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Vasopressin Analogue V2 (Antidiuretic/Haemostatic) Pregnancy: §4.6: data on a limited number (n=53) of exposed pregnancies in women with diabetes insipidus indicate rare cases of malformations in children treated during pregnancy; no other relevant epidemiological data are available. Animal studies do not indicate direct or indirect harmful effects with respect to pregnancy, embryonal/foetal development, parturition or postnatal development. Caution should be exercised when prescribing to pregnant women; blood pressure monitoring is recommended due to the increased risk of pre-eclampsia. Lactation: analyses of milk from nursing mothers receiving 300 micrograms desmopressin intranasally indicate that the amounts that may be transferred to the child are considerably less than the amounts required to influence diuresis or haemostasis.

Desmopressin (Surgical — Haemostasis/Platelet Dysfunction)

Brand names: DDAVP, Desmopressin Acetate, Octim (intranasal)

Desmopressin is a synthetic vasopressin analogue used in the surgical setting to improve haemostasis in mild haemophilia A, von Willebrand disease and certain platelet dysfunctions, including uraemic and antiplatelet-related bleeding.

Adult dose

Dose: Mild to moderate haemophilia (raising Factor VIII:C) or von Willebrand's disease, in patients undergoing surgery or following trauma: 0.3 micrograms per kilogram body weight by intravenous infusion or subcutaneous injection, given immediately prior to surgery or following trauma. For intravenous infusion, dilute the dose in 50 mL of 0.9% sodium chloride for injection and give over 20 minutes. Further doses may be given at 12 hourly intervals so long as cover is required.
Route: Intravenous infusion (diluted in 50 mL of 0.9% sodium chloride over 20 minutes) or subcutaneous injection
Frequency: Single dose immediately before surgery or after trauma; further doses 12-hourly while cover is required, but not beyond 2 days of ongoing bleeding (tachyphylaxis)
Indication and product match: the pinned product is Octim Injection (eMC product 111); its §4.1 is 'to increase Factor VIII:C and Factor VIII:Ag in patients with mild to moderate haemophilia or von Willebrand's disease undergoing surgery or following trauma' (plus a fibrinolytic response test, not dosed here), which fits this surgical-haemostasis page. Routes/uses NOT covered by this card: the intranasal route listed on the page, and uraemic platelet dysfunction - the SPC does not license either, and states that Octim Injection does not reduce prolonged bleeding time in thrombocytopenia. No maximum dose in micrograms is printed. Some patients show a diminishing response to successive doses, so continue to monitor Factor VIII levels; desmopressin should not be administered for haemostatic support beyond 2 days of ongoing bleeding because prolonged use is associated with tachyphylaxis and diminished efficacy. Factor VIII rises are dependent on basal levels and are normally between 2 and 5 times the pre-treatment levels; if no result from a previous administration is available, take blood pre-dose and 20 minutes post-dose for Factor VIII assay. During intravenous administration vasodilation may occur with decreased blood pressure, tachycardia and facial flushing. Unless contraindicated, when surgery is undertaken tranexamic acid may be given orally at the recommended dose from 24 hours beforehand until healing is complete. Maintain fluid and electrolyte balance: treatment without concomitant reduction of fluid intake may lead to fluid retention and/or hyponatraemia; restrict fluid intake to the least possible and check body weight regularly.

Paediatric dose

Dose: 0.3 micrograms per kilogram body weight by intravenous infusion or subcutaneous injection (the SPC states the dose for adults, children and infants is the same); for intravenous infusion dilute in 50 mL of 0.9% sodium chloride and give over 20 minutes.
Route: Intravenous infusion or subcutaneous injection
Frequency: Single dose immediately before surgery or after trauma; further doses 12-hourly while cover is required, not beyond 2 days of ongoing bleeding
Printed in §4.2 for mild to moderate haemophilia and von Willebrand's disease; no neonate-specific dose is printed and none is given here. §4.4: infants, the elderly and patients with serum sodium in the lower range of normal may have an increased risk of hyponatraemia - restrict fluid intake and check body weight regularly.

Dose adjustments

Renal

No dose reduction is stated. §4.4: precautions must be taken in moderate and severe renal insufficiency (creatinine clearance below 50 mL/min) because the antidiuretic effect could be prolonged, which increases the risk of hyponatraemia if fluid restriction is not strictly followed.

Hepatic

No hepatic dose adjustment is stated. Desmopressin is unlikely to interact with medicines affecting hepatic metabolism, as it shows no significant hepatic metabolism in in vitro studies with human microsomes (formal in vivo interaction studies have not been performed).

