ClinCalc Pro
Menu
Calculators Drugs Pathways AI Dx Donate Get the App
Vasopressin Analogue V2 (Antidiuretic/Haemostatic) Pregnancy: Use with caution — DDAVP crosses placenta minimally; used in pregnancy for haemostasis in vWD type 1; neonatal hyponatraemia monitoring required; discuss benefit/risk with haematologist

Desmopressin (Surgical — Haemostasis/Platelet Dysfunction)

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

Adult dose

Dose: Surgical haemostasis/vWD type 1/mild haemophilia A: 0.3 mcg/kg IV (max 24 mcg) in 50 mL saline over 30 minutes; may repeat once after 12–24 hours (tachyphylaxis after 2nd dose); intranasal Octim: 150 mcg each nostril (300 mcg total) 2h pre-procedure
Route: IV / Intranasal
Frequency: Single dose pre-procedure (repeat once maximum — tachyphylaxis)
Max: 24 mcg IV; 300 mcg intranasal
Releases vWF and FVIII from endothelial cells (Weibel-Palade bodies) via V2 receptor → 3–5× increase in vWF and FVIII within 30–60 min. Used in mild haemophilia A, vWD type 1, uremic platelet dysfunction, platelet storage pool disease. NOT effective in vWD type 2B (may worsen) or type 3 (no endothelial stores).

Paediatric dose

Dose: 0.3 mcg/kg
Route: IV over 30 minutes
Frequency: Single dose; may repeat after 12–24 hours (max 2 doses)
Max: 24 mcg per dose
Children ≥1 year: 0.3 mcg/kg IV. Fluid restriction essential in young children (hyponatraemia risk). BNFc: avoid in children <1 year or body weight <10 kg (hyponatraemia risk).

Dose adjustments

Renal

Useful specifically IN renal failure for uremic platelet dysfunction — DDAVP transiently improves platelet function in uraemia by releasing vWF. No dose reduction needed for effect; monitor for fluid retention (reduced urine output from V2 activation).

Hepatic

Use with caution in hepatic failure — fluid retention risk; monitor sodium.

Paediatric weight-based calculator

Children ≥1 year: 0.3 mcg/kg IV. Fluid restriction essential in young children (hyponatraemia risk). BNFc: avoid in children <1 year or body weight <10 kg (hyponatraemia risk).

Clinical pearls

  • Uremic platelet dysfunction: DDAVP 0.3 mcg/kg IV shortens bleeding time in dialysis patients with platelet dysfunction (mechanism: releases stored vWF → improves platelet adhesion); effect lasts 4–8 hours; useful bridge pre-procedure in renal failure patients with abnormal platelet function
  • Tachyphylaxis after 2nd dose: endothelial Weibel-Palade bodies depleted of vWF after 2–3 doses; subsequent doses ineffective for 48–72 hours while stores replenish; plan surgery timing to avoid third dose without benefit
  • MHRA hyponatraemia warning (neonates): desmopressin is CONTRAINDICATED in children <1 year and body weight <10 kg due to severe hyponatraemia risk — immature renal tubular response leads to severe water retention; adult patients should also restrict fluid intake to 500–750 mL for 8 hours post-dose

Contraindications

  • vWD type 2B (paradoxical thrombocytopenia — vWF releases ultra-large multimers that consume platelets)
  • Known DDAVP tachyphylaxis (after 2–3 consecutive doses)
  • Hyponatraemia
  • Severe cardiac failure
  • Habitual or psychogenic polydipsia

Side effects

  • Hyponatraemia (V2 anti-diuretic effect — serious in young children and elderly; restrict fluid intake for 8 hours post-dose)
  • Fluid retention
  • Facial flushing (vasodilation)
  • Tachycardia
  • Nausea
  • Tachyphylaxis (after 2–3 doses — endothelial vWF stores exhausted)

Interactions

  • NSAIDs (reduce V2-mediated antidiuretic effect — reduced haemostatic response with some NSAIDs)
  • Tricyclics and SSRIs (increase antidiuretic effect — hyponatraemia risk)

Monitoring

  • Serum sodium (at baseline and 4–8 hours post-dose)
  • Urine output and fluid balance
  • FVIII and vWF levels pre and post (haematology cases)
  • Blood pressure (facial flushing / BP changes during IV infusion)
  • Platelet count (exclude vWD type 2B before use)

Reference: BNFc; BNF 90; UKHCDO Guidelines on vWD Management 2014; BNFc; MHRA Drug Safety Update (desmopressin hyponatraemia); BCSH Guidelines on Perioperative Management of Anticoagulation and Antiplatelet Therapy 2016. Verify against your local formulary and the latest BNF before prescribing.

Related

Curated clinical cross-links plus same-class fallbacks.

Calculators
Pathways