Usual Adult Dose for Diabetes Insipidus

Initial dose: 0.05 mg orally twice a day or
1 to 2 mcg IV twice a day or
1 to 2 mcg subcutaneously twice a day or
5 to 40 mcg spray intranasally twice a day or
0.1 to 0.4 mL via rhinal tube intranasally twice a day.
The optimal dosage depends on the patient's response (duration of sleep and adequate, not excessive water turnover). The morning and evening doses should be separately adjusted for an adequate diurnal rhythm of water turnover.

Usual Adult Dose for Hemophilia A

IV: 0.3 mcg/kg once slowly over 15-30 minutes. Preoperative IV doses may be given 30 minutes prior to scheduled procedure. Blood pressure and heart rate monitoring during infusion is recommended. Repeat administration should be determined by laboratory response as well as the clinical condition of the patient.
Intranasal: 1 spray (1.5 mg/mL) in each nostril one time.
Demonstration of an adequate improvement in coagulation profile after administration is recommended prior to any surgical procedures. Preoperative doses may be given 2 hours prior to the scheduled procedure. Repeat administration should be determined by laboratory response and clinical condition of the patient.

Usual Adult Dose for von Willebrand's Disease

IV: 0.3 mcg/kg once slowly over 15-30 minutes. Preoperative IV doses may be given 30 minutes prior to scheduled procedure. Blood pressure and heart rate monitoring during infusion is recommended. Repeat administration should be determined by laboratory response as well as the clinical condition of the patient.
Intranasal: 1 spray (1.5 mg/mL) in each nostril one time.
Demonstration of an adequate improvement in coagulation profile after administration is recommended prior to any surgical procedures. Preoperative doses may be given 2 hours prior to the scheduled procedure. Repeat administration should be determined by laboratory response and clinical condition of the patient. The nasal spray should not be used to treat patients with type IIB von Willebrand's disease since platelet aggregation may be induced.

Usual Adult Dose for Primary Nocturnal Enuresis

Oral: 0.2 to 0.6 mg once before bedtime.

Usual Pediatric Dose for Diabetes Insipidus

Infants 3 months of age to children 12 years of age:
Intranasal: 5 mcg/day as a single dose or in 2 divided doses. Dose range is 5 to 30 mcg/day. The morning and evening doses should be separately adjusted for an adequate diurnal rhythm of water turnover.
Oral: 0.05 mg twice a day. Dose range is 0.1 to 0.8 mg daily.
IV and subcutaneously: No definitive dosing available. Adult dosing should not be used in this age group; adverse events such as hyponatremia-induced seizures may occur. Dose should be reduced. Some have suggested an initial dosage range of 0.1 to 1 mcg in 1 or 2 divided doses. Initiate at low dose and increase as necessary. Closely monitor serum sodium levels and urine output; fluid restriction is recommended.

Children more than 12 years of age:
Intranasal: 5 to 40 mcg/day divided into 1 to 3 doses. The morning and evening doses should be separately adjusted for an adequate diurnal rhythm of water turnover.
Oral: 0.05 mg twice daily. Dose range is 0.1 to 1.2 mg divided into 2 or 3 doses.
IV: 1 to 2 mcg twice a day
Subcutaneously: 1 to 2 mcg twice a day

Use in children requires careful fluid intake restrictions to prevent possible hyponatremia and water intoxication. The optimal dosage depends on the patient's response (duration of sleep and adequate, not excessive water turnover).

Usual Pediatric Dose for Hemophilia A

Infants 3 months of age and children:
IV: 0.3 mcg/kg by slow infusion over 15-30 minutes beginning 30 minutes before procedure. May repeat dose if needed.

Children more than 12 years of age:
IV: 0.3 mcg/kg once slowly over 15-30 minutes.
Intranasal:
50 kg or less: 150 mcg
more than 50 kg: 150 mcg in each nostril.
Demonstration of an adequate improvement in coagulation profile after administration is recommended prior to any surgical procedures. Preoperative doses may be given 2 hours prior to the scheduled procedure. Repeat administration should be determined by laboratory response and clinical condition of the patient.

Usual Pediatric Dose for von Willebrand's Disease

Infants 3 months of age and children:
IV: 0.3 mcg/kg by slow infusion over 15 to 30 minutes beginning 30 minutes before procedure. May repeat dose if needed.

Children more than 12 years of age:
IV: 0.3 mcg/kg once slowly over 15 to 30 minutes.
Intranasal:
50 kg or less: 150 mcg
More than 50 kg: 150 mcg in each nostril.
Demonstration of an adequate improvement in coagulation profile after administration is recommended prior to any surgical procedures. Preoperative doses may be given 2 hours prior to the scheduled procedure. Repeat administration should be determined by laboratory response and clinical condition of the patient. The nasal spray should not be used to treat patients with type IIB von Willebrand's disease since platelet aggregation may be induced.

Usual Pediatric Dose for Primary Nocturnal Enuresis

6 years or older:
0.2 to 0.6 mg orally once daily before bedtime.

Renal Dose Adjustments

Desmopressin is contraindicated in patients with moderate to severe renal impairment (defined as a creatinine clearance below 50 mL/min).

Liver Dose Adjustments

Data not available

Precautions

When desmopressin is administered to patients who do not have need of antidiuretic hormone for its antidiuretic effect, in particular pediatric and geriatric patients, fluid intake should be adjusted downward to decrease to potential occurrence of water intoxication and hyponatremia with accompanying signs and symptoms (headache, nausea/vomiting, decreased serum sodium and weight gain). Desmopressin intranasal formulations are no longer indicated for the treatment of primary nocturnal enuresis due to the risk for developing severe hyponatremia that can result in seizures and death.

Dialysis

Data not available

Other Comments

The comparable antidiuretic dose of the injection is approximately 1/10 the intranasal dose.

Frequently asked questions

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