Desmopressin (DDAVP) Dosing Guidelines
The recommended dosage of desmopressin varies by indication, with oral doses ranging from 0.2-0.6 mg nightly for enuresis, intravenous doses of 0.3 mcg/kg (maximum 20 mcg) for hemostasis, and intranasal doses of 0.1-0.4 mL daily for diabetes insipidus. 1, 2
Dosing by Indication
Diabetes Insipidus
- Parenteral (IV/SC): 2-4 mcg daily in 1-2 divided doses 2
- Intranasal:
- Oral: For patients switching from intranasal, oral dose is approximately 10-30 times the intranasal dose 4
Hemophilia A and von Willebrand Disease (Type I)
- Intravenous: 0.3 mcg/kg actual body weight (maximum 20 mcg) administered over 15-30 minutes 2
- For preoperative use: Administer 30 minutes before procedure 2
- For spontaneous/traumatic bleeding: May repeat after 8-12 hours and once daily thereafter if needed 2
- Reserved for patients with factor VIII levels >5% without factor VIII antibodies 2
- For von Willebrand disease, only indicated for mild to moderate Type I 2
Nocturnal Enuresis
- Oral: 0.2-0.6 mg nightly, starting with lowest effective dose 1
- Intranasal: 10-40 μg (1-4 sprays) nightly 1
Administration Guidelines
Preparation for IV Administration
- Dilute in 0.9% Sodium Chloride Injection using aseptic technique 2
- Dilution volume based on weight:
- ≤10 kg: Dilute in 10 mL saline
10 kg: Dilute in 50 mL saline 2
- Infuse slowly over 15-30 minutes while monitoring blood pressure and pulse 2
Special Considerations
- Restrict fluid intake during treatment to prevent hyponatremia 5, 2
- For enuresis: Limit evening fluid intake to 200 mL (6 ounces) or less with no drinking until morning 5
- Monitor serum sodium, especially in young children, elderly patients, and during intercurrent illness 5, 6
- Tachyphylaxis may occur with frequent administration (more often than every 48 hours) 2
Safety Precautions
Monitoring
- Assess baseline serum sodium, urine volume, and osmolality before treatment 2
- Monitor serum sodium during treatment, especially in children under 3 years and elderly patients 5, 6
- For hemostasis indications: Monitor factor VIII levels, bleeding time, and other relevant coagulation parameters 2
Risk of Hyponatremia
- Water intoxication leading to hyponatremia and seizures is a rare but serious side effect 5
- Higher risk in young children (<3 years) and with excessive fluid intake 5, 6
- Consider electrolyte monitoring if intercurrent illness occurs during treatment 1
Contraindications
- Ineffective for nephrogenic diabetes insipidus 2
- Not indicated for severe von Willebrand disease (Type I) 2
- Polydipsia (excessive drinking) is a contraindication 5