Last updated
Desmopressin ball-and-stick.png
Clinical data
Trade names DDAVP (deamino D-arginine vasopressin), Minirin, others
AHFS/ Monograph
  • AU:B2
Routes of
IV, IM, SC, intranasal, by mouth, under the tongue
ATC code
Legal status
Legal status
Pharmacokinetic data
Bioavailability Variable; 0.08–0.16% (by mouth)
Protein binding 50%
Elimination half-life 1.5–2.5 hours
Excretion Kidney
  • (2S)-N-[(2R)-1-[(2-amino-2-oxoethyl)amino]-5-
CAS Number
PubChem CID
CompTox Dashboard (EPA)
ECHA InfoCard 100.037.009 OOjs UI icon edit-ltr-progressive.svg
Chemical and physical data
Formula C46H64N14O12S2
Molar mass 1069.22 g·mol−1
3D model (JSmol)
  • c1ccc(cc1)C[C@H]2C(=O)N[C@H](C(=O)N[C@H](C(=O)N[C@@H](CSSCCC(=O)N[C@H](C(=O)N2)Cc3ccc(cc3)O)C(=O)N4CCC[C@H]4C(=O)N[C@H](CCCNC(=N)N)C(=O)NCC(=O)N)CC(=O)N)CCC(=O)N
  • InChI=1S/C46H64N14O12S2/c47-35(62)15-14-29-40(67)58-32(22-36(48)63)43(70)59-33(45(72)60-18-5-9-34(60)44(71)56-28(8-4-17-52-46(50)51)39(66)53-23-37(49)64)24-74-73-19-16-38(65)54-30(21-26-10-12-27(61)13-11-26)41(68)57-31(42(69)55-29)20-25-6-2-1-3-7-25/h1-3,6-7,10-13,28-34,61H,4-5,8-9,14-24H2,(H2,47,62)(H2,48,63)(H2,49,64)(H,53,66)(H,54,65)(H,55,69)(H,56,71)(H,57,68)(H,58,67)(H,59,70)(H4,50,51,52)/t28-,29+,30+,31+,32+,33+,34+/m1/s1 X mark.svgN
 X mark.svgNYes check.svgY  (what is this?)    (verify)

Desmopressin, sold under the trade name DDAVP among others, is a medication used to treat diabetes insipidus, bedwetting, hemophilia A, von Willebrand disease, and high blood urea levels. [1] In hemophilia A and von Willebrand disease, it should only be used for mild to moderate cases. [1] It may be given in the nose, by injection into a vein, by mouth, or under the tongue. [1]


Common side effects include headaches, diarrhea, and low blood sodium. [1] The low blood sodium that results may cause seizures. [1] It should not be used in people with significant kidney problems or low blood sodium. [1] It appears to be safe to use during pregnancy. [1] It is a synthetic analogue of vasopressin, the hormone that plays roles in the control of the body’s osmotic balance, blood pressure regulation, kidney function, [2] and reduction of urine production. [1]

Desmopressin was approved for medical use in the United States in 1978. [1] It is on the World Health Organization's List of Essential Medicines. [3] It is available as a generic medication. [1]

Medical uses

Bed wetting

Desmopressin is used to treat nocturnal enuresis (bedwetting). It is usually prescribed in the form of desmopressin acetate, by mouth. Children taking DDAVP have 2.2 fewer wet nights per week and are 4.5 times more likely to sleep without disruption compared with placebo. [4] [5]


In 2017, the FDA approved Desmopressin has some benefit for adults who have problems with nocturia (having a need to wake up at night for urination). [6] [7]

Bleeding disorders

Desmopressin (DDAVP) is usually the first line treatment for mild to moderate type 1 von Willebrand disease. [1] It is not recommended in severe disease or in those with abnormal factor VIII. [1] Usefulness in type 2A, 2M, or 2N von Willebrand disease is variable. [1] Generally not recommended in 2B and type 3 von Willebrand disease. [1]

Desmopressin is only recommended in mild hemophilia A. [1] It may be used both for bleeding due to trauma or to try to prevent bleeding due to surgery. [1] It is not effective in the treatment of hemophilia B (factor IX deficiency) or severe hemophilia A. [1] May also be used in uremia induced bleeding. [1]

Diabetes insipidus

Desmopressin is used in the treatment of central diabetes insipidus (DI) as a replacement for endogenous antidiuretic hormone (ADH) that is in insufficient quantity due to decreased or non-existent secretion or production of ADH by the posterior pituitary or hypothalamus, respectively. It is also used in the diagnostic workup for diabetes insipidus, in order to distinguish central from DI due to the kidneys. Desmopressin is not effective at treating nephrogenic DI, thus a positive response is generally indicative of central DI.

