This is a posterior pituitary hormone.

Indications: diabetes insipidus; nocturnal enuresis; nocturia diagnostic procedures.

Cautions: heart failure, asthma, epilepsy, migraine; renal impairment, in cardiovascular disease and in hypertension, pregnancy; elderly (avoid for nocturnal enuresis and nocturia in those over 65 years); in cystic fibrosis; In nocturia and nocturnal enuresis limit fluid intake to minimum from 1 hour before dose until 8 hours afterwards; in nocturia periodic blood pressure and weight checks needed to monitor for fluid overload; Hyponatraemic convulsions.

Patients being treated for primary nocturnal enuresis should be warned to avoid fluid overload and to stop taking desmopressin during an episode of vomiting or diarrhoea (until fluid balance normal). The risk of hyponatraemic convulsions can also be minimised by keeping to the recommended starting doses and by avoiding concomitant use of drugs which increase secretion of vasopressin (e.g. tricyclic antidepressants).

Contra-indications: cardiac insufficiency and conditions treated with diuretics; psychogenic polydipsia and polydipsia due to alcohol dependence.

Side Effects: fluid retention, and hyponatraemia (in more serious cases with convulsions) on administration without restricting fluid intake; headache, nausea, vomiting, abdominal pain, fluid retention and swelling, allergic reactions, and emotional disturbance in children, epistaxis, nasal congestion, rhinitis may developed with nasal spray.

Dose: intranasal, maintenance, 10-20 mcg 1-2 times daily.

Child, 5-10 mcg 1-2 times daily.

By mouth (as desmopressin acetate)

Diabetes insipidus, treatment, adult and child initially 300 mcg daily (in 3 divided doses); maintenance, 300– 600 mcg daily in 3 divided doses; range 0.2–1.2 mg daily.

Primary nocturnal enuresis (if urine concentrating ability normal), adult (under 65 years) and child over 7 years 200 mcg at bedtime, only increased to 400 mcg if lower dose not effective (important: see also cautions); withdraw for at least 1 week for reassessment after 3 months. Postoperative polyuria or polydipsia, adjust dose according to urine osmolality. Sublingually (as desmopressin base).

Diabetes insipidus, treatment, adult and child initially 180 mcg daily in 3 divided doses; range 120–720 mcg daily.

Primary nocturnal enuresis (if urine concentrating ability normal), adult (under 65 years) and child over 7 years 120 mcg at bedtime, only increased to 240 mcg if lower dose not effective; Polyuria or polydipsia after hypophysectomy, adjust dose according to urine osmolality. Intranasally (as desmopressin acetate).

Diabetes insipidus, diagnosis, adult and child 20 mcg (limit fluid intake to 500 ml from 1 hour before to 8 hours after administration).

Diabetes insipidus, treatment, adult 10–40 mcg daily (in 1–2 divided doses); child 5–20 mcg daily; infants may require lower doses.

Primary nocturnal enuresis (if urine concentrating ability normal), adult (under 65 years) and child over 7 years: initially 20 mcg at bedtime, only increased to 40 mcg if lower dose not effective.

Nocturia associated with multiple sclerosis (when other treatments have failed), adult (under 65 years) 10–20 mcg at bedtime, dose not to be repeated within 24 hours.

Use for diagnostic procedures:

Renal function testing (empty bladder at time of administration and limit fluid intake to 500 ml from 1 hour before until 8 hours after administration), adult 40 mcg; infant under 1 year 10 mcg (restrict fluid intake to 50% at next 2 feeds to avoid fluid overload), child 1–15 years 20 mcg.

Mild to moderate haemophilia and von Willebrand’s disease, adult 300 mcg (one 150 mcg spray into each nostril) 30 minutes before surgery or when bleeding; may be repeated at intervals of 12 hours (or at intervals of at least 3 days if self-administered)

Fibrinolytic response testing, adult 300 mcg (one 150 mcg spray into each nostril); blood sampled after 1 hour for fibrinolytic activity.

By injection (as desmopressin acetate)

Diabetes insipidus, diagnosis (subcutaneous or intramuscular), adult and child 2 mcg (limit fluid intake to 500 ml from 1 hour before to 8 hours after administration).

Note: withdraw for at least 1 week for reassessment after 3 months.

Pregnancy: can be taking in pregnancy only if clearly needed and should be used with caution.

Breast feeding: Not known to be harmful