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Desmopressin: Drug information

Desmopressin: Drug information
(For additional information see "Desmopressin: Patient drug information" and see "Desmopressin: Pediatric drug information")

For abbreviations, symbols, and age group definitions used in Lexicomp (show table)
ALERT: US Boxed Warning
Hyponatremia (DDAVP injection, Nocdurna, Noctiva nasal spray):

Desmopressin can cause hyponatremia. Severe hyponatremia can be life-threatening, leading to seizures, coma, respiratory arrest, or death. Desmopressin is contraindicated in patients at increased risk of severe hyponatremia, such as patients with excessive fluid intake, illnesses that can cause fluid or electrolyte imbalances, and in those using loop diuretics or systemic or inhaled glucocorticoids. Ensure serum sodium concentrations are normal before starting or resuming desmopressin. Measure serum sodium within 7 days and ~1 month after initiating therapy and periodically during treatment. More frequently monitor serum sodium in patients ≥65 years of age and in patients at increased risk of hyponatremia. If hyponatremia occurs, desmopressin may need to be temporarily or permanently discontinued.

Brand Names: US
  • DDAVP;
  • DDAVP Pf;
  • DDAVP Rhinal Tube [DSC];
  • Nocdurna;
  • Noctiva [DSC];
  • Stimate [DSC]
Brand Names: Canada
  • APO-Desmopressin;
  • Bipazen;
  • DDAVP;
  • DDAVP Melt;
  • DDAVP Rhinyle [DSC];
  • Nocdurna [DSC];
  • Octostim;
  • PMS-Desmopressin
Pharmacologic Category
  • Antihemophilic Agent;
  • Hemostatic Agent;
  • Hormone, Posterior Pituitary;
  • Vasopressin Analog, Synthetic
Dosing: Adult
Deceased organ donor management

Deceased organ donor management (hormonal replacement therapy) (off-label use): Note: Use if diabetes insipidus with hypernatremia is present without associated hypotension or in combination with vasopressin in hemodynamically unstable patients with severe hypernatremia. Use as part of combination hormone therapy (Ref).

IV: Initial: 1 to 4 mcg once; titrate dose based on urine osmolality, urine output, and serum sodium, if needed. Usual maintenance dose: 1 to 2 mcg every 6 hours (Ref).

Diabetes insipidus, central

Diabetes insipidus, central: Note: To avoid hyponatremia, use the minimum effective dose to control polyuria. In patients undergoing transsphenoidal surgery, diabetes insipidus may spontaneously resolve or revert to syndrome of inappropriate antidiuretic hormone secretion/hyponatremia (Ref).

IV, SUBQ (4 mcg/mL solution for injection):

Initial:

Treatment-naive individuals: 0.25 to 1 mcg every 12 to 24 hours (Ref).

Individuals converting from intranasal desmopressin: Administer one-tenth of the maintenance intranasal dose at the regular intervals.

Dosage adjustment: Adjust dose, if needed, to maintain urine volume and serum sodium within normal limits; may increase to 2 mcg IV if no response to the 1 mcg dose (Ref).

Intranasal (100 mcg/mL nasal solution [nasal spray or rhinal tube]): Note: Avoid intranasal administration within the first day after transsphenoidal surgery due to variable absorption (Ref).

Initial: 5 to 10 mcg once daily at bedtime; adjust bedtime dosage in 5 mcg increments, if needed, to control nocturia. Assess need for daytime dose based on subsequent daytime polyuria. Usual maintenance dose: 5 to 20 mcg once or twice daily; suggested maximum dose: 40 mcg/day (Ref). Note: The nasal spray pump can only deliver doses of 10 mcg or multiples of 10 mcg; if doses other than this are needed, the rhinal tube delivery system is preferred.

Conversion from injection to intranasal: Administer 10 times the amount of desmopressin acetate, rounded down to the nearest 10 mcg.

Conversion from oral to intranasal: Individual dose titration is required (intranasal desmopressin is ~10- to 40-fold more potent than oral desmopressin).

