desmopressin
Brand: DDAVP, Stimate
Prototype Drug
Drug Class: posterior pituitary hormone analog
Drug Family: hormone
Subclass: V2 vasopressin receptor agonist
Organ Systems: renalcardiovascular
Mechanism of Action
Synthetic ADH analog; activates V2 receptors in collecting duct causing insertion of aquaporin-2 water channels increasing free water reabsorption; also stimulates vWF and factor VIII release from endothelial cells.
V2 vasopressin receptor (renal collecting duct)
Indications
- central diabetes insipidus
- nocturnal enuresis
- von Willebrand disease type 1 (hemostasis)
- mild hemophilia A
- uremic bleeding
Contraindications
- psychogenic polydipsia
- hyponatremia
- severe renal impairment
- type 2B vWD or platelet-type vWD
Adverse Effects
Common
- hyponatremia
- headache
- flushing
- nausea
Serious
- severe hyponatremia (seizures)
- water intoxication
Pharmacokinetics (ADME)
| Absorption | oral: 5% bioavailability; intranasal: 10-20%; SC/IV near 100% |
| Distribution | moderate |
| Metabolism | hepatic |
| Excretion | renal |
| Half-life | 75 min (IV), 3.3h (intranasal) |
| Onset | 1-4 hours (intranasal) |
| Peak | 1-5 hours |
| Duration | 8-20 hours |
| Protein Binding | low |
| Vd | moderate |
Drug Interactions
| Drug / Agent | Mechanism | Severity |
|---|---|---|
| carbamazepine/chlorpropamide | potentiate ADH effect — hyponatremia risk | major |
| indomethacin | enhances desmopressin response | moderate |
Nursing Considerations
- Monitor serum sodium closely — hyponatremia risk with repeated doses
- Restrict fluid intake during therapy (free water restriction to prevent hyponatremia)
- For hemostasis: intranasal or IV before procedures in vWD type 1 or mild hemophilia A
- Nocturnal enuresis: oral tablet at bedtime; limit fluids 1 hour before to 8 hours after
Clinical Pearls
- V2 agonism without V1 pressor activity — no vasoconstriction at therapeutic doses
- Tachyphylaxis develops with repeated dosing due to receptor downregulation
Safety Profile
Pregnancy use-with-caution
Lactation use-with-caution
Renal Adjustment Required
Hepatic Adjustment Not required
TDM Not required
Concordance Terms
Cross-referenced clinical concepts — click any term to see all content where it appears.