

Curated clinical cross-links plus same-class fallbacks.

Calculators
Pathways