Oral: Initial: 0.05 to 0.2 mg once daily at bedtime; adjust bedtime dosage in 0.05 mg increments, if needed, to control nocturia. Assess need for daytime dose based on subsequent daytime polyuria. Usual maintenance dose: 0.1 to 0.8 mg/day in 2 to 3 equally divided doses; suggested maximum dose: 1.2 mg/day (Ref).

Sublingual (DDAVP Melt [Canadian product]): Initial: 60 mcg 3 times daily; total daily dose should be increased or decreased as needed to obtain adequate antidiuresis. Usual maintenance dose: 120 to 720 mcg/day in 2 to 3 equally divided doses.

Duration of therapy: Continue therapy for as long as symptoms persist; consider weekly therapy withdrawal to determine ongoing need for therapy and discontinue if polyuria does not recur (Ref).

Hemophilia A, mild

Hemophilia A, mild:

Note: May be used short-term for minor bleeding or before minor invasive procedures in patients who have previously demonstrated an adequate response to a therapeutic trial. Desmopressin is not effective in patients with hemophilia B (Ref). Prior to treatment, verify factor VIII coagulant activity is >5% and no factor VIII autoantibodies are present; careful monitoring needed for use in patients with factor VIII levels between 2% and 5%.

IV, SUBQ (off label): 0.3 mcg/kg once (maximum recommended dose: 20 to 30 mcg). If used for prevention of surgical bleeding, administer 30 to 60 minutes before procedure (Ref).

Intranasal: Note: If used for prevention of surgical bleeding, administer 2 hours before procedure.

Using high-concentration spray (1.5 mg/mL):

Patient weight <50 kg: 150 mcg (1 spray) in a single nostril.

Patient weight ≥50 kg: 150 mcg (1 spray) in each nostril (total dose: 300 mcg).

Repeat doses: For treatment of minor bleeding, dose may be repeated after 8 to 12 hours and once daily thereafter, if needed, based on clinical condition and von Willebrand factor and factor VIII activity levels; duration of use is generally limited to 3 days due to tachyphylaxis. In patients who are hospitalized or who receive repeat doses, restrict free water intake and monitor for hyponatremia (Ref).

Intracranial hemorrhage associated with antiplatelet agents

Intracranial hemorrhage associated with antiplatelet agents (off-label use):

Note: For use in combination with other first-line therapies (eg, platelet transfusion) (Ref).

IV: 0.4 mcg/kg once over 30 minutes (maximum suggested dose: 40 mcg [not well established]) (Ref).

Nocturia, refractory

Nocturia, refractory:

Note: For use in patients with symptoms refractory to nonpharmacologic and other first-line therapy options. Monitor closely for hyponatremia (eg, within 3 to 7 days after dosage change or change in clinical status); discontinue treatment if serum sodium is <135 mEq/L (Ref).

Sublingual (Nocdurna): Note: Dosage expressed as desmopressin acetate; desmopressin acetate 27.7 mcg is equivalent to desmopressin (base) 25 mcg.

Females: 27.7 mcg once daily 1 hour before bedtime.

Males: 55.3 mcg once daily 1 hour before bedtime.

Oral (off label): Initial: 0.05 to 0.1 mg once daily at bedtime; doses >0.1 mg/day are unlikely to provide additional benefit and may increase risk of hyponatremia (Ref).

Intranasal (Noctiva): Note: Noctiva intranasal spray has been discontinued in the United States for >1 year.

No risk for hyponatremia: 1.66 mcg in either nostril ~30 minutes before bedtime. Note: Two 0.83 mcg sprays are not equivalent to one 1.66 mcg spray.

Possible risk for hyponatremia or ≥65 years of age: Initial: 0.83 mcg in either nostril ~30 minutes before bedtime. After ≥7 days, may increase to 1.66 mcg, if needed, provided serum sodium is within the normal range. Note: The 0.83 mcg dose may be associated with a lower risk of hyponatremia; however, this dose did not meet all prespecified efficacy end points in clinical trials (Ref).

