From the Guidelines
Desmopressin intranasal spray, also known as DDAVP, is a synthetic analogue of vasopressin used to treat nocturnal enuresis.
Usage and Dosage
The typical dose for nocturnal enuresis is 10-40 μg nightly [ 1 ], administered as a single dose at bedtime, with a maximum daily dose of 40 μg.
- The dose is usually started at 10 μg and can be increased to 20-40 μg if needed [ 1 ].
- The duration of treatment is individualized and may be continued indefinitely, with regular monitoring of urine output, osmolality, and serum sodium levels to adjust the dose as needed.
Important Considerations
- Water intake should be limited to 200 ml (6 ounces) or less in the evening to minimize the risk of water intoxication and hyponatremia [ 1 ].
- Regular monitoring of serum electrolyte levels is recommended, especially in children who manifest unexplained symptoms [ 1 ].
- Nasal congestion or sinusitis may impair absorption, and the uncertain ability of children to effectively administer a nasal spray has led to a preference for the oral form of the medication [ 1 ].
Side Effects and Contraindications
- Headache, abdominal discomfort, nausea, and nasal congestion have been relatively rare side effects [ 1 ].
- Polydipsia is a contraindication to desmopressin treatment, and the risk of water intoxication and hyponatremia is higher when the nasal spray is used [ 1 ].
From the FDA Drug Label
Desmopressin acetate is also available as an intranasal preparation. However, this means of delivery can be compromised by a variety of factors that can make nasal insufflation ineffective or inappropriate. For patients who have been controlled on intranasal desmopressin acetate and who must be switched to the injection form, either because of poor intranasal absorption or because of the need for surgery, the comparable antidiuretic dose of the injection is about one-tenth the intranasal dose.
The usage of Desmopressin (DDAVP) intranasal spray is for:
- Central (cranial) diabetes insipidus: as antidiuretic replacement therapy
- Mild to moderate von Willebrand’s disease (Type I): to stop bleeding in patients with episodes of spontaneous or trauma-induced injuries
- Hemophilia A: to stop bleeding in patients with episodes of spontaneous or trauma-induced injuries However, the intranasal spray may be ineffective or inappropriate in certain situations, such as poor intranasal absorption, nasal congestion, or impaired level of consciousness 2, 2.
From the Research
Usage of Desmopressin (DDAVP) Intranasal Spray
The usage of Desmopressin (DDAVP) intranasal spray includes:
- Treatment of central diabetes insipidus, as seen in a case report where a 69-year-old man was treated with intranasal desmopressin at 10 µg twice daily for chronic polyuria and nocturia thought to be due to central diabetes insipidus 3
- Treatment of hemostatic disorders such as von Willebrand's disease, as studied in 22 patients with von Willebrand's disease type I who received intranasal desmopressin acetate by spray in a dose of 300 micrograms 4
- Treatment of mild hemophilia A, as assessed in 8 patients with hemophilia A who received intranasal desmopressin acetate by spray in a dose of 300 micrograms 4
- Treatment of nocturnal enuresis, as evaluated in a prospective self-controlled study of 23 children with primary nocturnal enuresis who received intranasal DDAVP therapy at a dose of 15-30 micrograms at bedtime 5
Dosage and Administration
The dosage and administration of Desmopressin (DDAVP) intranasal spray vary depending on the condition being treated:
- For central diabetes insipidus, the dose is typically 10-20 µg once or twice daily, as seen in a case report where a 69-year-old man was treated with intranasal desmopressin at 10 µg twice daily 3
- For von Willebrand's disease and mild hemophilia A, the dose is typically 300 micrograms, as studied in 22 patients with von Willebrand's disease type I and 8 patients with hemophilia A 4
- For nocturnal enuresis, the dose is typically 15-30 micrograms at bedtime, as evaluated in a prospective self-controlled study of 23 children with primary nocturnal enuresis 5
Efficacy and Safety
The efficacy and safety of Desmopressin (DDAVP) intranasal spray have been evaluated in several studies:
- A case report found that intranasal desmopressin was effective in treating central diabetes insipidus, but caused severe hyponatremia in a 69-year-old man 3
- A study of 22 patients with von Willebrand's disease type I and 8 patients with hemophilia A found that intranasal desmopressin acetate by spray was effective and safe in treating these conditions 4
- A prospective self-controlled study of 23 children with primary nocturnal enuresis found that intranasal DDAVP therapy was effective and safe in treating this condition, with 17 children (81%) responding with a more than 50% reduction in frequency of enuresis 5