Desmopressin
A vasopressin analogue that concentrates urine without raising blood pressure, and releases clotting factors: approved since 1978, with hyponatraemia as its defining risk
Desmopressin (DDAVP) is a synthetic analogue of vasopressin with stronger antidiuretic action, far weaker effects on blood pressure and a longer duration. It is the standard treatment for central diabetes insipidus, it treats bedwetting in children, and by releasing factor VIII and von Willebrand factor it prevents and treats bleeding in mild haemophilia A and von Willebrand disease. FDA first approved it in 1978. Because it makes the body hold water, its most serious risk is hyponatraemia, which can be fatal.
What is it?
Vasopressin, the pituitary's antidiuretic hormone, also raises blood pressure. Desmopressin removes the first amino acid's amine and swaps L-arginine at position 8 for D-arginine; the result has greater antidiuretic potency, markedly weaker pressor activity and a longer half-life. It acts on the V2 receptors of the kidney's collecting ducts, so the kidneys return more water to the blood. That makes it the treatment of choice for central diabetes insipidus, where the pituitary makes too little vasopressin; it does not work in nephrogenic diabetes insipidus, where the kidney cannot respond, except in some patients given high doses.
Its second use came from a side effect. Desmopressin raises the blood's factor VIII and von Willebrand factor, typically two to six times, for about eight hours. Since its first clinical use in 1977 it has become the treatment of choice for mild haemophilia A and many types of von Willebrand disease, sparing patients plasma products; a high-strength nasal spray, Stimate, let patients treat themselves at home, and in an open-label trial of 333 patients bleeding episodes were rated well controlled 95% of the time. It has also shortened bleeding times in kidney failure and reduced early blood loss after heart-valve surgery.
Its third use is urine volume at night. In children with bedwetting, a nasal spray more than doubled dry nights against placebo in an early crossover trial, and the melt formulation later outperformed tablets. In adults with nocturia, desmopressin halved night-time voids in 46% of women against 7% on placebo, and FDA approved two low-dose products for nocturia from nocturnal polyuria, Noctiva in 2017 and Nocdurna in 2018; both are now listed as discontinued. Women respond at lower doses than men, which matters because age and female sex are risk factors for hyponatraemia.
That is the drug's defining danger. By making the body retain water, desmopressin can cause water intoxication and hyponatraemia, which can be fatal unless recognised and treated; the DDAVP label contraindicates it in people with hyponatraemia or a history of it and in severe renal impairment, and recommends restricting fluid. Rarer reactions include coronary spasm, reported in a man with suspected endothelial dysfunction. FDA first approved desmopressin, as DDAVP, on February 21, 1978.
Mechanism of Action
Desmopressin acts on one of vasopressin's receptors and largely spares the other, and it releases stored clotting proteins.
V2 receptors and water
As a V2-selective agonist it increases water reabsorption in the kidney's collecting ducts, concentrating urine and reducing its volume; the effect needs a kidney that can respond, which is why it fails in most nephrogenic diabetes insipidus.
Factor VIII and von Willebrand factor
It raises plasma factor VIII and von Willebrand factor, typically two- to six-fold, returning to baseline within about eight hours, enough to cover minor surgery or a bleed in mild haemophilia A and von Willebrand disease.
Little effect on blood pressure
Its structural changes give markedly diminished pressor activity compared with vasopressin, along with greater antidiuretic potency and a longer duration of action.
Water retention and sodium
Because it makes the kidneys hold water, excess fluid intake dilutes blood sodium; age, female sex and dose raise the risk, and women reduced night-time urine at lower doses than men without differences in drug levels.
Published Research
These are studies of desmopressin read from their PubMed abstracts: reviews of its pharmacology and haemostatic use, trials in bleeding disorders, surgery and kidney failure, trials in bedwetting and nocturia, and a case report of a rare adverse reaction.
The drug in 1985
Desmopressin has enhanced antidiuretic potency, markedly diminished pressor activity and a longer half-life and duration of action than vasopressin. It is the treatment of choice for central diabetes insipidus, given intranasally or by injection, and a newly approved use transiently raises factor VIII and von Willebrand factor enough to allow minor surgery in mild haemophilia and von Willebrand disease.
Desmopressin in haemophilia
Since its first clinical use in 1977, desmopressin has become the treatment of choice for haemophilia A with factor VIII activity above 5%, sparing patients the viral risks of non-inactivated plasma concentrates. Factor VIII activity typically rises two- to six-fold and returns to baseline within about 8 hours; subcutaneous and nasal forms allow home treatment.