Prevention of overly rapid sodium correction in patients with chronic severe hyponatremia

Prevention of overly rapid sodium correction in patients with chronic severe hyponatremia (adjunct to hypertonic saline infusion) (off-label use):

Note: Hyponatremia is listed as a contraindication for use of desmopressin in some instances. Use only in consultation with clinicians experienced in the management of hyponatremia. For use only as adjunctive therapy to hypertonic saline in patients with severe hyponatremia (<120 mEq/L) due to rapidly reversible causes (eg, hypovolemia) who are likely to develop water diuresis during the course of therapy, or in those who are at high risk of osmotic demyelination syndrome (eg, severe liver disease, malnutrition, concurrent hypokalemia, chronic excess alcohol intake) (Ref).

IV, SUBQ: 1 to 2 mcg every 6 to 8 hours; titrate to response; maximum reported dose: 4 mcg every 6 to 8 hours (Ref). Restrict free water intake during treatment (Ref).

Duration of therapy: Continue therapy for 24 to 48 hours or until serum sodium increases to ≥125 mEq/L; goal of therapy is to correct serum sodium by ≤8 mEq/L in any 24-hour period (Ref).

Uremic bleeding

Uremic bleeding (off-label use):

Prevention of bleeding prior to invasive procedure: IV, SUBQ: 0.3 to 0.4 mcg/kg once, administered 30 to 60 minutes before procedure; doses >40 mcg have not been reported for bleeding indications (Ref).

Life-threatening bleeding: IV: 0.3 to 0.4 mcg/kg once (doses >40 mcg have not been reported for bleeding indications) (Ref). Additional doses may be administered if bleeding continues or if bleeding recurs; however, tachyphylaxis may develop after the second dose (Ref).

von Willebrand disease, mild to moderate

von Willebrand disease, mild to moderate:

Note: May be used short-term for minor bleeding or before minor invasive procedures in patients with type 1 von Willebrand disease (VWD) (labeled use) or type 2 VWD (off-label use) who have previously demonstrated an adequate response to a therapeutic trial; avoid use in patients with type 2B VWD. Desmopressin is not effective in patients with type 3 VWD (Ref). Prior to treatment, verify factor VIII coagulant activity levels >5%; exclude type I disease, and factor VIII von Willebrand antigen levels. Avoid use in patients with active cardiovascular disease and/or increased thrombosis risk (ASH/ISTH/NHF/WFH [Connell 2021]).

IV, SUBQ (off label): 0.3 mcg/kg once; do not exceed 20 mcg/dose. If used for prevention of surgical bleeding, administer 30 to 60 minutes before procedure (Ref).

Intranasal: Note: If used for prevention of surgical bleeding, administer 2 hours before procedure.

Using high-concentration spray (1.5 mg/mL):

Patient weight <50 kg: 150 mcg (1 spray) in a single nostril.

Patient weight ≥50 kg: 150 mcg (1 spray) in each nostril (total dose: 300 mcg).

Repeat doses: For treatment of minor bleeding, dose may be repeated after 8 to 12 hours and once daily thereafter, if needed, based on the patient's clinical condition and von Willebrand factor and factor VIII activity levels; duration of use is generally limited to 3 to 5 days due to tachyphylaxis. In patients who are hospitalized or who receive repeat doses, restrict free water intake and monitor for hyponatremia (Ref).

Dosing: Kidney Impairment: Adult

The renal dosing recommendations are based upon the best available evidence and clinical expertise. Senior Editorial Team: Bruce Mueller, PharmD, FCCP, FASN, FNKF; Jason Roberts, PhD, BPharm (Hons), B App Sc, FSHP, FISAC; Michael Heung, MD, MS.

IV, intranasal, SUBQ, sublingual, oral:

Altered kidney function:

CrCl ≥50 mL/minute: No dosage adjustment necessary (Ref).

CrCl <50 mL/minute: Use is contraindicated according to some manufacturers' labeling due to prolonged half-life and predisposition to developing hyponatremia in patients with kidney impairment. However, no dosage adjustment is necessary for bleeding-related indications if limited to short-term use. In patients with central diabetes insipidus, no empiric dosage adjustment is necessary; lower doses may be required, use with caution (Ref).

Hemodialysis, intermittent (thrice weekly): Dose as for CrCl <50 mL/minute. The risk of developing hyponatremia from desmopressin in intermittent hemodialysis patients is minimal (Ref).

