• PO, SL, SC, IV, Intranasal: Central diabetes insipidus caused by a deficiency of vasopressin.
• IV: Bleeding in certain types of hemophilia and von Willebrand’s disease.
• Intranasal, SL: Nocturia due to nocturnal polyuria in patients who awaken ≥2 times per night to void (Nocdurna only)
• PO, SL: Primary nocturnal enuresis.

Contraindicated in:

• Hypersensitivity
• Hypersensitivity to chlorobutanol
• Patients with severe type I, type IIB, or platelet-type (pseudo) von Willebrand’s disease, hemophilia A with factor VIII levels <5%, or hemophilia B
• Renal impairment (CCr <50 mL/min)
• Current or a history of hyponatremia
• Polydipsia (Nocdurna only)
• Concurrent use with loop diuretics or systemic/inhaled glucocorticoids (Nocdurna only)
• Known or suspected syndrome of inappropriate antidiuretic hormone secretion (Nocdurna only)
• Conditions that can lead to electrolyte or fluid imbalances, including gastroenteritis, salt-wasting nephropathies, or infection (Nocdurna only)
• HF (New York Heart Association class II-IV) (Nocdurna only)
• Uncontrolled hypertension (Nocdurna only)
• OB: Nocdurna not recommended for treatment of nocturia in pregnancy.

Use Cautiously in:

• Angina pectoris
• Hypertension
• Patients at risk for hyponatremia
• Patients at risk for ↑ intracranial hypertension (Nocdurna only)
• Urinary retention (Nocdurna only)
• Women (↑ risk of hyponatremia; require ↓ dose) (Nocdurna only)
• Patients who require use of other intranasal medications
• Pedi: Safety and effectiveness not established in children (Nocdurna only)
• Geri: Appears on Beers list. ↑ risk of hyponatremia in older adults. Avoid use for treatment of nocturia or nocturnal polyuria in older adults..

CV: edema, hypertension, hypotension, tachycardia (large IV doses only).

Derm: flushing.

EENT: intranasal: epistaxis, nasal congestion, nasal discomfort, rhinitis, sneezing.

F and E: HYPONATREMIA.

GI: dry mouth, mild abdominal cramps, nausea.

GU: vulval pain.

Local: phlebitis at IV site.

MS: back pain.

Neuro: dizziness, drowsiness, headache, listlessness., SEIZURES.

Resp: dyspnea.

Drug-Drug:

• Loop diuretics, systemic glucocorticoids, or inhaled glucocorticoids ↑ risk of severe hyponatremia; concurrent use with Nocdurna contraindicated
• Carbamazepine, chlorpromazine, lamotrigine, NSAIDs, opioids, SSRIs, sulfonylureas, TCAs, or thiazide diuretics may ↑ risk of fluid retention and hyponatremia.
• Demeclocycline, lithium, or norepinephrine may diminish the antidiuretic response to desmopressin.
• Large doses may enhance the effects of vasopressors.

(Generic available)

• Tablets: 0.1 mg; 0.2 mg;
• Sublingual tablet (Nocdurna): 27.7 mcg; 55.3 mcg; 60 mcg; 120 mcg;
• Nasal spray : 10 mcg/spray in 5-mL bottle (contains 50 sprays);
• Solution for injection: 4 mcg/mL; 15 mcg/mL;

Primary Nocturnal Enuresis

• PO (Adults and Children ≥6 yr): 0.2 mg at bedtime; may be titrated up to 0.6 mg at bedtime to achieve desired response.
• SL (Adults and Children): 120 mcg 1 hr before bedtime; may be titrated up to 360 mcg at bedtime to achieve desired response.

Diabetes Insipidus

• PO (Adults and Children): 0.05 mg twice daily; adjusted as needed (usual range: 0.1–1.2 mg/day for adults or 0.1–0.8 mg/day for children in 2–3 divided doses).
• SL (Adults and Children): 60 mcg 3 times daily; adjusted as needed (usual range: 120–720 mcg/day in 2–3 divided doses).
• Intranasal (Adults and Children ≥12 yr): DDAVP: 5–40 mcg (0.0.05–0.4 mL) in 1–3 divided doses.
• Intranasal (Children 3 mo–12 yr): DDAVP: 5–30 mcg (0.05–0.3 mL) in 1–2 divided doses.
• SC, IV (Adults and Children ≥12 yr): 2–4 mcg/day in 2 divided doses.
• SC, IV (Children <12 yr): 0.1–1 mcg/day in 1–2 divided doses.

Hemophilia A/von Willebrand's Disease

• IV (Adults and Children >3 mo): 0.3 mcg/kg, repeated as needed.

Nocturia

• SL (Adults): Women: 27.7 mcg 1 hr before bedtime; Men: 55.3 mcg 1 hr before bedtime.

DDAVP, Nocdurna

• An analogue of naturally occurring vasopressin (antidiuretic hormone). Primary action is enhanced reabsorption of water in the kidneys.

• Prevention of nocturnal enuresis.
• Reduction in number of episodes of nocturia.
• Maintenance of appropriate body water content in diabetes insipidus.
• Control of bleeding in certain types of hemophilia or von Willebrand’s disease.

Therapeutic Classification: hormones

Pharmacologic Classification: antidiuretic hormones

Absorption: <1% absorbed following oral or SL administration; nasal solution 10–20% absorbed; nasal spray 3–4% absorbed.

Distribution: Distribution not fully known.

Metabolism/Excretion: Primarily excreted in urine.

Half-life: PO: 1.5–2.5 hr; SL: 2.8 hr; IV: 75 min (↑ in renal impairment); Intranasal: 1.8–3.5 hr.

Bipazen, DDAVP Melt, Octostim

(PO, intranasal = antidiuretic effect; IV = effect on factor VIII activity)

†4–24 hr in mild hemophilia A.

• Explain purpose of desmopressin to patient.
• Advise patient to notify health care professional if bleeding is not controlled or if headache, dyspnea, heartburn, nausea, abdominal cramps, vulval pain, or severe nasal congestion or irritation occurs.
  • Caution patient to avoid concurrent use of alcohol with this medication.
  • Instruct patient to notify health care professional of all Rx or OTC medications, vitamins, or herbal products being taken and to consult with health care professional before taking other medications.
• Advise females of reproductive potential to notify health care professional if pregnancy is planned or suspected or if breastfeeding.
• Diabetes Insipidus:
  • If nasal spray is used, prime pump prior to first use by pressing down 4 times. Caution patient that nasal spray should not be used beyond the labeled number of sprays; subsequent sprays may not deliver accurate dose. Do not attempt to transfer remaining solution to another bottle.
  • Instruct patient to take missed doses as soon as remembered but not if it is almost time for the next dose. Do not double doses.
  • Advise patient that rhinitis or upper respiratory infection may decrease effectiveness of this therapy. If increased urine output occurs, patient should contact health care professional for dose adjustment.
  • Patients with diabetes insipidus should carry identification at all times describing disease process and medication regimen.
• Nocturia: Instruct patient to place tablet under tongue 1 hr before bedtime and empty bladder immediately before bedtime.
  • Advise patient to limit fluid intake before bedtime and to avoid caffeine and alcohol before bedtime.
  • Advise patient to notify health care professional immediately if signs and symptoms of hyponatremia (headache, feeling restless, drowsiness, muscle cramps, nausea or vomiting, fatigue, dizziness, change in mental condition [hallucinations, confusion, decreased awareness or alertness] occur.
  • Instruct patient to notify health care professional if fever, infection, or diarrhea occurs. May need to hold medication.

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