What is the recommended treatment and dosage of desmopressin (Desmopressin) for central Diabetes Insipidus (DI)?

Desmopressin Treatment for Central Diabetes Insipidus

For central diabetes insipidus, desmopressin is the first-line treatment with a recommended starting dose of 2-4 mcg daily administered as one or two divided doses by subcutaneous or intravenous injection. 1

Formulations and Administration

• Desmopressin is available in multiple formulations including oral tablets, oral melt tablets, nasal spray, and injectable forms 1
• Injectable desmopressin (for central DI) should not be diluted and can be administered subcutaneously or intravenously 1
• Morning and evening doses should be separately adjusted to establish an adequate diurnal rhythm of water turnover 1
• For oral formulations:
  • Tablets: 0.2-0.4 mg per dose, typically 2-3 times daily 2, 3
  • Oral melt tablets: 120-240 μg per dose 4
  • Oral formulations require approximately 15-30 times higher dosing than intranasal formulations 3

Dosage Adjustment and Monitoring

• Dose should be adjusted based on:
  • Adequate duration of sleep (without disruption for urination)
  • Adequate but not excessive water turnover 1
• Prior to treatment initiation, assess:
  • Serum sodium
  • Urine volume
  • Urine osmolality 1
• During treatment, intermittently monitor:
  • Serum sodium
  • Urine volume
  • Urine or plasma osmolality 1

Safety Considerations

• Fluid restriction is essential during desmopressin treatment to prevent water intoxication and hyponatremia 1, 5
• Major adverse effect is hyponatremia, which can be prevented by:
  • Careful dose titration when initiating therapy
  • Restricting free water intake
  • Close monitoring of serum sodium 1, 5
• Ensure serum sodium is normal before initiating or resuming treatment 1
• For patients on oral formulations, evening fluid intake should be limited to 200 ml or less with no drinking until morning 4

Special Populations

• For patients switching from intranasal desmopressin to injectable form, the recommended starting dose is 1/10th of the daily intranasal maintenance dose 1
• In children, dosing correlates with body weight and body surface area (approximately 474 ± 222 μg/m²/day for oral formulations) 2

Treatment Efficacy

• Desmopressin is highly effective in controlling polyuria and polydipsia in central diabetes insipidus 6, 7
• Long-term treatment with oral desmopressin has been shown to effectively control diuresis for up to 5 years 3
• Compared to vasopressin (the natural hormone), desmopressin has:
  • Enhanced antidiuretic potency
  • Markedly diminished pressor activity
  • Prolonged half-life and duration of action 7

Important Considerations

• Desmopressin is ineffective and not indicated for nephrogenic diabetes insipidus 1
• Tachyphylaxis (lessening of response) may occur with frequent administration (more often than every 48 hours) 1
• The initial response is reproducible if desmopressin is administered every 2-3 days 1

Remember that central diabetes insipidus requires lifelong treatment in most cases, and careful monitoring is essential to prevent complications while maintaining quality of life through adequate symptom control.