Peritoneal dialysis: Dose as for CrCl <50 mL/minute. The risk of developing hyponatremia from desmopressin in peritoneal dialysis patients is minimal (Ref).

CRRT/PIRRT: Dose as for CrCl <50 mL/minute (Ref).

Dosing: Hepatic Impairment: Adult

There are no dosage adjustments provided in the manufacturer's labeling.

Dosing: Older Adult

Refer to adult dosing.

Nocturia: Avoid use (Ref).

Dosing: Pediatric

(For additional information see "Desmopressin: Pediatric drug information")

Dosage guidance:

Dosing: Dosing presented is in mcg, mg, and mL (dependent upon product formulation); use extra precaution to verify product formulation and dosing units.

Dosage form information: Intranasal dosage forms have unique concentrations and indications for use and should not be used interchangeably; approved ages and uses may vary by product, consult product labeling.

Diabetes insipidus

Diabetes insipidus: Note: Fluid restriction should be observed in these patients; younger patients are more susceptible to plasma osmolality shifts and possible hyponatremia. Dosing should be individualized to response.

Oral: Children ≥4 years and Adolescents: Initial: 0.05 mg twice daily; titrate to desired response; optimal daily dose range: 0.1 to 0.8 mg/day in 2 to 3 divided doses; reported daily dose range: 0.1 to 1.2 mg/day.

Intranasal:

DDAVP nasal spray (10 mcg/spray): Note: The nasal spray pump can only deliver fixed doses in 10 mcg (0.1 mL) increments; if doses other than this are needed, the rhinal tube delivery system is preferred.

Children ≥4 years and Adolescents: Initial: 10 mcg once daily into 1 nostril, may titrate dose up to 30 mcg/day in 1 to 2 divided doses; if administered twice daily, adjust morning and evening doses separately to provide for an adequate diurnal rhythm of urine output.

Rhinal tube (100 mcg/mL nasal solution):

Infants ≥3 months and Children: Initial: 5 mcg/day in 1 to 2 divided doses; usual range: 5 to 30 mcg/day in 1 to 2 divided doses; if administered twice daily, adjust morning and evening doses separately to provide for an adequate diurnal rhythm of urine output.

Adolescents: Usual range: 5 to 40 mcg/day in 1 to 3 divided doses; usual adult dose is 20 mcg/day in 2 divided doses; adjust morning and evening doses separately to provide for an adequate diurnal rhythm of urine output.

Parenteral:

Infants and Children <12 years: IV, SubQ: 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/day in 1 or 2 divided doses (Ref). Initiate at low dose and increase as necessary. Closely monitor serum sodium levels and urine output; fluid restriction is recommended.

Children ≥12 years and Adolescents: IV, SubQ: 2 to 4 mcg/day in 2 divided doses or one-tenth (1/10) of the maintenance intranasal dose; adjust morning and evening doses separately for an adequate diurnal rhythm of water turnover.

Sublingual: Canadian labeling: DDAVP Melt [Canadian product]: Children and Adolescents: Sublingual: Initial: 60 mcg 3 times daily; total daily dose should be increased or decreased as needed to obtain adequate antidiuresis. Usual maintenance dose: 120 to 720 mcg in divided doses 2 to 3 times daily; divide daily doses so that the evening dose is 2 times higher than the morning or afternoon dose to ensure adequate antidiuresis during the night; fluid restriction should be observed.

Hemophilia A and von Willebrand disease

Hemophilia A and von Willebrand disease (type 1; mild to moderate): Note: Adverse events such as hyponatremia-induced seizures have been reported especially in young children with IV use (Ref). Fluid restriction and careful monitoring of serum sodium levels and urine output are necessary.

IV: Infants ≥3 months, Children, and Adolescents: 0.3 mcg/kg; maximum dose: 20 mcg/dose; if used preoperatively administer 30 minutes before procedure.

Repeat doses: For treatment of spontaneous or traumatic bleeding, dose may be repeated after 8 to 12 hours and once daily thereafter, if needed, based on clinical condition and von Willebrand factor and factor VIII activity levels. Note: Tachyphylaxis may occur with administration more frequently than every 48 hours; the initial response is reproducible with administration every 48 to 72 hours.

