From the Guidelines
Desmopressin should be administered at a dose of 0.2 to 0.4 mg for tablets and 120 to 240mg for oral melt tablets, taken 1 hour before sleep for tablets and 30 to 60 minutes before bedtime for oral melt tablets, as this timing allows for the maximum renal concentrating effect and minimal diuresis 1. The dosing of desmopressin is not influenced by body weight or age, and the prescribing physician may choose to start with the higher dose and taper down in cases of good effect or use the opposite strategy 1. Key considerations for desmopressin administration include:
- Taking the medication at the correct time to achieve the maximum renal concentrating effect and minimal diuresis
- Starting with a dose of 0.2 to 0.4 mg for tablets and 120 to 240mg for oral melt tablets
- Adjusting the dose based on patient response, rather than age or body weight
- Having regular short drug holidays to assess whether medication is still needed if daily medication is chosen 1. It is essential to monitor patients for potential side effects, such as hyponatremia, especially in elderly patients, and to restrict fluid intake during treatment to prevent water intoxication.
From the FDA Drug Label
2.2 Recommended Dosage
Initiate fluid restriction during treatment with desmopressin acetate injection [see Warnings and Precautions (5.1), Use in Specific Populations (8.4,8. 5)]. Diabetes Insipidus Treatment naïve patients: The recommended starting daily dosage is 2 mcg to 4 mcg administered as one or two divided doses by subcutaneous or intravenous injection. Patients changing from intranasal desmopressin: The recommended starting dose of desmopressin acetate injection is 1/10th the daily maintenance intranasal dose administered by subcutaneous or intravenous injection as one or two divided doses Hemophilia A and von Willebrand's Disease (Type I) The recommended dosage is 0. 3 mcg/kg actual body weight (to a maximum of 20 mcg) administered by intravenous infusion over 15 minutes to 30 minutes.
The recommended desmopressin dose is:
- For Diabetes Insipidus: 2 mcg to 4 mcg daily, administered as one or two divided doses by subcutaneous or intravenous injection.
- For Hemophilia A and von Willebrand's Disease (Type I): 0.3 mcg/kg actual body weight (to a maximum of 20 mcg) administered by intravenous infusion over 15 minutes to 30 minutes 2.
From the Research
Desmopressin Dose Information
- The optimal dose of desmopressin varies depending on the condition being treated, age, and other factors 3, 4.
- For children with central diabetes insipidus, a dose of 50 mcg may be effective in reducing urine production and improving efficacy 4.
- In adults, desmopressin has been used to treat nocturia, with different recommended doses for men and women 5.
- The risk of hyponatremia, a potential side effect of desmopressin, can be reduced by adhering to indication-specific doses and monitoring electrolyte levels 6, 3.
Formulations and Administration
- Desmopressin is available in various formulations, including intranasal, oral, and sublingual tablets 5, 3.
- The sublingual tablet formulation has been shown to be effective in treating nocturia in adults 5.
- The choice of formulation and dose should be individualized based on the patient's specific needs and medical history 3.
Special Considerations
- Pediatric patients require careful dosing and monitoring due to the risk of hyponatremia and other side effects 3, 4.
- Patients with certain medical conditions, such as kidney disease or heart failure, may require adjusted doses or closer monitoring 3.
- Desmopressin should be used with caution in patients taking other medications that may interact with it 3.