From the Guidelines
Indications for Desmopressin
Desmopressin is indicated for the treatment of central diabetes insipidus, nocturnal enuresis, and hemophilia A and von Willebrand's disease 1.
Dosage and Administration
The typical dose for central diabetes insipidus is 5-20 micrograms intranasally at bedtime, and for nocturnal enuresis, it is 20-40 micrograms intranasally at bedtime, although oral formulations are preferred due to the risk of water intoxication with the nasal spray 1. For hemophilia A and von Willebrand's disease, the dose is 0.3 micrograms per kilogram intravenously 1.
Key Considerations
- Monitoring for Hyponatremia: It is essential to monitor patients for signs of hyponatremia, such as headache, nausea, and vomiting, and to adjust the dose accordingly 1.
- Fluid Intake: Patients should be advised to limit fluid intake in the evening to minimize the risk of water intoxication, with a recommended evening intake of 200 ml (6 ounces) or less 1.
- Duration of Treatment: The duration of treatment varies depending on the condition being treated, but desmopressin is generally used long-term for central diabetes insipidus and short-term for hemophilia A and von Willebrand's disease 1.
- Contraindications and Precautions: Desmopressin is contraindicated in patients with polydipsia, and caution should be exercised in patients with a history of nasal congestion or sinusitis, as these conditions may impair absorption 1.
Additional Uses
Desmopressin may also be used in patients treated with platelet-inhibiting drugs or with von Willebrand disease to enhance platelet function and reduce bleeding risk 1. However, its use in these settings should be guided by clinical judgment and evidence-based recommendations.
From the FDA Drug Label
Hemophilia A: Desmopressin Acetate Injection 4 mcg/mL is indicated for patients with hemophilia A with factor VIII coagulant activity levels greater than 5%. von Willebrand’s Disease (Type I): Desmopressin acetate injection 4 mcg/mL is indicated for patients with mild to moderate classic von Willebrand’s disease (Type I) with factor VIII levels greater than 5% Diabetes Insipidus: Desmopressin acetate injection 4 mcg/mL is indicated 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.
The indications for desmopressin are:
- Hemophilia A with factor VIII coagulant activity levels greater than 5%
- Mild to moderate von Willebrand’s Disease (Type I) with factor VIII levels greater than 5%
- Central (cranial) diabetes insipidus
- Management of temporary polyuria and polydipsia following head trauma or surgery in the pituitary region 2
From the Research
Indications for Desmopressin
The indications for desmopressin (1-deamino-8-D-arginine vasopressin) include:
- Central diabetes insipidus 3, 4, 5, 6
- Hemostatic disorders such as von Willebrand's disease 4, 5, 6, 7
- Mild hemophilia A 4, 7
- Nocturnal enuresis 3, 5, 6, 7
- Nocturnal polyuria leading to nocturia 5, 7
- Uremic bleeding 7
- Dental extractions 7
- Epistaxis 7
- Menstrual bleeding 7
- Avoiding rapid sodium correction along with hypertonic saline 7
- Management of intracranial bleed due to the use of antiplatelet agents 7
- Trauma resuscitation with active hemorrhage 7
Key Points
- Desmopressin is a synthetic vasopressin analog with enhanced antidiuretic potency and a prolonged half-life and duration of action compared to the natural hormone 4
- It can be administered either intranasally or parenterally 4, 6
- The risk of hyponatremia is a potential side effect of desmopressin therapy, especially in extremes of age, existing comorbidity, drug interaction, intranasal formulations, and intercurrent illness 5