ADH Analogue Pregnancy: B

Desmopressin (Paediatric)

Brand names: DesmoMelt, DDAVP, Desmospray

Adult dose

Dose: See separate desmopressin entry

Route: Various

Frequency: Per indication

Refer to main desmopressin entry for adult dosing.

Paediatric dose

Route: Oral, sublingual, or intranasal

Frequency: Once at night (enuresis)

Nocturnal enuresis (>5 years): oral 200mcg at bedtime, increase to 400mcg if no response after 2 weeks. Sublingual (DesmoMelt): 120mcg, increase to 240mcg. Intranasal: 20–40mcg at night. Restrict fluid 1h before and 8h after dose.

Clinical pearls

CRITICAL: fluid restriction 1 hour before and 8 hours after each dose — prevents hyponatraemia
Hyponatraemic seizures reported — risk highest when used with concurrent illness (fever, vomiting, diarrhoea)
STOP during febrile illness, vomiting, or diarrhoea — fluid balance disrupted
DesmoMelt sublingual: most convenient for children — dissolves on tongue without water
Success rate ~70% — stop and reassess after 3 months of no effect

Contraindications

Polydipsia
Hyponatraemia
Cardiac failure
Age <5 years for enuresis

Side effects

Hyponatraemia (water intoxication — SERIOUS)
Headache
Nausea
Abdominal cramps
Seizures (hyponatraemia)

Interactions

NSAIDs — increased hyponatraemia risk
Antiepileptics (carbamazepine, valproate) — increased ADH effect

Monitoring

Serum sodium (if illness, prolonged use, or symptoms)
Fluid balance
Symptom response (enuresis diary)

Reference: BNFc; NICE Enuresis in Children CG111; ICCS Enuresis Guidelines 2020. Verify against your local formulary and the latest BNF before prescribing.

Curated clinical cross-links plus same-class fallbacks.

Calculators

Drugs

Desmopressin · ADH Analogue

Pathways