Dose independently re-sourced from UK Summary of Product Characteristics (SPC) via the eMC; US FDA prescribing information (openFDA / DailyMed) — cross-check; US labelling may differ from UK — clinician-reviewed. Always confirm against the product SmPC and your local formulary before prescribing.

Contraindications

  • Hypersensitivity to the active substance or to any of the excipients
  • Habitual or psychogenic polydipsia (urine production exceeding 40 mL/kg/24 hours)
  • History of unstable angina and/or known or suspected cardiac insufficiency and other conditions requiring treatment with diuretics
  • Known hyponatraemia
  • Syndrome of inappropriate ADH secretion (SIADH)
  • Von Willebrand's disease type II B

Side effects

  • Hyponatraemia (the most frequently reported adverse reaction post-marketing) - may cause headache, nausea, vomiting, weight increase, malaise, abdominal pain, muscle cramps, dizziness, confusional state, decreased consciousness and, in severe cases, brain oedema, hyponatraemic encephalopathy, convulsions and coma
  • Serious hypersensitivity reactions including anaphylactic/anaphylactoid shock
  • Headache, dizziness, nausea, abdominal pain, fatigue
  • Transient fall in blood pressure with reflex tachycardia and facial flushing at the time of intravenous administration (haematological indications, high dose)
  • Venous and arterial thromboembolic events (deep vein thrombosis, cerebral thrombosis, pulmonary embolism, acute myocardial infarction, ischaemic stroke) reported mainly with the high-dose haematological indications, in patients with risk factors for thrombosis or atherosclerotic disease
  • Urticaria and pruritus

Interactions

  • Drugs affecting water and/or sodium homeostasis - opioids, SSRIs, tricyclic antidepressants, NSAIDs, chlorpromazine, carbamazepine and some sulfonylurea antidiabetics - concurrent use increases the risk of fluid retention/hyponatraemia
  • Diuretic agents - measures to prevent fluid overload must be taken (use is contraindicated where diuretic treatment is required for cardiac insufficiency)
  • In patients on chronic therapy with drugs affecting water and/or sodium homeostasis, give only after confirmation of normal baseline sodium

Monitoring

  • Factor VIII levels: pre-dose and 20 minutes post-dose if no prior desmopressin response is available, and continue monitoring because response can diminish with successive doses
  • Fluid and electrolyte balance and body weight regularly; if weight rises gradually, serum sodium falls below 130 mmol/L or plasma osmolality below 270 mOsm/kg, reduce fluid intake drastically and interrupt administration
  • Blood pressure and heart rate during intravenous infusion (vasodilation, hypotension, tachycardia, flushing)
  • Consider thrombosis risk before use in patients with risk factors for, or a history of, thrombosis, atherosclerotic cardiovascular or cerebrovascular disease or angioplasty
  • Interrupt or carefully adjust treatment during acute intercurrent illness with fluid/electrolyte imbalance (systemic infection, fever, gastroenteritis) and in excessive bleeding
  • Precautions in patients at risk of raised intracranial pressure, and in moderate or severe renal insufficiency (creatinine clearance below 50 mL/min)

Clinical monograph

How it works

It releases stored von Willebrand factor and factor VIII from endothelium and enhances platelet adhesion, transiently improving primary haemostasis.

Prescribing in practice

  • It has an antidiuretic effect and can cause dilutional hyponatraemia and seizures, so restrict fluid intake and monitor sodium, with particular caution in young children and the elderly.
  • Tachyphylaxis occurs with repeated dosing as factor stores deplete, limiting its usefulness for prolonged bleeding.
  • Use cautiously in cardiovascular disease because of fluid retention and rare thrombotic events, and avoid in type 2B von Willebrand disease.

Monitoring

Monitor serum sodium, fluid balance, blood pressure and the haemostatic response when used to cover surgery or bleeding.

Counselling the patient

  • Limit how much you drink for the period advised after the dose to protect your salt levels.
  • Report headache, nausea, confusion or drowsiness promptly.

Evidence & guidelines

Its haemostatic use is established in haemophilia and von Willebrand disease management guidelines and supported by long-standing clinical use.

Reference: UKHCDO Guidelines on vWD Management 2014; MHRA Drug Safety Update (desmopressin hyponatraemia); BCSH Guidelines on Perioperative Management of Anticoagulation and Antiplatelet Therapy 2016; 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).

Related

Curated clinical cross-links plus same-class fallbacks.

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