desmopressine

Desmopressine, also spelled desmopressin, is a synthetic analogue of the antidiuretic hormone vasopressin. It has potent antidiuretic effects with reduced peripheral vasoconstriction, achieved mainly by selective activation of vasopressin V2 receptors in the renal collecting ducts. This promotes insertion of aquaporin-2 water channels, increasing water reabsorption and reducing urine output. Desmopressine also stimulates release of von Willebrand factor and factor VIII from endothelial stores, which underlies its use in certain bleeding disorders.

Indications for desmopressine include central diabetes insipidus, where it compensates for deficient vasopressin activity; nocturnal enuresis (bedwetting) in children older than about five years, when behavioral measures have failed; and mild von Willebrand disease or mild hemophilia A as a complement to bleeding management in procedures or surgeries, due to the rise in circulating factor VIII and von Willebrand factor.

Administration is available as intranasal spray, oral tablet, and parenteral solution. Dosing is route- and indication-dependent and is typically started at low levels and adjusted based on response and safety monitoring. Onset and duration vary by route; intranasal forms act relatively quickly, while oral forms are slower, with effects lasting several hours.

Safety considerations include a risk of hyponatremia and water intoxication, especially with excessive fluid intake or in vulnerable populations (children, the elderly, renal impairment). Desmopressine is ineffective in nephrogenic diabetes insipidus. Caution is advised in patients with cardiovascular disease, hyponatremia, or conditions predisposing to fluid retention, and it may interact with drugs that impact sodium balance.