High-strength nasal spray (Stimate) in 333 patients
In an open-label multicentre trial in mild haemophilia A, type 1 von Willebrand disease and symptomatic carriers, 278 patients used 2,170 doses of the 1.5 mg/mL spray. Patients rated efficacy excellent or good in 95% of 784 bleeding episodes, excellent in 93% of prophylactic uses, and excellent after 92% of daily uses for heavy menstrual bleeding.
Bleeding time in kidney failure
In a double-blind, placebo-controlled crossover study in nine patients with uraemia, subcutaneous desmopressin shortened the prolonged bleeding time within an hour (P<0.01), normalising it in seven; at four hours it was still shorter than baseline but normal in only three. Placebo had no effect.
Heart-valve surgery: 102 patients
A single intravenous dose of 0.3 µg/kg during rewarming reduced blood loss over the first 6 hours after valve surgery (202 against 258 ml, P=0.023) and fresh frozen plasma transfusion (3.8% against 12%), without changing platelet aggregation, red-cell transfusion or blood loss at 24 hours.
Nocturia in women: 144 randomised
After dose titration, responders were randomised to oral desmopressin or placebo for three weeks. Night-time voids fell by at least half in 33 of 72 women (46%) on desmopressin against 5 of 72 (7%) on placebo (P<0.0001), with longer sleep before the first void and less nocturnal urine.
Noctiva for nocturia
Nocturia affects 70% of people over 70, and nocturnal polyuria is present in up to 88% of adults with nocturia. Noctiva, a desmopressin nasal spray, was approved by FDA in March 2017 for nocturia due to nocturnal polyuria and was studied in adults over 50; 49% on the higher dose had at least a halving of night-time voids.
Women respond at lower doses
In an exploratory analysis of three trials, desmopressin reduced nocturnal urine volume more in women than men at the lower melt doses of 10 and 25 µg, a difference not explained by pharmacokinetics; the modelled ED50 was 43.2 µg for men and 16.1 µg for women. Age and female sex are known risk factors for desmopressin-induced hyponatraemia.
Bedwetting: a crossover trial in 52 children
Finnish children aged 5 to 13 whose bedwetting had resisted earlier treatments received 20 µg nasal desmopressin or placebo in four 3-week periods. Dry nights rose from 0.6 a week before treatment to 4.3 and 4.6 during desmopressin periods, against 2.1 and 2.4 on placebo (P<0.01).
Melt against tablet in 221 children
In a crossover analysis of children aged 5 to 15 already taking desmopressin tablets, the orally disintegrating melt made a partial or full response more likely than tablets (odds ratio 2.0, 95% CI 1.07 to 3.73), and better compliance went with fewer wet nights on both formulations.
Nephrogenic diabetes insipidus in Japanese children
In a nationwide survey by the Japanese Society for Pediatric Endocrinology of children with congenital nephrogenic diabetes insipidus, whose kidneys resist vasopressin, a secondary survey of 13 patients given desmopressin found it effective in five.
Coronary spasm after oral desmopressin
A 60-year-old man developed chest pain at rest a week after starting oral desmopressin for nocturnal polyuria. Angiography showed no fixed stenosis, but acetylcholine provoked severe coronary spasm with ST elevation; desmopressin was stopped. The authors suggest it may provoke spasm in patients with endothelial dysfunction.
Dosing Data
Desmopressin is a prescription medicine dosed by indication and formulation. The label sets the uses; the dose is individual.
Educational information, not medical advice. Each dose above is tagged with its source: an approved label, a published human study, animal data, or amounts reported by users. None is a recommendation for you. An unapproved compound has no established safe or effective human dose, and products sold for “research use only” are not made or tested for people. Talk to a doctor before acting on anything on this site, including before you start, stop or change any medicine or dose. Full medical disclaimer.
Side Effects & Contraindications
Reported Side Effects
From the DDAVP label and the studies above.
Contraindications & Cautions
From the DDAVP tablet label; a clinician decides.
Legal Status
Desmopressin is an FDA-approved prescription medicine.
Frequently Asked Questions
?What is desmopressin used for?
Central diabetes insipidus, bedwetting in children, and preventing or treating bleeding in mild haemophilia A and von Willebrand disease. Low-dose forms were also approved for nocturia caused by producing too much urine at night.
?How is desmopressin different from vasopressin?
It has stronger antidiuretic action, much weaker effects on blood pressure and a longer duration, because two changes to the molecule favour the kidney's V2 receptors.
?What is the biggest risk?