Side effects

US drug regulators added warning to the nasal sprays after two people died and fifty-nine other people had seizures. This occurred due to hyponatremia, a deficit of the body's sodium levels, and the nasal spray is no longer approved for use in children in the United States. [8] However, US drug regulators have said that desmopressin tablets can still be considered safe for treatment of nocturnal enuresis in children as long as the person is otherwise healthy.

Patients must stop taking desmopressin if they develop severe vomiting and diarrhea, fever, the flu, or severe cold. Patients should also be very cautious about taking desmopressin during hot weather conditions or following strenuous exercise, as these conditions can place stress on the body's electrolyte and water balance.

A body needs to maintain a balance of water and sodium. If sodium levels become too low (hyponatremia) – either as a result of increased water take-up or reduced salt levels – a person may have seizures and, in extreme cases, may die. [9]

Mechanism of action

Desmopressin works by limiting the amount of water that is eliminated in the urine; that is, it is an antidiuretic. It works at the level of the renal collecting duct by binding to V2 receptors, which signal for the translocation of aquaporin channels via cytosolic vesicles to the apical membrane of the collecting duct. The presence of these aquaporin channels in the distal nephron causes increasing water reabsorption from the urine, which becomes passively re-distributed from the nephron to systemic circulation by way of basolateral membrane channels. [10] Desmopressin also stimulates release of von Willebrand factor from endothelial cells by acting on the V2 receptor. It also increases endogenous levels of factor VIII, making it useful in the treatment of hemophilia A. [11]

Desmopressin is degraded more slowly than recombinant vasopressin, and requires less frequent administration. In addition, it has little effect on blood pressure, while vasopressin may cause arterial hypertension. [12] Vasopressin stimulates the release of ACTH, which indirectly increases responsiveness of alpha-1 receptor in blood vessel smooth muscle, increasing vessel tone and blood pressure. [2] Several studies have shown that Desmopressin does not stimulate ACTH release (except in Cushing's Disease), [13] [14] [15] and therefore does not directly raise blood pressure, however, one study showed that it stimulates ACTH release in over 50% of healthy subjects. [16] Additionally, desmopressin is able to enhance ACTH and cortisol release in normal subjects following oCRH administration, but not in patients with anorexia nervosa. [15]


Desmopressin (1-deamino-8-D-arginine vasopressin) is a synthetic form of the normal human hormone arginine vasopressin (the antidiuretic hormone, or ADH), a peptide containing nine amino acids.

Compared to vasopressin, desmopressin's first amino acid has been deaminated, and the arginine at the eighth position is in the dextro rather than the levo form (see stereochemistry).

Related Research Articles

<span class="mw-page-title-main">Haemophilia</span> Genetic disease involving blood clotting

Haemophilia, or hemophilia, is a mostly inherited genetic disorder that impairs the body's ability to make blood clots, a process needed to stop bleeding. This results in people bleeding for a longer time after an injury, easy bruising, and an increased risk of bleeding inside joints or the brain. Those with a mild case of the disease may have symptoms only after an accident or during surgery. Bleeding into a joint can result in permanent damage while bleeding in the brain can result in long term headaches, seizures, or a decreased level of consciousness.

<span class="mw-page-title-main">Diabetes insipidus</span> Condition characterized by large amounts of dilute urine and increased thirst

Diabetes insipidus (DI), alternately called arginine vasopressin deficiency (AVP-D) or arginine vasopressin resistance (AVP-R), is a condition characterized by large amounts of dilute urine and increased thirst. The amount of urine produced can be nearly 20 liters per day. Reduction of fluid has little effect on the concentration of the urine. Complications may include dehydration or seizures.

