What is the recommended dose of desmopressin (Desmopressin) for various conditions?

Recommended Desmopressin Dosing for Various Conditions

The recommended dose of desmopressin varies by condition, with 0.3 μg/kg diluted in 50 ml saline infused over 30 minutes being the standard dose for hemostatic purposes, while oral formulations of 0.2-0.4 mg tablets or 120-240 μg melt tablets are preferred for nocturnal enuresis. 1, 2

Hemostatic Indications

• For patients with platelet-inhibiting drug effects or von Willebrand disease, the standard dose is 0.3 μg/kg diluted in 50 ml saline and infused over 30 minutes 1
• Desmopressin is not recommended for routine use in bleeding trauma patients but may be considered in refractory microvascular bleeding if the patient has been treated with platelet-inhibiting drugs 1
• For patients with hemophilia A with factor VIII levels >5% experiencing minor bleeding, desmopressin at 0.3 μg/kg is recommended 3
• Platelet function testing with platelet function analyzer PFA-100 or whole blood multiple electrode aggregometer may help identify patients who would benefit from desmopressin therapy 1

Central Diabetes Insipidus

• For nasal spray solution (0.01%): 4
  • Adults: 0.1 mL to 0.4 mL daily (10-40 μg), either as a single dose or divided into two or three doses
  • Children (3 months to 12 years): 0.05 mL to 0.3 mL daily (5-30 μg), either as a single dose or divided into two doses
  • About 25-33% of patients can be controlled by a single daily dose
• For children with AVP-deficiency, an initial outpatient dose of at least 50 μg oral desmopressin is recommended for children between 1 and 5 years of age 5

Nocturnal Enuresis

• Oral tablets: 0.2 to 0.4 mg taken at least 1 hour before going to sleep 1
• Oral melt tablets: 120 to 240 μg taken 30 to 60 minutes before bedtime 1
• Dose is not influenced by body weight or age, and physicians may choose to start with the higher dose and taper down or use the opposite strategy 1
• Oral formulations are preferred over nasal spray due to safety concerns with the latter 6
• Studies show efficacy at doses from 0.2 to 0.6 mg with a linear dose-response relationship 7

Nocturia in Elderly Patients

• Lower starting doses (0.1 mg) are recommended for elderly patients with nocturnal polyuria, with possible escalation to 0.2 mg depending on symptoms 8
• Close monitoring of serum sodium levels is essential due to risk of hyponatremia in elderly patients 8

Special Considerations for Exstrophy-Epispadias Complex

• Low-dose intranasal desmopressin (10-30 μg) at bedtime has been effective for nocturnal incontinence in children who have undergone staged reconstruction 9

Safety Precautions

• Fluid restriction is essential to prevent water intoxication and hyponatremia 1, 6, 4
• Evening fluid intake should be limited to 200 mL (6 ounces) or less, with no drinking until morning 6
• Polydipsia is a contraindication to desmopressin treatment 6
• Regular short drug holidays are important when using desmopressin daily to assess whether medication is still needed 6
• Elderly patients require careful dose selection due to decreased renal function and increased risk of hyponatremia 4, 8

Administration Routes

• Oral formulations are preferred over nasal spray for most indications due to lower risk of water intoxication, hyponatremia, and convulsions 6
• For nasal spray, the pump must be primed prior to first use by pressing down five times, and should be discarded after 50 sprays 4

This dosing guidance provides a framework for desmopressin administration across various conditions, but monitoring for efficacy and adverse effects remains essential, particularly regarding fluid balance and serum sodium levels.