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Vasopressin Analogue — Haemostasis / Haemophilia A / vWD Pregnancy: No §4.6 pregnancy section was captured for the Octim Injection SPC in this bundle, so no UK injection-specific pregnancy statement is available here. The only pregnancy text in the bundle belongs to the US label for desmopressin acetate TABLETS (a different product, route and indication) and is reproduced for provenance only, verbatim: 'Pregnancy Category B ... There are, however, no adequate and well-controlled studies in pregnant women. Because animal studies are not always predictive of human response, this drug should be used during pregnancy only if clearly needed.' Confirm against the current UK SPC §4.6 and haematology advice before use in pregnancy.

Desmopressin (DDAVP)

Brand names: Octim, DDAVP, Desmospray

Desmopressin (DDAVP) is a synthetic vasopressin analogue used in the vascular and haematology setting to raise factor VIII and von Willebrand factor in mild haemophilia A and type 1 von Willebrand disease, as well as for diabetes insipidus and nocturnal enuresis.

Adult dose

Dose: 0.3 micrograms/kg body weight — mild to moderate haemophilia A and von Willebrand's disease. §4.2, verbatim: 'The dose for adults, children and infants is 0.3 micrograms per kilogram body weight, administered by subcutaneous injection or intravenous infusion.'
Route: Subcutaneous injection or intravenous infusion. §4.2, verbatim: 'For intravenous infusion, the dose should be diluted in 50ml of 0.9% sodium chloride for injection and given over 20 minutes.'
Frequency: A single dose given immediately before surgery or after trauma, repeatable 12-hourly while cover is needed. §4.2, verbatim: 'This dose should be given immediately prior to surgery or following trauma.' and 'Further doses may be administered at 12 hourly intervals so long as cover is required.'
maxDose is blank because §4.2 of this SPC states no absolute ceiling for the haemostatic dose — no 'maximum' figure of any kind appears in the bundle. Response wanes with repeat dosing: §4.2, verbatim: 'As some patients have shown a diminishing response to successive doses, it is recommended that monitoring of Factor VIII levels should continue.' Expected effect: 'Increase of Factor VIII levels are dependent on basal levels and are normally between 2 and 5 times the pre-treatment levels. If results from a previous administration of desmopressin are not available then blood should be taken pre-dose and 20 minutes post-dose for assay of Factor VIII levels in order to monitor response.' Adjunct: 'Unless contraindicated, when surgery is undertaken tranexamic acid may be given orally at the recommended dose from 24 hours beforehand until healing is complete.' Infusing over 20 minutes limits the vasodilator effect: 'During administration of intravenous desmopressin, vasodilation may occur resulting in decreased blood pressure and tachycardia with facial flushing in some patients.' Fluid must be restricted (§4.4): 'Fluid should not be forced, orally or parenterally, and patients should only take as much fluid as they require to satisfy thirst. Intravenous infusions should not be left up as a routine after surgery.' and 'If there is a gradual increase of the body weight, decrease of serum sodium to below 130mmol/l or plasma osmolality to below 270mOsm/kg, the fluid intake must be reduced drastically and the administration of OCTIM Injection interrupted.' §4.4 also notes: 'OCTIM Injection does not reduce prolonged bleeding time in thrombocytopenia.' A separate §4.2 use, fibrinolytic response testing, uses the same 0.3 micrograms/kg dose with a venous sample taken 20 minutes after administration; it is a diagnostic test, not this page's haemostatic indication.

Paediatric dose

Dose: 0.3 micrograms/kg
Route: Subcutaneous injection or intravenous infusion — for intravenous use diluted in 50 ml of sodium chloride 0.9% and given over 20 minutes
Frequency: Single dose immediately before surgery or after trauma; further doses may be given at 12-hourly intervals so long as cover is required
The same per-kilogram figure covers the whole age range in this SPC — §4.2, verbatim: 'The dose for adults, children and infants is 0.3 micrograms per kilogram body weight, administered by subcutaneous injection or intravenous infusion.' It is a per-dose (not per-day) figure, so it is applied unchanged to the weight calculator. maxDose is blank because this SPC states no paediatric absolute ceiling; concentration is null because no injection strength in mg/ml appears anywhere in the bundle, so no infusion volume can be calculated from this source — read the strength off the ampoule. Fluid overload is the principal paediatric hazard: §4.4, verbatim: 'When repeated doses are used to control bleeding in haemophilia or von Willebrand's disease, care should be taken to prevent fluid overload.' §4.8, verbatim: 'Very rare cases of emotional disorders including aggression in children have been reported.' and 'Treatment with desmopressin without concomitant reduction of fluid intake may lead to water retention/hyponatraemia with accompanying symptoms of headache, nausea, vomiting, weight gain, decreased serum sodium and in serious cases, convulsions.' Verify any paediatric use against a children's formulary and haematology advice.

