From the Guidelines
DDAVP (desmopressin) is a recommended treatment for nocturnal enuresis in children, particularly those with nocturnal polyuria, with a dose of 0.2-0.6 mg orally at bedtime. The use of DDAVP in treating nocturnal enuresis is supported by grade Ia evidence 1. It is essential to note that DDAVP is most efficient in children with nocturnal polyuria and normal bladder reservoir function.
When considering DDAVP treatment, it is crucial to assess the child's fluid intake to prevent water intoxication with hyponatremia and convulsions 1. A general recommendation for fluid intake is to limit evening intake to 200 ml (6 ounces) or less and avoid drinking until morning.
The treatment of nocturnal enuresis with DDAVP should be part of a comprehensive approach that includes counseling the child to void regularly during the day and addressing any underlying issues such as constipation 1. Physical activity should also be encouraged, and the child should be reassured that bedwetting is not their fault.
Key points to consider when prescribing DDAVP for nocturnal enuresis include:
- Restricting fluid intake in the evening to minimize the risk of water intoxication
- Monitoring for side effects such as headache, nausea, and hyponatremia
- Encouraging physical activity and a normal lifestyle despite the condition
- Addressing underlying issues such as constipation
- Providing reassurance and support to the child and their family 1.
From the FDA Drug Label
Desmopressin acetate increases plasma levels of factor VIII activity in patients with hemophilia and von Willebrand's disease Type I. The antidiuretic effects of desmopressin acetate are mediated by stimulation of vasopressin 2 (V2) receptors, thereby increasing water re-absorption in the kidney, and hence reducing urine production Desmopressin acetate is a replacement hormone for antidiuretic hormone in the treatment of central diabetes insipidus
The drug DDAVP is another name for desmopressin acetate. It is used to treat:
- Central Diabetes Insipidus: as antidiuretic replacement therapy
- Hemophilia A: to maintain hemostasis during surgical procedures and postoperatively or reduce bleeding with episodes of spontaneous or traumatic injuries
- von Willebrand's disease (Type I): to maintain hemostasis during surgical procedures or traumatic injuries 2 2
From the Research
DDAVP Overview
- DDAVP, also known as desmopressin, is a synthetic analogue of vasopressin with increased antidiuretic activity and decreased pressor activity 3.
- It has a greatly enhanced therapeutic profile compared to previously available treatments, allowing for more specific antidiuresis without adverse reactions 4.
Uses of DDAVP
- DDAVP is recognized as the drug of choice for central diabetes insipidus due to its selective antidiuretic activity 4.
- It is also used in the treatment of nocturnal enuresis and as a diagnostic test of tubular function 4.
- Additionally, DDAVP has been used for hemostatic disorders such as von Willebrand's disease and hemophilia A 5.
- It has also been licensed for the treatment of nocturia due to idiopathic nocturnal polyuria in adults 6.
Administration and Dosage
- DDAVP is available for intranasal, parenteral, and oral administration 4, 7.
- Antidiuretic doses range from 10 to 40 micrograms intranasally and from 2 to 4 micrograms intravenously or subcutaneously 4.
- For oral administration, a dose of 100 microg of desmopressin acetate has been used, with a mean plasma level of 14.7 +/- 5.4 pg/ml 7.
- The average oral DDAVP dose required to control diuresis in patients with central diabetes insipidus was 19 +/- 2 times more than that of prior intranasal treatment 7.
Safety and Efficacy
- DDAVP has been shown to be safe and efficacious as a selective antidiuretic agent for the treatment of central diabetes insipidus and nocturnal enuresis 4.
- It appears to be well tolerated even at higher doses used in bleeding disorders 4.
- Long-term treatment with oral DDAVP resulted in control of diuresis in 8 of the 9 patients with central diabetes insipidus, with no adverse effects observed during the follow-up period 7.