Desmopressin is a synthetic analogue of the natural pituitary hormone arginine vasopressin (ADH). It has potent antidiuretic activity with minimal pressor effects. The 0.06mg oral lyophilisate (melt-in-mouth) formulation is primarily indicated for the treatment of nocturia due to idiopathic nocturnal polyuria in adults. It acts on V2 receptors in the renal collecting ducts to increase water reabsorption, reducing urine volume.
Adult: Nocturia: 0.06mg (one oral lyophilisate) placed under the tongue at bedtime. Allow to dissolve completely without water. Fluid intake should be restricted to a minimum from 1 hour before until 8 hours after administration. Diabetes Insipidus: Individualized. Oral tablet: 0.1-0.8 mg daily in divided doses.
Note: For Oral Lyophilisate (0.06mg): 1. Remove from blister with dry hands. 2. Place immediately under the tongue. 3. Do not chew, swallow, or take with water. 4. Allow it to dissolve completely (takes ~30-60 seconds). 5. Do not eat or drink for 1 hour before and at least 1 hour after taking the dose. For nocturia, take at bedtime after restricting fluids from late evening.
Desmopressin is a selective agonist for vasopressin V2 receptors located primarily on the basolateral membrane of the principal cells in the renal collecting ducts. Activation stimulates adenylate cyclase, increasing intracellular cAMP. This leads to the insertion of aquaporin-2 (AQP2) water channels into the apical membrane, greatly increasing the permeability of the collecting duct to water. This results in reabsorption of water from the renal tubules, concentration of urine, and reduction in urine volume.
Pregnancy: Category B: Animal studies show no risk, but no adequate human studies. Use only if potential benefit justifies potential risk to the fetus. Monitor for fluid overload/hyponatremia.
Driving: Generally safe. However, if hyponatremia occurs, it can cause dizziness, confusion, or seizures, impairing ability to drive or operate machinery. Patients should be cautioned.
| Loop Diuretics (Furosemide, Torsemide) | Increased risk of severe hyponatremia due to synergistic water retention and sodium loss. | Major |
| Thiazide Diuretics (Hydrochlorothiazide) | Increased risk of severe hyponatremia. | Major |
| Glucocorticoids (e.g., Prednisolone) | May reduce antidiuretic effect of desmopressin. | Moderate |
| SSRIs/SNRIs (e.g., Sertraline, Venlafaxine) | Increased risk of hyponatremia via SIADH-like effect. | Moderate |
| Tricyclic Antidepressants (e.g., Amitriptyline) | Increased risk of hyponatremia. | Moderate |
| Carbamazepine, Oxcarbazepine | Increased risk of hyponatremia. | Moderate |
| NSAIDs (e.g., Ibuprofen, Diclofenac) | May potentiate water retention and increase risk of hyponatremia. | Moderate |
| Loperamide | May potentiate the antidiuretic effect and increase plasma levels of desmopressin. | Moderate |
Same composition (Desmopressin (0.06mg)), different brands: