From the Guidelines
Desmopressin (DDAVP) dosing in obese patients should generally follow standard dosing guidelines, as there is no strong evidence supporting dose adjustments based on weight. For intranasal administration, the typical adult dose is 10-40 mcg (0.1-0.4 mL of 100 mcg/mL solution) divided into 1-3 doses daily. For oral tablets, 0.1-0.8 mg daily is commonly used, often divided into 2-3 doses. For intravenous administration, 0.3 mcg/kg (maximum 20 mcg) is recommended. Despite obesity, DDAVP is primarily distributed in extracellular fluid rather than adipose tissue, so dosing based on ideal body weight rather than actual body weight is appropriate. Clinicians should monitor response carefully, particularly fluid retention and hyponatremia, which may be more concerning in obese patients who often have comorbidities like hypertension or heart failure. Start with standard doses and titrate based on clinical response and sodium levels. Fluid restriction during DDAVP therapy is especially important in obese patients to minimize the risk of water intoxication 1.
Some key points to consider when using DDAVP in obese patients include:
- Monitoring for signs of fluid retention and hyponatremia
- Starting with standard doses and titrating based on clinical response
- Restricting fluid intake to minimize the risk of water intoxication
- Considering the potential for increased risk of adverse effects in patients with comorbidities such as hypertension or heart failure
- Using ideal body weight rather than actual body weight for dosing calculations 1.
It's also important to note that the provided evidence does not specifically address the use of DDAVP in obese patients, but rather provides general guidelines for the use of DDAVP in the treatment of enuresis 1. However, the principles of dosing and monitoring can still be applied to the use of DDAVP in obese patients. The most recent and highest quality study on the topic of obesity management is from 1, but it does not provide specific guidance on the use of DDAVP in obese patients. Therefore, the recommendation is based on the available evidence from studies on the use of DDAVP in general, rather than specifically in obese patients.
From the Research
Dose of Desmopressin (DDAVP) in Obesity
There is no direct information available in the provided studies regarding the dose of Desmopressin (DDAVP) specifically in obesity.
General Information on DDAVP Dosage
- The dose of DDAVP can vary depending on the condition being treated and the individual patient's response to the medication 2, 3.
- In patients with central diabetes insipidus, the average oral DDAVP dose required to control diuresis was 19 +/- 2 (range: 15-30) times more than that of prior intranasal treatment 3.
- The mean daily dose of intranasal desmopressin was 10 ± 8 μg/day, and that of desmopressin orally disintegrating tablet (ODT) was 142 ± 59 μg/day 4.
- In one case report, a patient was treated with intranasal desmopressin at 10 µg twice daily for chronic polyuria and nocturia thought to be due to central diabetes insipidus 5.
Important Considerations
- DDAVP should be used with caution in patients with certain medical conditions, such as cystic fibrosis, renal or cardiovascular diseases, and hypodipsia 2.
- Fluid intake should be limited 1 hour before and 8 hours after the dose of DDAVP to avoid fluid overload and rapid fluctuations in sodium concentration 2.
- Frequent home monitoring of body weight and regular determinations of serum sodium may help to disclose the early phase of over-hydration or dehydration 2.