Section 13 · Monograph
Desmopressin
Reviewed Nov 2026FDA label
DDAVPVasopressin analog (V2 agonist)
- Forms
- Inj: 4mcg/mL | NS: 10mcg/spray | Tab: 0.1, 0.2mg
- Dose
- Central diabetes insipidus: 2-4mcg/day IV/SC in 2 divided doses; nasal 10-40mcg/day; oral 0.05-0.2mg BID-TID, titrated to urine output and sodium
- MOA
- V2 receptor agonism, ↑renal water reabsorption
Indications
- Central (cranial) diabetes insipidusFDA-labeled
- Primary nocturnal enuresisFDA-labeled
- Hemophilia A and type 1 von Willebrand disease (injection)FDA-labeled
Off-Label Uses
- Diabetes insipidus after pituitary surgery or traumatic brain injuryOff-label
Mechanism of Action
- Synthetic vasopressin analog with selective V2 receptor agonism, increasing renal collecting-duct water reabsorption and concentrating urine
Full Dosing
Adult / usual
- Central DI: 2-4mcg/day IV or SC in 2 divided doses; intranasal 10-40mcg/day in 1-3 doses; oral 0.05-0.2mg two to three times daily, titrated to urine output and serum sodium
- Perioperative/neurosurgical DI: often 1-2mcg IV/SC every 12 hours, titrated to urine output, osmolality and sodium
- Restrict fluids as appropriate to avoid water intoxication
Contraindications
- Hyponatremia or history of hyponatremia
- Moderate to severe renal impairment (CrCl below 50mL/min) for oral/nasal forms
- Excessive fluid intake states; known hypersensitivity
Drug Interactions
- SSRIs, tricyclics, carbamazepine, loop diuretics and NSAIDs raise hyponatremia risk
- Other vasopressors may be additive
Adverse Effects
- Hyponatremia with seizures
- Fluid retention and headache
- Facial flushing, nausea
- Nasal irritation (intranasal form)
Monitoring Parameters
- Serum sodium (frequent early in therapy), serum and urine osmolality
- Urine output and fluid balance
- Weight
Pregnancy & Lactation
- Used for diabetes insipidus in pregnancy with monitoring
- Small amounts in milk; generally compatible