From the Guidelines
Desmopressin is primarily indicated for the treatment of nocturnal enuresis, central diabetes insipidus, and certain bleeding disorders, with a recommended dose of 0.2-0.6 mg orally at bedtime for nocturnal enuresis in children over 6 years 1.
Indications for Desmopressin
- Nocturnal enuresis (bedwetting) in children over 6 years
- Central diabetes insipidus
- Certain bleeding disorders, such as mild to moderate hemophilia A and von Willebrand disease type 1
Dosage and Administration
- For nocturnal enuresis: 0.2-0.6 mg orally at bedtime 1
- For central diabetes insipidus: 0.1-0.2 mg orally twice daily or 10-40 mcg intranasally daily in divided doses
- For bleeding disorders: 0.3 mcg/kg IV to stimulate the release of von Willebrand factor and factor VIII from endothelial cells
Mechanism of Action and Precautions
- Desmopressin works by binding to V2 receptors in the kidney collecting ducts, increasing water reabsorption 1
- Caution is needed regarding fluid intake to prevent hyponatremia, especially in elderly patients and children 1
- Contraindications include hyponatremia, severe renal impairment, and conditions with fluid or electrolyte imbalance 1
Efficacy and Safety
- Desmopressin has been shown to be effective in reducing nocturnal enuresis, with a success rate of 10-65% and a relapse rate of up to 80% 1
- The drug is generally safe, with few side effects and low risks, but water intoxication is a rare but serious side effect that requires electrolyte monitoring 1
From the FDA Drug Label
Desmopressin Acetate Injection is a vasopressin analog used for: Central Diabetes Insipidus - as antidiuretic replacement therapy in the management of central (cranial) diabetes insipidus and for the management of the temporary polyuria and polydipsia following head trauma or surgery in the pituitary region. Hemophilia A- for patients with factor VIII coagulant activity levels greater than 5% to maintain hemostasis during surgical procedures and postoperatively or reduce bleeding with episodes of spontaneous or traumatic injuries such as hemarthroses, intramuscular hematomas, or mucosal bleeding. von Willebrand's disease (Type I) - for patients with mild to moderate disease with factor VIII levels greater than 5% to maintain hemostasis during surgical procedures or traumatic injuries such as hemarthroses, intramuscular hematomas, or mucosal bleeding.
The indications for desmopressin are:
- Central Diabetes Insipidus: as antidiuretic replacement therapy
- Hemophilia A: to maintain hemostasis during surgical procedures 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
Desmopressin Indications
- Central diabetes insipidus: Desmopressin is recognized as the drug of choice for central diabetes insipidus due to its selective antidiuretic activity 3, 4, 5, 6.
- Nocturnal enuresis: Desmopressin is used in the treatment of nocturnal enuresis, taking advantage of its selective antidiuretic activity 3, 7.
- Diagnostic test of tubular function: Desmopressin is used as a diagnostic test of tubular function due to its antidiuretic properties 3.
- Mild hemophilia A and von Willebrand's disease: Desmopressin is used to transiently increase the levels of factor VIII and von Willebrand's factor, allowing for minor surgery 4, 7.
- Adult nocturnal polyuria: Desmopressin is used to treat adult nocturnal polyuria, utilizing its antidiuretic effects 7.
- Primary monosymptomatic nocturnal enuresis: Desmopressin is used in the treatment of primary monosymptomatic nocturnal enuresis, due to its ability to reduce nocturnal urine production 7.