Hyponatremia or hyponatraemia is a low concentration of sodium in the blood. It is generally defined as a sodium concentration of less than 135 mmol/L (135 mEq/L), with severe hyponatremia being below 120 mEq/L. Symptoms can be absent, mild or severe. Mild symptoms include a decreased ability to think, headaches, nausea, and poor balance. Severe symptoms include confusion, seizures, and coma; death can ensue.

<span class="mw-page-title-main">Haemophilia A</span> Medical condition

Haemophilia A is a genetic deficiency in clotting factor VIII, which causes increased bleeding and usually affects males. In the majority of cases it is inherited as an X-linked recessive trait, though there are cases which arise from spontaneous mutations.

<span class="mw-page-title-main">Vasopressin</span> Mammalian hormone released from the pituitary gland

Human vasopressin, also called antidiuretic hormone (ADH), arginine vasopressin (AVP) or argipressin, is a hormone synthesized from the AVP gene as a peptide prohormone in neurons in the hypothalamus, and is converted to AVP. It then travels down the axon terminating in the posterior pituitary, and is released from vesicles into the circulation in response to extracellular fluid hypertonicity (hyperosmolality). AVP has two primary functions. First, it increases the amount of solute-free water reabsorbed back into the circulation from the filtrate in the kidney tubules of the nephrons. Second, AVP constricts arterioles, which increases peripheral vascular resistance and raises arterial blood pressure.

von Willebrand disease Medical condition

Von Willebrand disease (VWD) is the most common hereditary blood-clotting disorder in humans. An acquired form can sometimes result from other medical conditions. It arises from a deficiency in the quality or quantity of von Willebrand factor (VWF), a multimeric protein that is required for platelet adhesion. It is known to affect several breeds of dogs as well as humans. The three forms of VWD are hereditary, acquired, and pseudo or platelet type. The three types of hereditary VWD are VWD type 1, VWD type 2, and VWD type 3. Type 2 contains various subtypes. Platelet type VWD is also an inherited condition.

<span class="mw-page-title-main">Nocturnal enuresis</span> Involuntary urination while asleep

Nocturnal enuresis, also informally called bedwetting, is involuntary urination while asleep after the age at which bladder control usually begins. Bedwetting in children and adults can result in emotional stress. Complications can include urinary tract infections.

<span class="mw-page-title-main">Adrenal insufficiency</span> Medical condition

Adrenal insufficiency is a condition in which the adrenal glands do not produce adequate amounts of steroid hormones. The adrenal gland normally secretes glucocorticoids, mineralocorticoids, and androgens. These hormones are important in regulating blood pressure, electrolytes, and metabolism as a whole. Deficiency of these hormones leads to symptoms ranging from abdominal pain, vomiting, muscle weakness and fatigue, low blood pressure, depression, mood and personality changes to organ failure and shock. An adrenal crisis may occur if the body is subjected to stress, such as an accident, injury, surgery, or severe infection; this is a life-threatening medical condition resulting from severe deficiency of cortisol in the body. Death may quickly follow.

<span class="mw-page-title-main">Hypopituitarism</span> Medical condition

Hypopituitarism is the decreased (hypo) secretion of one or more of the eight hormones normally produced by the pituitary gland at the base of the brain. If there is decreased secretion of one specific pituitary hormone, the condition is known as selective hypopituitarism. If there is decreased secretion of most or all pituitary hormones, the term panhypopituitarism is used.

Syndrome of inappropriate antidiuretic hormone secretion (SIADH) is characterized by excessive unsuppressible release of antidiuretic hormone (ADH) either from the posterior pituitary gland, or an abnormal non-pituitary source. Unsuppressed ADH causes an unrelenting increase in solute-free water being returned by the tubules of the kidney to the venous circulation.

<span class="mw-page-title-main">Demeclocycline</span> Chemical compound

Demeclocycline is a tetracycline antibiotic which was derived from a mutant strain of Streptomyces aureofaciens.

Nocturia is defined by the International Continence Society (ICS) as “the complaint that the individual has to wake at night one or more times for voiding .” The term is derived from Latin nox, night, and Greek [τα] ούρα, urine. Causes are varied and can be difficult to discern. Although not every patient needs treatment, most people seek treatment for severe nocturia, waking up to void more than 2–3 times per night.

