Pharmacology · Vasopressin and its analogues
Desmopressin !
A synthetic antidiuretic hormone that makes the kidney hold water. Used for central diabetes insipidus, bedwetting and some bleeding disorders.
Updated 2026-11-01
Also called: DDAVP (1-deamino-8-D-arginine vasopressin)
The figure shows arginine vasopressin, the natural hormone (a peptide chain), bound to the human V2 receptor with its G protein; desmopressin is a modified vasopressin that binds the same site.
Mechanism of action
Desmopressin is vasopressin with two changes (the first amino acid deaminated and D-arginine in place of L-arginine) that make it last longer and select the V2 receptor. In the collecting duct, V2 activation raises cAMP and inserts aquaporin-2 water channels, so water is reabsorbed and urine volume falls. It also raises factor VIII and von Willebrand factor levels by releasing them from endothelial stores, with little pressor effect.
- Desmopressin activates V2 receptors in the renal collecting duct
- Gs raises cAMP; aquaporin-2 channels move to the luminal membrane
- Water is reabsorbed and urine becomes concentrated
- In vessels it releases von Willebrand factor and factor VIII
Pharmacokinetics
- Absorption
- Given by mouth, under the tongue, in the nose, IV or subcutaneously; oral absorption is low, so doses differ by route
- Elimination
- Mainly by the kidneys, so it accumulates in kidney failure
- Half-life
- Longer-acting than natural vasopressin
Indications
- Central (cranial) diabetes insipidus, including after head injury or pituitary surgery
- Primary nocturnal enuresis (bedwetting)
- Haemophilia A and type 1 von Willebrand disease with measurable factor VIII, to prevent or control bleeding
Adverse effects
Common
- Headache
- Nausea and abdominal cramps
- Facial flushing
- Nasal irritation with the spray
Contraindications
- Hyponatraemia or a history of it
- Moderate to severe kidney impairment
- Syndrome of inappropriate antidiuretic hormone secretion (SIADH)
- Polydipsia or excessive fluid intake
- Use with loop diuretics or systemic or inhaled glucocorticoids
Key interactions
- Loop diuretics
- Higher risk of severe hyponatraemia (combination contraindicated)
- Systemic or inhaled glucocorticoids
- Higher risk of severe hyponatraemia (combination contraindicated)
- Drugs that promote water retention (for example tricyclic antidepressants, SSRIs, carbamazepine)
- Additive risk of hyponatraemia
What is monitored
- Serum sodium, especially when starting or changing the dose
- Urine volume and fluid intake
- Body weight
- Factor VIII and von Willebrand factor levels in bleeding disorders
Administration and safety
- Routes are not interchangeable: nasal, oral, sublingual and injectable products differ in potency
- Fluid intake is limited as instructed around doses, especially at night for bedwetting
- Look-alike risk with vasopressin: confirm the drug, product and route
Nursing care
- Check sodium before and during treatment; watch for headache, nausea, confusion or seizures
- Record fluid intake, urine output and daily weight
- Teach patients and parents the fluid limits around doses
- In bleeding disorders, note the response with factor levels as ordered
Pregnancy and breastfeeding
Decades of use in pregnancy have not shown a drug-related risk of malformations; it is used for diabetes insipidus when needed.
Test yourself
Think of the answer, then tap the question to see it.
What is the most dangerous adverse effect of desmopressin and why does it happen?
Hyponatraemia: V2 stimulation retains free water, which dilutes sodium, especially if the patient keeps drinking.
Why is desmopressin useful before minor surgery in type 1 von Willebrand disease?
It releases stored von Willebrand factor and factor VIII from the endothelium, raising their levels for a short time.
Which two drug groups are contraindicated with desmopressin because of hyponatraemia risk?
Loop diuretics and systemic or inhaled glucocorticoids.
Related drugs
← Back to the class: Vasopressin and its analogues
Educational content on how drugs work; not a prescribing guide and no substitute for a health professional's advice. No doses are given.
Sources: Desmopressin: MedlinePlus Drug Information (MedlinePlus (U.S. National Library of Medicine), 2026); DailyMed - DESMOPRESSIN ACETATE injection, solution (DailyMed (U.S. National Library of Medicine), 2026); ATCDDD - ATC/DDD Index (WHO Collaborating Centre for Drug Statistics Methodology, 2026); Farmacología básica y clínica (Katzung), 16.ª ed., cap. 37 (McGraw Hill, 2025).
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Representative model, for educational purposes only.