Desmopressin is the non-proprietary name for an anti-diuretic primarily used in diabetes insipidus and bedwetting. Less commonly it is used following injury or surgery near the pituitary region of the brain, or as a clotting agent in patients with mild to moderate hemophilia A or von Willebrand disease. It has seen widespread use since its introduction in the 1970s.

Desmopressin is available in several formulas and sold under a wide variety of names. Patients who prefer tablets or orally-dissolving tablets typically buy desmopressin as DDAVP, Stimate, Minirin, or DesmoMelt. Alternatively, patients who prefer the nasal spray version buy desmopressin as DDAVP Nasal Spray or Minirin Nasal Spray. The medication is also available as an injection, but this is typically reserved for use in a healthcare setting.

Product Overview

Desmopressin is a synthetic version of the naturally-occurring hormone vasopressin, which is responsible for increasing water permeability in renal tubular cells. When permeability is increased, the need for excessive urination and excessive thirst decreases. This has obvious benefits with respect to diabetes insipidus and bedwetting.

The medication also stimulates release of clotting factoribly effective in severe cases, however.

Fluid regulation, particularly at night, is common with desmopressin use. Between that and taking the medication, electrolyte imbalance is possible---in fact, the USA no longer approves desmopressin nasal sprays for children for exactly that reason. This effect is reduced with tablets or orally-dissolving tablet use, but those individuals prone to electrolyte imbalances may not want to buy desmopressin in any form.

Treating Diabetes Insipidus

Treating diabetes insipidus is largely personalized according to patient response, and of course according to age. Desmopressin can be used in any age, but patients under age 13 will need modified doses. The end goal is to get an adequate response---sufficient sleep (not needing to get up to urinate) and sufficient turnover of water, using the lowest possible dose.

In otherwise healthy patients age 13 and up, if using tablets:

• Start with 0.05 mg twice per day (1/2 of the 0.1 mg tablet; tablets can be split)
• Dosage may be increased according to patient response.
• The majority of patients find 0.1 to 0.8 mg per day to be sufficient.

And in patients age 13 and up using nasal spray:

• Start with 10 mcg (one spray), administered in a single dose.
• Dosage may be increased up to 40 mcg (four sprays) three or four times per day according to patient response.
• The majority of patients find 20 mcg (two sprays) taken twice per day to be sufficient.

Effects should be noticeable a few days after starting treatment. A doctor may recommend adjusting fluid intake, particularly before bed. Treatment may continue indefinitely.

Stopping Bedwetting

Desmopressin is typically used in patients age 6 and up, for the simple reason that under age 6 bedwetting is normal and it's generally not treated with medications. Often patients much older buy desmopressin to help with accidents.

Fluid intake should be minimized one hour prior to administering DDAVP, and maintained for at least 8 hours after a dose has been administered. Small sips of water can be given if needed.

If taking tablets or orally-dissolving tablets:

• Start with 0.2 mg before bedtime.
• Dosage may be increased to 0.4 or 0.6 mg before bedtime if needed.
• Do not exceed 0.6 mg in children. If it doesn't produce results at this dosage, alternatives should be considered.

And nasal spray:

• Start with 10 mcg (one spray) before bed.
• This may be increased up to 40 mcg (four sprays) according to patient response.
• If 40 mcg does not produce desired results, alternative products should be considered.

Treatment should continue for three months, after which it should be stopped for at least one week to see if bedwetting continues. If relapse occurs after three months, treatment may continue for another three months.

Some parents buy desmopressin for as-needed use, such as during sleepovers, to prevent bedwetting, once an effective dose is known.

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