Bottom line
Desmopressin (DDAVP) is a synthetic analogue of vasopressin with two key modifications — deamination at position 1 and substitution of L-Arg with D-Arg at position 8 — conferring V2-receptor selectivity and prolonged half-life. It is approved in multiple named jurisdictions, with product-specific indications for central diabetes insipidus, primary nocturnal enuresis, mild haemophilia A/von Willebrand disease (factor VIII release), and nocturia (by sublingual formulation). The injectable formulation carries a boxed warning for severe hyponatraemia and seizure.
Identity and composition
| Field | Verified information |
|---|---|
| Preferred name | Desmopressin |
| Key aliases | DDAVP, 1-deamino-8-D-arginine vasopressin, Minirin, Nocdurna, Stimate |
| Molecular/sequence identity | Mpa-Tyr-Phe-Gln-Asn-Cys-Pro-D-Arg-Gly-NH₂ (synthetic modified nonapeptide; Mpa = 3-mercaptopropionic acid; disulfide bridge Mpa¹–Cys⁶) |
| Modifications/form | Deamination at position 1 (3-mercaptopropionic acid replaces Cys to reduce proteolysis); D-Arg at position 8 (V2 selectivity); C-terminal amide |
| Stable identifiers | CAS 16679-58-6; PubChem CID 5311065; DrugBank DB00035; UNII ENR1LLB0FP; ATC H01BA02 |
| Identity caveats | Distinct from vasopressin — V2-selective, substantially longer half-life (2–3 h vs 10–35 min), negligible V1a activity; not interchangeable for vasodilatory shock; different pharmacokinetics across the oral, intranasal, sublingual, and injectable routes |
Development and approval status
| Jurisdiction | Status and indication | Product/source | As of |
|---|---|---|---|
| FDA (US) | Approved — central DI, primary nocturnal enuresis (PNE), haemophilia A with factor VIII >5%, von Willebrand disease (type 1), nocturia (sublingual) | DDAVP (tablet, spray, injection), Nocdurna (sublingual), Stimate (high-concentration spray) | Various NDA dates |
| EMA (EU) | Approved — same indications | Minirin (tablet, melt, spray, injection) | Approved |
| MHRA (UK) | Approved — same | Desmopressin (generic) | Approved |
Mechanism and pharmacology
Desmopressin is a selective agonist at the V2 receptor (renal collecting duct), stimulating Gs/AC/cAMP/PKA signalling leading to aquaporin-2 insertion and free water reabsorption. At high doses, it also stimulates V2-mediated release of von Willebrand factor and factor VIII from endothelial Weibel-Palade bodies. Its selectivity for V2 over V1a is >100-fold, minimising vasopressor effects. Half-life is 2–3 hours (vs 10–35 min for vasopressin). Well-characterised — high confidence.
Evidence by claim
| Claim/indication | Stage | Grade | Best human evidence | Main result | Important limitations |
|---|---|---|---|---|---|
| Central diabetes insipidus | Approved (global) | A | Multiple RCTs; label data | Effective antidiuresis | Well-established |
| Primary nocturnal enuresis | Approved (global) | A | Multiple RCTs; regulatory review | Reduces wet nights vs placebo | Relapse common after discontinuation |
| Haemophilia A / von Willebrand disease | Approved (FDA) | A | Pivotal clinical trials | Increased factor VIII and vWF sufficient for minor procedures (Stimate intranasal spray) | Efficacy limited to mild disease (FVIII >5%) |
| Nocturia (adults) | Approved (sublingual) | A | Pivotal RCTs | Reduced nocturnal voids | Fluid restriction required |
| Bedwetting in children on SubQ | Off-label | — | — | — | Not approved for SC route in children |
Key studies
| Study | Design/population | Exposure studied | Endpoints and result | Limitations |
|---|---|---|---|---|
| FDA label DDAVP | Central DI — open-label, multiple trials | 0.1–0.4 mg oral; 5–40 mcg intranasal | Controlled urine output, normalised serum sodium | Some older; no modern placebo-controlled DI trial (ethically problematic) |
| PNE meta-analysis (many) | Meta-analysis, children (n=1000+) | 0.2–0.4 mg oral at bedtime | 1.3 fewer wet nights/week vs placebo | High response variability |
| Nocdurna pivotal trial | Nocturia adults, RCT (n≈1000) | 25–100 mcg sublingual | Clinically meaningful reduction in nocturnal voids | Fluid restriction protocol required |
Dose and administration evidence
Approved labeled regimen
The label summary below is product-, indication-, and jurisdiction-specific; consult the full current label and a licensed clinician/pharmacist.
Route-specific regimens:
Central DI (DDAVP tablets, US): Start 0.05 mg twice daily. The label says most clinical-trial patients had an optimal total daily dose of 0.1–0.8 mg and permits individualized adjustment within 0.1–1.2 mg/day, divided into two or three doses.
