What is desmopressin and what are its indications?

From the Guidelines

Desmopressin is a synthetic analog of vasopressin (antidiuretic hormone) that helps regulate water retention in the body and is primarily used to treat diabetes insipidus, nocturnal enuresis, and certain bleeding disorders like mild to moderate hemophilia A and von Willebrand disease type 1. The indications for desmopressin include:

• Diabetes insipidus: a condition where the kidneys cannot conserve water due to a deficiency in vasopressin production 1
• Nocturnal enuresis (bedwetting) in children and adults: desmopressin can be taken at least 1 hour before going to sleep to reduce urine production 1
• Mild to moderate hemophilia A and von Willebrand disease type 1: desmopressin can temporarily increase factor VIII and von Willebrand factor levels 1
• Bleeding disorders: desmopressin can enhance platelet function and increase von Willebrand factor levels, making it useful in the management of bleeding disorders 1 The typical dosing ranges for desmopressin are:
• 0.1-0.8 mg daily for diabetes insipidus
• 0.2-0.6 mg at bedtime for nocturnal enuresis
• 0.3 μg/kg for bleeding disorders, administered intravenously or subcutaneously 1 It is essential to monitor patients for hyponatremia (low sodium levels), especially when beginning treatment, as water retention without sodium retention can dilute serum sodium levels 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.

Desmopressin is a vasopressin analog. The indications for desmopressin are:

• 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

From the Research

Desmopressin Overview

Desmopressin, also known as 1-deamino-8-D-arginine vasopressin, is a synthetic analogue of the antidiuretic hormone L-arginine vasopressin 3, 4, 5, 6. It is used to treat various conditions, including diabetes insipidus, bleeding disorders, and nocturnal enuresis.

Indications for Desmopressin

The indications for desmopressin include:

• Diabetes insipidus 3, 5
• Bleeding disorders, such as:
  • Von Willebrand disease 3, 4, 6
  • Hemophilia A 3, 4, 6
  • Uremic bleeding 3
• Nocturnal polyuria leading to nocturia or nocturnal enuresis 3, 7, 5
• Menstrual bleeding 3
• Dental extractions 3
• Epistaxis 3
• Trauma resuscitation with active hemorrhage 3
• Intracranial bleed due to the use of antiplatelet agents 3

Mechanism of Action

Desmopressin works by releasing prothrombotic factors FVIII and von Willebrand factor (vWF) from storage sites, facilitating platelet-vessel wall adhesion, and resulting in a substantial hemostatic effect 3. It can lead to up to a fourfold increase in vWF levels, highlighting its hemostatic actions 3.