Nephrogenic diabetes insipidus, also known as renal diabetes insipidus, is a form of diabetes insipidus primarily due to pathology of the kidney. This is in contrast to central or neurogenic diabetes insipidus, which is caused by insufficient levels of antidiuretic hormone. Nephrogenic diabetes insipidus is caused by an improper response of the kidney to antidiuretic hormone, leading to a decrease in the ability of the kidney to concentrate the urine by removing free water.

<span class="mw-page-title-main">Primary polydipsia</span> Medical condition

Primary polydipsia and psychogenic polydipsia are forms of polydipsia characterised by excessive fluid intake in the absence of physiological stimuli to drink. Psychogenic polydipsia which is caused by psychiatric disorders, often schizophrenia, is often accompanied by the sensation of dry mouth. Some forms of polydipsia are explicitly non-psychogenic. Primary polydipsia is a diagnosis of exclusion.

<span class="mw-page-title-main">Vasopressin receptor 2</span> Protein-coding gene in the species Homo sapiens

Vasopressin receptor 2 (V2R), or arginine vasopressin receptor 2, is a protein that acts as receptor for vasopressin. AVPR2 belongs to the subfamily of G-protein-coupled receptors. Its activity is mediated by the Gs type of G proteins, which stimulate adenylate cyclase.

Pituitary apoplexy is bleeding into or impaired blood supply of the pituitary gland. This usually occurs in the presence of a tumor of the pituitary, although in 80% of cases this has not been diagnosed previously. The most common initial symptom is a sudden headache, often associated with a rapidly worsening visual field defect or double vision caused by compression of nerves surrounding the gland. This is often followed by acute symptoms caused by lack of secretion of essential hormones, predominantly adrenal insufficiency.

A vasopressin receptor antagonist (VRA) is an agent that interferes with action at the vasopressin receptors. Most commonly VRAs are used in the treatment of hyponatremia, especially in patients with congestive heart failure, liver cirrhosis or SIADH.

<span class="mw-page-title-main">Jeanne Lusher</span> American physician

Jeanne Marie Lusher, M.D. was an American physician, pediatric hematologist/oncologist, and a researcher in the field of bleeding disorders of childhood, and has served as the director of Hemostasis Program at the Children's Hospital of Michigan until her retirement on June 28, 2013.

<span class="mw-page-title-main">Adipsia</span> Medical condition

Adipsia, also known as hypodipsia, is a symptom of inappropriately decreased or absent feelings of thirst. It involves an increased osmolality or concentration of solute in the urine, which stimulates secretion of antidiuretic hormone (ADH) from the hypothalamus to the kidneys. This causes the person to retain water and ultimately become unable to feel thirst. Due to its rarity, the disorder has not been the subject of many research studies.

<span class="mw-page-title-main">Vasopressin (medication)</span> Chemical compound

Vasopressin infusions are in use for septic shock patients not responding to fluid resuscitation or infusions of catecholamines to increase the blood pressure while sparing the use of catecholamines. These argipressins have much shorter elimination half-life than synthetic non-arginine vasopresines with much longer elimination half-life of many hours. Further, argipressins act on V1a, V1b, and V2 receptors which consequently lead to higher eGFR and lower vascular resistance in the lungs. A number of injectable arginine vasopressins are in clinical use in the United States and the European Union. Pitressin among others, is a medication most commonly used in the treatment of frequent urination, increased thirst, and dehydration such as that resulting from diabetes insipidus, which causes increased and diluted urine. It is used to treat abdominal distension following some surgeries, and in stomach roentgenography. Vasopressin is a hormone that affects the kidneys and reduces urine flow.


