Vasopressin Analogue — Haemostasis / Haemophilia A / vWD
Pregnancy: Use with caution — limited data; used for obstetric haemostasis in vWD/haemophilia under haematology guidance
Desmopressin (DDAVP)
Brand names: Octim, DDAVP, Desmospray
Adult dose
Dose: Haemostasis (surgical): 0.3 micrograms/kg IV over 20–30 minutes OR 300 micrograms intranasally; vWD type 1 / mild haemophilia A: same dose
Route: IV slow infusion, subcutaneous, or intranasal
Frequency: Single dose (surgical); may repeat at 12–24 hour intervals (tachyphylaxis develops)
Max: 20 micrograms IV (cap at 20–24 micrograms regardless of weight to avoid severe hyponatraemia)
Releases endogenous vWF and factor VIII from endothelial stores (Weibel-Palade bodies) — useful in mild haemophilia A and vWD type 1. Tachyphylaxis after 2–3 doses (stores depleted). Restrict fluid after IV dose to prevent dilutional hyponatraemia. Avoid in children <2 years and in hyponatraemia.
Paediatric dose
Dose: 0.3 micrograms/kg IV mcg/kg
Route: IV or intranasal
Frequency: Single dose (haemostasis)
Max: 20 micrograms IV
BNFc: avoid in children <2 years (risk of severe hyponatraemia); use with strict fluid restriction
Dose adjustments
Renal
Avoid if CrCl <30 mL/min — risk of severe hyponatraemia and fluid retention
Hepatic
Use with caution
Paediatric weight-based calculator
BNFc: avoid in children <2 years (risk of severe hyponatraemia); use with strict fluid restriction
Clinical pearls
- Mechanism: V2 receptor agonist — releases pre-formed vWF and Factor VIII from endothelial Weibel-Palade bodies; no new synthesis required — hence tachyphylaxis after 2–3 doses
- vWD type 2B contraindication: vWF released is abnormal and hyperactive — causes platelet aggregation and worsens thrombocytopaenia paradoxically
- Fluid restriction mandatory post-IV dose: max 500–750 mL/24 hours to prevent hyponatraemia — particularly important in elderly and children
- Platelet function disorders (aspirin-induced, uraemic): desmopressin shortens bleeding time by releasing vWF — used perioperatively in patients on antiplatelet drugs
- Intranasal 300 mcg (Octim) achieves haemostatic plasma levels — 10× concentration of standard nasal spray; used for mild haemophilia A home treatment
Contraindications
- Hyponatraemia
- Psychogenic polydipsia
- Habitual or psychogenic polydipsia
- Cardiac insufficiency requiring diuretics
- Children <2 years (IV/SC haemostatic doses)
- vWD type 2B (causes platelet aggregation — worsens thrombocytopaenia)
Side effects
- Hyponatraemia (dilutional — SIADH-like)
- Facial flushing
- Headache
- Nausea
- Tachycardia
- Hypotension
- Fluid retention
- Seizures (hyponatraemia-related)
Interactions
- Indomethacin/NSAIDs — potentiate antidiuretic effect, increase hyponatraemia risk
- Carbamazepine, SSRIs — enhance antidiuretic effect
- Chlorpropamide — potentiates desmopressin
Monitoring
- Serum sodium (2–4 hours post-dose and at 24 hours)
- Fluid intake and urine output
- Blood pressure
- vWF and Factor VIII levels (haemophilia/vWD — confirm response)
- Platelet count (vWD — rule out type 2B)
Reference: BNFc; BNF 90; UK Haemophilia Centre Doctors Organisation (UKHCDO) Guidelines; NICE NG24; BSH vWD Guidelines. Verify against your local formulary and the latest BNF before prescribing.
Related
Curated clinical cross-links plus same-class fallbacks.