Vasopressin Analogue
Pregnancy: B
Desmopressin (Nocturnal Polyuria)
Brand names: DDAVP, Desmomelt, Noqdirna
Adult dose
Dose: 25–100 micrograms (oral lyophilisate) or 0.1–0.4 mg (tablet)
Route: sublingual or oral
Frequency: once nightly
Max: 100 micrograms sublingual or 0.4 mg oral
Sex-differentiated dosing: men 25–100 micrograms sublingual; women 25–50 micrograms; avoid fluid intake 1h before and 8h after; check sodium before and at 3 days
Paediatric dose
Route: oral/sublingual/intranasal
Frequency: once nightly
Max: 200 micrograms intranasal for enuresis
Enuresis: 20 micrograms intranasal or 0.2 mg oral at bedtime; restrict fluids from 1h before to 8h after dose
Dose adjustments
Renal
Avoid if eGFR <50 ml/min (hyponatraemia risk)
Hepatic
Use with caution
Clinical pearls
- MHRA alert: hyponatraemia can be fatal — check sodium before initiation and after 3 days
- Restrict fluid to minimum for 8h after dose — mandatory counselling
- Women require lower doses than men (pharmacokinetic difference); Noqdirna 25 mcg licensed specifically for women
Contraindications
- Habitual polydipsia
- Cardiac insufficiency
- Hyponatraemia
- eGFR <50 ml/min
- SIADH
Side effects
- Hyponatraemia (potentially fatal)
- Headache
- Nausea
- Fluid retention
- Seizures (if hyponatraemia)
Interactions
- NSAIDs (hyponatraemia)
- Tricyclics (increase antidiuretic effect)
- Loop diuretics (reduce effect)
Monitoring
- Serum sodium (before, day 3, then periodically)
- Fluid balance
- Blood pressure
Reference: BNFc; BNF 86; MHRA Drug Safety Update 2019; NICE NG123. Verify against your local formulary and the latest BNF before prescribing.
Related
Curated clinical cross-links plus same-class fallbacks.
Drugs