Central DI (intranasal): 5–40 mcg/day in 1–3 divided doses
Central DI (injectable): 2–4 mcg SC/IV/IM
PNE (oral): 0.2–0.4 mg at bedtime, fluid restriction
Nocturia (sublingual Nocdurna): Women — 25 mcg at bedtime; Men — 50 mcg at bedtime (sex-specific dosing per FDA label)
Haemophilia A/vWD (Stimate intranasal spray): 150 mcg (one spray) per nostril; 300 mcg total dose (two sprays)
Haemophilia A/vWD (DDAVP injection): 0.3 mcg/kg IV in 50 mL NS over 15–30 min
Stimate is a high-concentration intranasal spray; DDAVP injection is a separate product with a different formulation, route, and dose. These are NOT interchangeable.
Studied regimens (not recommendations)
No additional significant studied regimens beyond approved routes and doses.
What is not established
Long-term efficacy for nocturia (durability of effect)
Dose adjustment protocols for elective surgery in haemophilia/vWD
Optimal fluid-restriction protocols
Chronic intranasal use safety concerns (rhinological changes)
Safety
Established label risks
Boxed warning (injectable formulation, and sublingual Nocdurna): Severe hyponatraemia can result in seizure, coma, respiratory arrest, and death. Extreme caution with patients at risk: hyponatraemia-prone conditions, cystic fibrosis, concomitant drugs increasing water intake or ADH/cox-2 effect.
Injection boxed warning also includes: Contraindicated in patients receiving loop diuretics, systemic/inhaled glucocorticoids.
Major warnings (all routes):
Hyponatraemia risk: monitor sodium (especially at initiation and dose changes)
Fluid overload in cardiovascular disease
Thrombotic events (rare, with high-dose IV for haemophilia)
Anaphylaxis/hypersensitivity (rare)
Contraindications: Hyponatraemia, moderate-to-severe renal impairment (CrCl less than 50 mL/min), polydipsia, and (for injection) concomitant loop diuretics or glucocorticoids.
Human-study signals
Well-characterised safety profile. Hyponatraemia is the primary dose-limiting concern and is more common without fluid restriction.
Unknowns and product-quality risks
Chronic high-dose intranasal use may alter nasal mucosa absorption
Research chemical desmopressin products are adulterated and unsafe
Not for use in patients with cystic fibrosis without careful sodium monitoring
Interactions and special populations
Drugs increasing hyponatraemia risk: SSRIs, NSAIDs, carbamazepine, oxcarbazepine, lamotrigine, chlorpromazine, TCAs, thiazide diuretics, loop diuretics
Drugs decreasing effect: lithium, demeclocycline
Renal impairment: contraindicated if CrCl less than 50 mL/min
Elderly: higher hyponatraemia risk; monitor sodium
Pregnancy: no adequate studies; small amounts cross placenta; use if needed
Lactation: desmopressin excreted in breast milk in small amounts
Regulatory, compounding, and sport notes
WADA: prohibited — desmopressin is a masking agent on the WADA Prohibited List (category S5, Diuretics and Masking Agents); prohibited at all times
US DEA: not scheduled
Prescription scheduling and access vary by jurisdiction and formulation; the US products reviewed in this monograph are prescription products
Multiple generic formulations available
Injection: boxed warning; oral: no boxed warning but strong hyponatraemia warning
Evidence gaps
Modern placebo-controlled RCT for central DI would be ethically difficult; reliance on older data
Optimal dose individualisation for nocturia (age, sex, comorbidities)
Durability of nocturia effect over >12 months
Paediatric safety data for long-term use
Comparative efficacy of different routes for specific indications
Search notes
Databases and registries: PubMed, DailyMed, FDA Drugs@FDA, WADA Prohibited List, EMA product information
Search terms: Desmopressin, DDAVP, Minirin, Nocdurna, Stimate, 16679-58-6, hyponatraemia, WADA
Last searched: 2026-08-06
Inclusion emphasis: regulatory labels, clinical trials, safety communications
Sources
FDA label: DDAVP (desmopressin acetate) tablets. DailyMed. https://dailymed.nlm.nih.gov/dailymed/lookup.cfm?setid=6d55baa9-2b62-469c-93ae-3909ab249332&version=7
FDA label: Nocdurna (desmopressin sublingual). DailyMed.
FDA label: Stimate (desmopressin nasal spray). DailyMed.
DrugBank DB00035. https://go.drugbank.com/drugs/DB00035
PubChem CID 5311065. https://pubchem.ncbi.nlm.nih.gov/compound/5311065
WADA Prohibited List 2026. https://www.wada-ama.org/en/prohibited-list