DDAVP (Desmopressin) Dosage and Administration for Central Diabetes Insipidus and Bedwetting
For central diabetes insipidus, DDAVP nasal spray should be administered at 0.1-0.4 mL (10-40 μg) daily in adults, either as a single dose or divided into two or three doses, with most adults requiring 0.2 mL daily in two divided doses. For children aged 3 months to 12 years, the usual dosage range is 0.05-0.3 mL daily. 1
Central Diabetes Insipidus Treatment
Nasal Spray Administration
- Dosage must be individually determined and adjusted according to the patient's diurnal pattern of response 1
- Response should be evaluated by adequate duration of sleep and appropriate water turnover 1
- For adults: 0.1-0.4 mL (10-40 μg) daily, either as a single dose or divided into two or three doses 1
- For children (3 months-12 years): 0.05-0.3 mL (5-30 μg) daily, as a single dose or divided into two doses 1
- Approximately 25-33% of patients can be controlled with a single daily dose 1
- The nasal spray pump delivers doses of 0.1 mL (10 μg) or multiples of 0.1 mL 1
Oral Tablet Administration
- Oral DDAVP tablets are an effective alternative to nasal spray with better patient compliance 2
- Typical dosage: 100-300 μg 2-3 times daily (total 200-600 μg/day) 2, 3
- Duration of action ranges from 8-12.5 hours depending on the patient 3
- Oral administration is particularly useful for patients with nasal congestion or who have difficulty with nasal administration 2
Monitoring and Adjustments
- Morning and evening doses should be separately adjusted for adequate diurnal rhythm of water turnover 1
- Fluid restriction should be observed to prevent water intoxication 1
- Regular monitoring of serum electrolytes is recommended, especially during intercurrent illnesses 4
- Elderly patients may require dose adjustments due to decreased renal function 1
Bedwetting (Enuresis) Treatment
DDAVP Administration for Enuresis
- Available in two forms: nasal spray and oral tablets 5
- Nasal spray: 10-40 μg (1-4 sprays) at bedtime 5
- Oral tablets: Start with one 0.2 mg tablet before bedtime, increasing to two or three tablets if lower dose is ineffective 5
- Duration of action is 10-12 hours, with compensatory polyuria following as the effect wears off 5
Efficacy and Considerations
- Success rates range from 10-65%, with relapse rates as high as 80% after treatment discontinuation 5
- DDAVP can be prescribed for short periods (e.g., when the child is going to camp) 5
- Long-term administration has not been associated with depression of endogenous ADH secretion 5
- The combination of DDAVP with a sustained-release anticholinergic agent may be more effective than DDAVP alone in some cases 5
Safety Considerations and Side Effects
Water Intoxication Risk
- Water intoxication leading to hyponatremia and seizures is a potential serious side effect 5, 4
- Risk factors include excessive water intake, nasal polyps, and overdose 5
- Monitoring serum electrolyte levels is recommended at least once early in treatment 5
- Additional monitoring is necessary during intercurrent illnesses that might affect hydration status 5, 4
Other Side Effects
- Headache, abdominal discomfort, nausea, and nasal congestion are relatively rare side effects 5
- Side effects are generally minimal compared to other treatments like vasopressin tannate in oil 6
Special Populations
- Geriatric patients: Dose adjustments may be needed due to decreased renal function 1
- DDAVP is substantially excreted by the kidney, increasing risk of toxicity in patients with impaired renal function 1
Practical Administration Tips
- The nasal spray pump must be primed with 5 presses before first use 1
- Discard nasal spray after 50 sprays as subsequent doses may deliver substantially less than 10 μg 1
- For doses not deliverable by the spray pump, the rhinal tube delivery system may be used 1
- DDAVP is considered the preferred treatment for central diabetes insipidus in both children and adults due to its efficacy, long duration of action, and infrequent side effects 6, 7