Vasopressin analogue / Haemostatic Pregnancy: Caution when prescribing in pregnancy; blood pressure monitoring recommended (increased risk of pre-eclampsia). Limited data (n=53 diabetes insipidus pregnancies) indicate rare malformations; animal studies show no direct harmful effects. Breast-feeding: amounts transferred to child considerably less than needed to influence diuresis — not considered necessary to stop breastfeeding.

Desmopressin (DDAVP)

Brand names: Octim, DDAVP, Desmomelt, DesmoMelt

A synthetic analogue of antidiuretic hormone (vasopressin) used to treat cranial diabetes insipidus, nocturnal enuresis, nocturia, and certain bleeding disorders.

Auto-extracted from the source labelling — not yet independently clinician-verified. These values were distilled from the UK SPC (or the US label where noted) but have not had a clinician sign-off. Confirm against the current SmPC before prescribing.

Adult dose

Dose: Primary nocturnal enuresis: 120 micrograms at bedtime (initial); may increase to 240 micrograms if insufficiently effective. Diabetes insipidus: total daily dose usually 120–720 micrograms; suitable starting dose 60 micrograms three times daily

Route: Sublingual (place tablet under tongue to dissolve; no water needed)

Frequency: Nocturnal enuresis: once at bedtime. Diabetes insipidus: three times daily (maintenance for most patients 60–120 micrograms three times daily)

Max: Nocturnal enuresis: 240 micrograms at bedtime. Diabetes insipidus: total daily dose normally up to 720 micrograms

Doses are for the sublingual tablet formulation. NOCTURNAL ENURESIS: fluid restriction must be observed; intended for treatment periods up to 3 months, then reassess with ≥1 week off; discontinue if no adequate clinical effect within 4 weeks of appropriate titration; interrupt if signs of water retention/hyponatraemia. DIABETES INSIPIDUS: dose is individual and titrated to response. Post-hypophysectomy polyuria/polydipsia: dose controlled by urine osmolality measurement. Initiation of treatment not recommended in patients over 65 years. Food may reduce intensity/duration of antidiuretic effect at low doses.

Dose adjustments

Renal

Contraindicated in moderate and severe renal insufficiency (creatinine clearance below 50 ml/min). In chronic renal disease the antidiuretic effect is less than normal.

Dose auto-extracted from UK Summary of Product Characteristics (SPC) via the eMC; US FDA prescribing information (openFDA / DailyMed) — cross-check; US labelling may differ from UK — not yet clinician-verified. Always confirm against the product SmPC and your local formulary before prescribing.

Contraindications

Hypersensitivity to desmopressin or any excipient
Known or suspected cardiac insufficiency and other conditions requiring treatment with diuretics (enuresis indication)
Should only be used in patients with normal blood pressure (enuresis indication)
Habitual or psychogenic polydipsia (urine production >40 ml/kg/24 h) and alcohol abuse
Should not be prescribed to patients over the age of 65 (enuresis indication)
Moderate and severe renal insufficiency (creatinine clearance below 50 ml/min)
Known hyponatraemia
Syndrome of inappropriate ADH secretion (SIADH)

Side effects

Hyponatraemia (most serious; with headache, nausea, vomiting, weight gain, malaise, abdominal pain, muscle cramps, dizziness, confusion; severe cases convulsions/coma)
Headache
Abdominal pain, nausea, vomiting, diarrhoea
Somnolence
Hypertension

Interactions

Substances known to induce SIADH (tricyclic antidepressants, SSRIs, chlorpromazine, carbamazepine) and sulfonylureas particularly chlorpropamide — additive antidiuretic effect, increased risk of water retention/hyponatraemia
NSAIDs may induce water retention and/or hyponatraemia
Loperamide may cause a 3-fold increase in desmopressin plasma concentrations, increasing risk of water retention/hyponatraemia

Clinical monograph

How it works

Desmopressin selectively activates renal V2 receptors to increase water reabsorption in the collecting ducts, concentrating urine, and also raises plasma factor VIII and von Willebrand factor.

Prescribing in practice

The most important safety point is the risk of dilutional hyponatraemia and water intoxication; fluid intake must be restricted around dosing and the drug used with caution wherever fluid or electrolyte balance is disturbed.
Withhold during acute intercurrent illness with vomiting or diarrhoea, or any condition causing fluid and electrolyte imbalance, and avoid in significant cardiac failure or conditions requiring diuretics.
Risk of hyponatraemia is higher in the elderly and young children, so additional caution applies in these groups.

Monitoring

Monitor serum sodium, fluid balance, and body weight, especially when starting or up-titrating and in those at higher risk of hyponatraemia.

Counselling the patient

Limit your fluid intake from shortly before until several hours after each dose, as advised.
Stop the medicine and seek advice if you develop headache, nausea, vomiting, weight gain, or confusion.
Pause treatment during any illness causing vomiting, diarrhoea, or fever until reviewed.

Evidence & guidelines

Desmopressin is the established first-line treatment for cranial diabetes insipidus, with the MHRA having issued warnings on the risk of severe hyponatraemia.

Reference: UKHCDO Guidelines; Drug verified in RxNorm (NLM); confirm dosing against the manufacturer SPC (eMC). Verify against your local formulary and current prescribing references before prescribing. The structured dose values shown have been reviewed by a clinician. Monograph status: clinician-reviewed (2026-07-04).

Curated clinical cross-links plus same-class fallbacks.

Pathways