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Vasopressin analogue / Haemostatic Pregnancy: Use only if essential. May be used for haemostasis — monitor fluid balance.

Desmopressin (DDAVP)

Brand names: Octim, DDAVP, Desmomelt, DesmoMelt

Adult dose

Dose: Mild haemophilia A / VWD type 1: 0.3 micrograms/kg IV (max 24 micrograms); intranasal 300 micrograms (Octim)
Route: IV (over 30 min), SC, or intranasal (concentrated 150 micrograms/spray)
Frequency: Every 12–24 hours; response diminishes with repeated doses (tachyphylaxis after 2–3 doses)
Max: 24 micrograms IV
Mild haemophilia A / VWD Type 1: 0.3 micrograms/kg IV in 50 mL saline over 30 min. Check DDAVP responsiveness (FVIII/VWF:RCo) before use in VWD. Avoid in VWD type 2B (can worsen thrombocytopenia).

Paediatric dose

Dose: 0.3 mcg/kg
Route: IV or intranasal
Frequency: Every 12–24 hours
Max: 24 micrograms IV
Concentration: 4 mcg/ml
Haemostasis: 0.3 micrograms/kg IV over 30 min. Nocturnal enuresis (≥5 years): 200–400 micrograms oral at night (Desmomelt) or 20 micrograms intranasal. Restrict fluid intake for 8 hours after dose.

Dose adjustments

Renal

Contraindicated if eGFR <50 for nocturnal enuresis (hyponatraemia risk).

Hepatic

No specific adjustment required.

Paediatric weight-based calculator

Haemostasis: 0.3 micrograms/kg IV over 30 min. Nocturnal enuresis (≥5 years): 200–400 micrograms oral at night (Desmomelt) or 20 micrograms intranasal. Restrict fluid intake for 8 hours after dose.

Clinical pearls

  • DDAVP test dose advised before surgical use to confirm FVIII/VWF response
  • Avoid repeated doses within 24 hours — tachyphylaxis
  • Restrict fluid to 1 L for 8 hours post-dose (hyponatraemia prevention)
  • Octim nasal spray (150 micrograms/spray) different from standard desmopressin nasal spray — do not interchange
  • Effective for mild haemophilia A and VWD type 1 without needing factor concentrates

Contraindications

  • VWD type 2B and type 3
  • Cardiac failure or other conditions requiring diuretics
  • Habitual or psychogenic polydipsia
  • Hyponatraemia
  • Renal impairment (eGFR <50 for enuresis indication)

Side effects

  • Hyponatraemia (dilutional — particularly with excessive fluid intake)
  • Headache and flushing
  • Nausea
  • Hypotension (IV)
  • Tachyphylaxis with repeat dosing

Interactions

  • NSAIDs and tricyclic antidepressants — increase risk of hyponatraemia
  • Carbamazepine, chlorpropamide — enhance antidiuretic effect (hyponatraemia risk)

Monitoring

  • Serum sodium (before and 4–8h after dose)
  • Blood pressure
  • Fluid balance
  • FVIII and VWF:RCo levels (for haemostatic use)

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

Related

Curated clinical cross-links plus same-class fallbacks.

Pathways