Dose adjustments

Renal

No renal dose adjustment is stated in §4.2 of this SPC. §4.4, verbatim: 'Care should be taken with patients who have reduced renal function and/or cardiovascular disease.'

Hepatic

Not addressed — this bundle contains no hepatic-impairment posology or hepatic dose adjustment for desmopressin injection.

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.

Paediatric weight-based calculator

The same per-kilogram figure covers the whole age range in this SPC — §4.2, verbatim: 'The dose for adults, children and infants is 0.3 micrograms per kilogram body weight, administered by subcutaneous injection or intravenous infusion.' It is a per-dose (not per-day) figure, so it is applied unchanged to the weight calculator. maxDose is blank because this SPC states no paediatric absolute ceiling; concentration is null because no injection strength in mg/ml appears anywhere in the bundle, so no infusion volume can be calculated from this source — read the strength off the ampoule. Fluid overload is the principal paediatric hazard: §4.4, verbatim: 'When repeated doses are used to control bleeding in haemophilia or von Willebrand's disease, care should be taken to prevent fluid overload.' §4.8, verbatim: 'Very rare cases of emotional disorders including aggression in children have been reported.' and 'Treatment with desmopressin without concomitant reduction of fluid intake may lead to water retention/hyponatraemia with accompanying symptoms of headache, nausea, vomiting, weight gain, decreased serum sodium and in serious cases, convulsions.' Verify any paediatric use against a children's formulary and haematology advice.

Verify in a children's formulary

Contraindications

  • Habitual and psychogenic polydipsia (§4.3)
  • Unstable angina pectoris (§4.3)
  • Decompensated cardiac insufficiency (§4.3)
  • von Willebrand's Disease Type IIB — §4.3, verbatim: 'where the administration of desmopressin may result in pseudothrombocytopenia due to the release of abnormal clotting factors which cause platelet aggregation'
  • Fibrinolytic response testing must not be carried out in hypertension, heart disease, cardiac insufficiency, or other conditions requiring treatment with diuretic agents (§4.3)

Side effects

  • Headache (§4.8)
  • Stomach pain (§4.8)
  • Nausea (§4.8)
  • Water retention / hyponatraemia with headache, nausea, vomiting, weight gain and decreased serum sodium — convulsions in serious cases, where fluid intake is not reduced (§4.8)
  • Vasodilation during intravenous infusion causing decreased blood pressure and tachycardia with facial flushing — normally avoided by infusing over 20 minutes (§4.8)
  • Allergic skin reactions, and isolated more severe general allergic reactions (§4.8)
  • Emotional disorders including aggression in children — very rare (§4.8)

Monitoring

  • Factor VIII levels — pre-dose and 20 minutes post-dose to confirm response, and continued monitoring across successive doses because response diminishes (§4.2)
  • Body weight, plasma sodium or plasma osmolality to detect fluid accumulation; interrupt treatment and cut fluid intake if weight rises gradually, sodium falls below 130 mmol/l or osmolality below 270 mOsm/kg (§4.4)
  • Fluid intake — restricted to the least possible; fluid must not be forced orally or parenterally (§4.4)
  • Blood pressure — §4.4, verbatim: 'During administration of OCTIM Injection, it is recommended that the patient's blood pressure is monitored continuously.'

Clinical monograph

How it works

It is a selective V2 receptor agonist that promotes renal water reabsorption and triggers release of von Willebrand factor and factor VIII from endothelial stores, improving primary haemostasis.

Prescribing in practice

  • Its antidiuretic action can cause dilutional hyponatraemia and seizures, so fluid intake should be restricted around dosing and sodium monitored, with particular caution in young children and the elderly.
  • A test dose is used to confirm an adequate factor response before relying on it for haemostatic cover.
  • Avoid in unstable cardiovascular disease and in those with a history of hyponatraemia, and use cautiously with drugs that potentiate antidiuretic effect.

Monitoring

Monitor fluid balance, body weight and plasma sodium when used for its antidiuretic or haemostatic effect, and check the factor VIII or von Willebrand response when treating bleeding disorders.

Counselling the patient

  • Restrict your fluid intake around each dose as advised.
  • Report headache, nausea, confusion or undue drowsiness, which may signal low sodium.
  • Tachyphylaxis means repeated closely spaced doses become less effective.

Evidence & guidelines

Long-standing clinical experience and haemostasis guidelines support desmopressin for mild haemophilia A and type 1 von Willebrand disease where a documented response exists.

Reference: UK Haemophilia Centre Doctors Organisation (UKHCDO) Guidelines; NICE NG24; BSH vWD Guidelines; 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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