Desmopressin Dosage and Administration for Various Medical Conditions
Desmopressin dosage varies by indication, with oral formulations generally preferred over nasal spray due to safety concerns, and specific dosing protocols exist for central diabetes insipidus, nocturnal enuresis, hemostatic applications, and other conditions. 1
Central Diabetes Insipidus
Nasal Spray Administration
- For adults: 0.1-0.4 mL (10-40 μg) daily, either as a single dose or divided into 2-3 doses; most adults require 0.2 mL daily in two divided doses 2
- For children (3 months to 12 years): 0.05-0.3 mL (5-30 μg) daily, either as a single dose or divided into two doses 2
- Approximately 25-33% of patients can be controlled by a single daily dose 2
- The nasal spray pump delivers doses of 0.1 mL (10 μg) or multiples of 0.1 mL; must be primed with 5 presses before first use 2
- Discard after 50 sprays as subsequent doses may deliver substantially less than 10 μg 2
Oral Administration
- Oral desmopressin is used in the majority of patients, including infants and toddlers 3
- Median oral dose: 9.5 μg/kg/day with median frequency of 2.5 times daily 3
- When switching from nasal to oral formulation, the median dose conversion factor is approximately 20:1 (oral:nasal) 3
- Oral tablets as small as 10 μg have effects on renal concentrating ability 4
Nocturnal Enuresis
Oral Administration (Preferred)
- Tablets: 0.2-0.4 mg taken at least 1 hour before bedtime 5
- Oral melt tablets (lyophilisate): 120-240 μg taken 30-60 minutes before bedtime 5
- Dosage is not influenced by body weight or age 5
- Prescribing physician may start with higher dose and taper down if effective, or start low and increase as needed 5
Important Safety Considerations
- Fluid restriction is essential: evening intake should be limited to 200 mL (6 ounces) or less with no drinking until morning 5, 1
- Polydipsia is a contraindication to desmopressin treatment 5, 1
- Regular short drug holidays are important when using desmopressin daily to assess whether medication is still needed 5, 1
- Nasal spray is discouraged for enuresis due to higher risk of water intoxication, hyponatremia, and convulsions 1
Hemostatic Applications (Bleeding/Coagulation Disorders)
Intravenous Administration
- Standard dosing for hemostatic purposes: 0.3 μg/kg diluted in 50 mL saline and infused over 30 minutes 6, 7
- Indicated for treatment of mild type I von Willebrand disease and mild hemophilia A with FVIII levels at least 5% of normal 6
- Can be used to manage bleeding in patients on antiplatelet therapy 6, 7
Intranasal Administration for von Willebrand Disease
- Effective for minor bleeding episodes in patients with type 1 and type 2A von Willebrand disease 8
- Can increase von Willebrand factor antigen two to threefold from baseline 8
- Normalizes bleeding time in approximately 86% of patients 8
Reversal of Antithrombotic Agents in Intracranial Hemorrhage
- For patients with antiplatelet-related bleeding: Desmopressin 0.4 μg/kg IV × 1 5
- Consider platelet transfusion (one apheresis unit) if neurosurgical intervention is needed 5
Special Considerations
Elderly Patients
- Dose adjustment may be necessary as the drug is substantially excreted by the kidney 2
- Elderly patients are more likely to have decreased renal function, requiring careful dose selection 2
- Monitoring of renal function may be useful 2
Adverse Effects to Monitor
- Water intoxication with hyponatremia and convulsions, particularly in elderly patients 7
- Systemic vasodilator effects leading to arterial hypotension, reactive tachycardia, and facial flushing 6
- Rare cases of thromboembolic events have been reported 6
Contraindications
By following these dosing guidelines and safety precautions, desmopressin can be effectively used to treat various medical conditions while minimizing the risk of adverse effects.