Desmopressin (Paediatric)

How it works

It acts on renal V2 receptors to increase water reabsorption in the collecting ducts, concentrating urine, and additionally raises plasma factor VIII and von Willebrand factor.

Prescribing in practice

• The key paediatric hazard is hyponatraemic water intoxication and seizures, so fluid intake must be restricted around dosing and the drug withheld during vomiting, diarrhoea or other fluid balance disturbance.
• Avoid in children with habitual or psychogenic polydipsia and use cautiously in those with conditions predisposing to fluid or electrolyte imbalance.
• For nocturnal enuresis avoid fluids from shortly before until the morning after a dose and use a children's formulary for route and frequency.

Monitoring

Monitor for signs of fluid overload and hyponatraemia, with periodic review of weight and serum sodium especially when treatment is prolonged or during intercurrent illness.

Counselling the patient

• Limit drinks in the evening and stop the medicine if the child is unwell with vomiting or diarrhoea.
• Seek help urgently for headache, nausea, drowsiness or fits, which may indicate low sodium.
• Take the dose at the time advised, typically before bedtime for bedwetting.

Evidence & guidelines

NICE guidance supports desmopressin as a first-line option for managing nocturnal enuresis in children, with hyponatraemia recognised as the principal safety concern.