IV Desmopressin Dosing for Central Diabetes Insipidus
The recommended dose of IV desmopressin for central diabetes insipidus is 0.5-1 mL (2-4 mcg) daily, usually administered in two divided doses. 1
Dosing Guidelines
Initial Dosing
- For adults with central diabetes insipidus: 2-4 mcg total daily dose administered intravenously
- Typically divided into two doses to maintain adequate diurnal rhythm of water turnover
- Morning and evening doses should be separately adjusted for optimal control
Dosing Considerations
- Dosage must be individualized based on patient response
- Response should be evaluated by:
- Adequate duration of sleep
- Adequate (not excessive) water turnover
- For patients switching from intranasal to IV formulation: IV dose is approximately one-tenth of the intranasal dose 1
Administration Method
- Administer by direct intravenous injection or slow IV infusion
- When administered as an infusion, dilute in sterile physiological saline and infuse slowly over 15-30 minutes
- For adults: 50 mL of diluent is recommended
- For children weighing ≤10 kg: 10 mL of diluent is recommended
Monitoring and Safety
Essential Monitoring
- Blood pressure and pulse should be monitored during infusion
- Regular monitoring of serum sodium levels
- Assessment of urine output and fluid balance
Important Precautions
- Fluid restriction should be observed to prevent water intoxication
- Tachyphylaxis may occur with repeated administration more frequently than every 48 hours
- Elderly patients require careful dose selection due to potential decreased renal function 1
Major Adverse Effects
- Hyponatremia is the most significant risk 2, 3
- Water intoxication can occur with excessive dosing or fluid intake
- Risk of hyponatremia can be reduced by careful dose titration and close monitoring of serum osmolality 3
Special Populations
Pediatric Patients
- Dosing must be adjusted based on weight and response
- Careful fluid management is essential
Elderly Patients
- Desmopressin is substantially excreted by the kidney
- Risk of adverse reactions may be greater in patients with impaired renal function
- Lower initial doses may be appropriate
- Consider monitoring renal function 1
Clinical Pearls
- Desmopressin is recognized as the drug of choice for central diabetes insipidus due to its selective antidiuretic activity 4
- The oral disintegrating tablet formulation may provide better control of water balance with lower risk of hyponatremia compared to intranasal formulation, if IV therapy is not required 5
- Patient education is necessary to avoid the risk of water intoxication and hyponatremia 6
- Emergency plans should be in place for patients with diabetes insipidus, including information about their diagnosis and treatment 7
Remember that the goal of treatment is to control polyuria and polydipsia while maintaining normal serum sodium levels and providing adequate sleep without nocturnal polyuria.