Vasopressin Analogue V2 (Antidiuretic/Haemostatic) Pregnancy: Data on a limited number of exposed pregnancies (diabetes insipidus) indicate rare cases of malformations; caution advised when prescribing; blood pressure monitoring recommended due to increased risk of pre-eclampsia. Breastfeeding need not be stopped.

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.

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: Diabetes insipidus: total daily sublingual dose normally in the range 120 micrograms to 720 micrograms; suitable starting dose 60 micrograms three times daily

Route: Sublingual

Frequency: Three times daily (starting regimen)

Max: Diabetes insipidus total daily dose normally up to 720 micrograms/day sublingually

IMPORTANT: this source is the UK SPC for 'Desmopressin 240 microgram sublingual tablets', which covers ONLY primary nocturnal enuresis and diabetes insipidus. It contains NO surgical haemostasis / platelet dysfunction / bleeding-prophylaxis posology — the haemostatic indication (typically a weight-based IV/subcutaneous or high-concentration intranasal dose) is NOT present in this labelling and cannot be verified from this source — clinician to source the surgical/haemostasis dose from the appropriate parenteral desmopressin SPC. Doses transcribed here are the diabetes insipidus and enuresis regimens only: diabetes insipidus starting dose 60 micrograms three times daily sublingually, adjusted to response, maintenance 60–120 micrograms three times daily; nocturnal enuresis 120 micrograms at bedtime, may increase up to 240 micrograms with fluid restriction.

Dose adjustments

Renal

Contraindicated in moderate and severe renal insufficiency (creatinine clearance below 50 ml/min); no dose adjustment stated for hepatic impairment

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 diuretic agents
Habitual or psychogenic polydipsia (urine production exceeding 40 ml/kg/24 hours) and alcohol abuse
Should not be prescribed to patients over 65 years (enuresis)
Moderate and severe renal insufficiency (creatinine clearance below 50 ml/min)
Known hyponatraemia
Syndrome of inappropriate ADH secretion (SIADH)

Side effects

Hyponatraemia (most serious; headache, nausea, vomiting, decreased serum sodium, weight increase, malaise, muscle cramps, and in severe cases convulsions and coma)
Headache
Abdominal pain, nausea, vomiting, diarrhoea
Hypertension
Peripheral oedema, fatigue

Interactions

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

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).

Curated clinical cross-links plus same-class fallbacks.

Calculators

Pathways