Hyponatraemia: because it makes the body keep water, drinking too much can dilute blood sodium dangerously, which can be fatal. The label contraindicates it in people with low sodium or severe kidney impairment and recommends fluid restriction.
?How does it help bleeding?
It raises the blood's factor VIII and von Willebrand factor two- to six-fold for about eight hours, enough to cover minor surgery or a bleed in mild haemophilia A and many types of von Willebrand disease.
?Does it work for nephrogenic diabetes insipidus?
Generally no, because the kidney cannot respond to it; the label says it is ineffective, although high doses helped some children in a Japanese survey.
?Why is it on a peptide site?
It is a synthetic nine-amino-acid peptide, and it sits beside vasopressin, oxytocin and carbetocin in our encyclopedia.
References
- [fda-pi] Ferring Pharmaceuticals. DDAVP (desmopressin acetate) tablets, US prescribing information: indications (central diabetes insipidus; primary nocturnal enuresis), contraindications (hyponatremia or history of hyponatremia; severe renal impairment), warnings (hyponatremia, fluid restriction) and pharmacokinetics (half-life 1.5 to 2.5 hours; terminal 3 hours, 9 hours in severe renal impairment). DailyMed version effective February 3, 2021; read September 30, 2026.
- [pubmed] Richardson DW, et al. "Desmopressin." Ann Intern Med, 1985;103(2):228-39. PMID: 3893256.
- [pubmed] Castaman G. "Desmopressin for the treatment of haemophilia." Haemophilia, 2008;14 Suppl 1:15-20. PMID: 18173690.
- [pubmed] Leissinger C, et al. "High-dose DDAVP intranasal spray (Stimate) for the prevention and treatment of bleeding in patients with mild haemophilia A, mild or moderate type 1 von Willebrand disease and symptomatic carriers of haemophilia A." Haemophilia, 2001;7(3):258-66. PMID: 11380629.
- [pubmed] Viganò GL, et al. "Subcutaneous desmopressin (DDAVP) shortens the bleeding time in uremia." Am J Hematol, 1989;31(1):32-5. PMID: 2705441.
- [pubmed] Jin L, et al. "Effect of desmopressin on platelet aggregation and blood loss in patients undergoing valvular heart surgery." Chin Med J (Engl), 2015;128(5):644-7. PMID: 25698197.
- [pubmed] Lose G, et al. "Efficacy of desmopressin (Minirin) in the treatment of nocturia: a double-blind placebo-controlled study in women." Am J Obstet Gynecol, 2003;189(4):1106-13. PMID: 14586363.
- [pubmed] Cohn JA, et al. "Desmopressin acetate nasal spray for adults with nocturia." Expert Rev Clin Pharmacol, 2017;10(12):1281-1293. PMID: 29048257.
- [pubmed] Juul KV, et al. "Gender difference in antidiuretic response to desmopressin." Am J Physiol Renal Physiol, 2011;300(5):F1116-22. PMID: 21367921.
- [pubmed] Terho P. "Desmopressin in nocturnal enuresis." J Urol, 1991;145(4):818-20. PMID: 2005708.
- [pubmed] Juul KV, et al. "Desmopressin melt improves response and compliance compared with tablet in treatment of primary monosymptomatic nocturnal enuresis." Eur J Pediatr, 2013;172(9):1235-42. PMID: 23677249.
- [pubmed] Ikegawa K, et al. "Use, efficacy, and safety of desmopressin for congenital nephrogenic diabetes insipidus in children: a nationwide survey." Endocr J, 2026;73(5):597-605. PMID: 41605691.
- [pubmed] Adachi Y, et al. "Coronary Spastic Angina Induced after Oral Desmopressin (DDAVP) Administration." Intern Med, 2016;55(24):3603-3606. PMID: 27980260.
- [fda] FDA. Drugs@FDA (openFDA): DDAVP NDA 017922 (February 21, 1978), NDA 018938 (March 30, 1984), NDA 019955 (September 6, 1995); Stimate NDA 020355 (March 7, 1994); Noctiva NDA 201656 (March 3, 2017); Nocdurna NDA 022517 (June 21, 2018). Read September 30, 2026.
Sources & Citations
Every study on this page was read from its PubMed record. Indications, warnings and pharmacokinetics come from the DDAVP tablet label on DailyMed, and approval dates from FDA's Drugs@FDA database, read September 30, 2026. Grey Peptides sells nothing and links to no vendor.
Medical Disclaimer: This content is for educational and informational purposes only. It is not medical advice, and nothing here is an instruction to obtain or use any compound. Talk to a licensed clinician about your own situation.