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ADH Analogue Pregnancy: B

Desmopressin

Brand names: DDAVP, Desmospray, Noqdirna

Adult dose

Dose: Diabetes insipidus: intranasal 10–40 micrograms OD/BD or oral 100–800 mcg daily. Nocturia: 25–100 mcg oral (Noqdirna)
Route: Intranasal, Oral, or IV/SC
Frequency: Once or twice daily (DI); once at night (nocturia)
IV/SC for DI: 1–4 mcg BD. vWD/haemophilia: 0.3 mcg/kg IV over 30min (max 20 mcg). Do not repeat within 48h.

Paediatric dose

Dose: 0.3 mcg/kg
Route: IV
Max: 20mcg
For vWD/haemophilia: 0.3 mcg/kg over 30min. DI: intranasal 5–10 mcg/dose.
Paediatric weight-based calculator

For vWD/haemophilia: 0.3 mcg/kg over 30min. DI: intranasal 5–10 mcg/dose.

Clinical pearls

  • Risk of hyponatraemia: MUST restrict fluids to 500mL–1L/day with treatment
  • For haemostasis: repeat dose only after 48h (tachyphylaxis/vWF stores exhausted)
  • Intranasal bioavailability 3–4% — oral dose ~10× higher than intranasal
  • Differentiate central vs nephrogenic DI: water deprivation test with DDAVP challenge
  • Elderly: high risk of hyponatraemia — use nocturia formulations (low dose) with caution

Contraindications

  • Polydipsia (psychogenic)
  • Hyponatraemia
  • Cardiac failure
  • Syndrome of inappropriate ADH

Side effects

  • Hyponatraemia (fluid retention — SERIOUS)
  • Headache
  • Nausea
  • Fluid retention
  • Flushing (IV)

Interactions

  • NSAIDs, SSRIs, tricyclics — increased hyponatraemia risk
  • Carbamazepine — potentiates effect

Monitoring

  • Serum sodium (especially in first month)
  • Urine osmolality (in DI)
  • Fluid balance

Reference: BNFc; BNF; Haemophilia Society Guidelines. Verify against your local formulary and the latest BNF before prescribing.

Related

Curated clinical cross-links plus same-class fallbacks.

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