  1. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 "Desmopressin Acetate". The American Society of Health-System Pharmacists. Archived from the original on 3 December 2016. Retrieved 2 December 2016.
  2. 1 2 Cuzzo, Brian; Padala, Sandeep A.; Lappin, Sarah L. (2021), "Physiology, Vasopressin", StatPearls, Treasure Island (FL): StatPearls Publishing, PMID   30252325 , retrieved 2021-06-29
  3. World Health Organization (2019). World Health Organization model list of essential medicines: 21st list 2019. Geneva: World Health Organization. hdl: 10665/325771 . WHO/MVP/EMP/IAU/2019.06. License: CC BY-NC-SA 3.0 IGO.
  4. Evans, JH (2001). "Evidence based management of nocturnal enuresis". BMJ (Clinical Research Ed.). 323 (7322): 1167–9. doi:10.1136/bmj.323.7322.1167. PMC   1121645 . PMID   11711411.
  5. "La prise en charge de l'énurésie nocturne primaire". Paediatr Child Health. 10 (10): 616–620. 2005. doi:10.1093/pch/10.10.616. PMC   2722621 . PMID   19668677.
  6. Ebell, MH; Radke, T; Gardner, J (Sep 2014). "A systematic review of the efficacy and safety of desmopressin for nocturia in adults". The Journal of Urology. 192 (3): 829–35. doi:10.1016/j.juro.2014.03.095. PMID   24704009.
  7. 1 2 "FDA approves first treatment for frequent urination at night due to overproduction of urine". (Press release). 3 March 2017. Archived from the original on 2017-03-06.
  8. Miranda Hitti (4 December 2007). "2 Deaths Spur sleep apnea Drug Warning". WebMD. Archived from the original on 2007-12-07. Retrieved 2011-04-18.
  9. "Information for Healthcare Professionals — Desmopressin Acetate (marketed as DDAVP Nasal Spray, DDAVP Rhinal Tube, DDAVP, DDVP, Minirin, and Stimate Nasal Spray)". Center for Drug Evaluation and Research. FDA. December 4, 2007. Archived from the original on December 13, 2007.
  10. Friedman FM, Weiss JP (December 2013). "Desmopressin in the treatment of nocturia: clinical evidence and experience". Ther Adv Urol. 5 (6): 310–7. doi:10.1177/1756287213502116. PMC   3825109 . PMID   24294289.
  11. Loomans, Janneke I.; Kruip, Marieke J.H.A.; Carcao, Manuel; Jackson, Shannon; van Velzen, Alice S.; Peters, Marjolein; Santagostino, Elena; Platokouki, Helen; Beckers, Erik; Voorberg, Jan; van der Bom, Johanna G.; Fijnvandraat, Karin (March 2018). "Desmopressin in moderate hemophilia A patients: a treatment worth considering". Haematologica. 103 (3): 550–557. doi:10.3324/haematol.2017.180059. ISSN   0390-6078. PMC   5830393 . PMID   29305412.
  12. Sharman, Andrew; Low, James (2008-08-01). "Vasopressin and its role in critical care". Continuing Education in Anaesthesia, Critical Care & Pain. 8 (4): 134–137. doi: 10.1093/bjaceaccp/mkn021 . ISSN   1743-1816.
  13. Pecori Giraldi, F; Marini, E; Torchiana, E; Mortini, P; Dubini, A; Cavagnini, F (June 2003). "Corticotrophin-releasing activity of desmopressin in Cushing's disease: lack of correlation between in vivo and in vitro responsiveness". The Journal of Endocrinology. 177 (3): 373–9. doi: 10.1677/joe.0.1770373 . PMID   12773117.
  14. Colombo, P; Passini, E; Re, T; Faglia, G; Ambrosi, B (June 1997). "Effect of desmopressin on ACTH and cortisol secretion in states of ACTH excess". Clinical Endocrinology. 46 (6): 661–8. doi:10.1046/j.1365-2265.1997.1330954.x. PMID   9274696. S2CID   23167207.
  15. 1 2 Foppiani, L; Sessarego, P; Valenti, S; Falivene, MR; Cuttica, CM; Giusti Disem, M (October 1996). "Lack of effect of desmopressin on ACTH and cortisol responses to ovine corticotropin-releasing hormone in anorexia nervosa". European Journal of Clinical Investigation. 26 (10): 879–83. doi:10.1111/j.1365-2362.1996.tb02133.x. PMID   8911861. S2CID   34560015.
  16. Scott, LV; Medbak, S; Dinan, TG (November 1999). "ACTH and cortisol release following intravenous desmopressin: a dose-response study". Clinical Endocrinology. 51 (5): 653–8. doi:10.1046/j.1365-2265.1999.00850.x. PMID   10594528. S2CID   27334220.

Further reading