Intranasal: High concentration spray 1.5 mg/mL: Infants ≥11 months, Children, and Adolescents:

<50 kg: 150 mcg (1 spray).

≥50 kg: 300 mcg (1 spray in each nostril).

Repeat use is determined by the patient's clinical condition and laboratory work; if using preoperatively, administer 2 hours before surgery.

Subcutaneous: Canadian labeling: Octostim [Canadian product]: Infants ≥3 months, Children, and Adolescents: SubQ: 0.3 mcg/kg; if used preoperatively administer 30 minutes before procedure.

Nocturnal enuresis

Nocturnal enuresis: Note: Intranasal formulations are not recommended for nocturnal enuresis treatment.

Oral:

Children ≥6 years and Adolescents: Initial: 0.2 mg once before bedtime; titrate as needed to a maximum of 0.6 mg/day; fluid intake should be limited to a minimum from 1 hour before desmopressin administration until the next morning, or at least 8 hours after administration.

Canadian labeling: Children ≥5 years and Adolescents: Initial: 0.2 mg once before bedtime; may titrate by 0.2 mg/day every 3 days as needed to a maximum dose of 0.6 mg/day; fluid intake should be limited to a minimum from 1 hour before desmopressin administration until the next morning, or at least 8 hours after administration. Treatment period is up to 3 months and then reassess with 1 week off treatment; if additional therapy is necessary, resume at same dosage prior to discontinuation.

Sublingual: Canadian labeling: DDAVP Melt [Canadian product]: Children ≥5 years and Adolescents: Sublingual: Initial: 120 mcg administered 1 hour before bedtime; may titrate by 120 mcg/day every 3 days as necessary to a maximum dose of 360 mcg/day to achieve desired response. Treatment period is up to 3 months and then reassess with 1 week off treatment; if additional therapy is necessary, resume at same dosage prior to discontinuation.

Dosing: Kidney Impairment: Pediatric

CrCl ≥50 mL/minute: There are no dosage adjustments provided in the manufacturer's labeling.

CrCl <50 mL/minute: Use is contraindicated according to the manufacturer (except 1.5 mg/mL nasal spray); however, has been used in acute and chronic renal failure adult patients experiencing uremic bleeding or for prevention of surgical bleeding (Ref).

Dosing: Hepatic Impairment: Pediatric

There are no dosage adjustments provided in manufacturer's labeling.

Adverse Reactions

The following adverse drug reactions and incidences are derived from product labeling unless otherwise specified. Adverse reactions are for the intranasal product unless otherwise indicated.

>10%:

Endocrine & metabolic: Hyponatremia (intranasal: 2% to 12%; sublingual: 3% to 4%)

Gastrointestinal: Xerostomia (sublingual: 12% to 14%)

1% to 10%:

Cardiovascular: Hypertension (2% to 3%)

Gastrointestinal: Abdominal pain (2%), nausea (2%)

Nervous system: Asthenia (2%), chills (2%), dizziness (intranasal, sublingual: 2% to 3%), headache (intranasal, oral, sublingual: 2% to 5%)

Neuromuscular & skeletal: Back pain (1% to 2%)

Ophthalmic: Abnormal lacrimation (2%), conjunctivitis (2%), ocular edema (2%)

Respiratory: Bronchitis (2%), epistaxis (2% to 3%), nasal congestion (3%), nasal discomfort (6%), nasopharyngitis (4%), nostril pain (2%), rhinitis (3% to 8%), sneezing (2% to 3%)

Frequency not defined (any formulation):

Cardiovascular: Chest pain, edema, palpitations, tachycardia

Gastrointestinal: Dyspepsia, vomiting

Genitourinary: Balanitis, vulvar pain

Hepatic: Increased serum aspartate aminotransferase (transient)

Local: Localized warm feeling

Nervous system: Agitation, drowsiness, insomnia, pain

Ophthalmic: Eye pruritus, photophobia

Postmarketing (any formulation):

Cardiovascular: Facial flushing, flushing, hypotension, thrombosis

Dermatologic: Erythema of skin

Endocrine & metabolic: Fluid retention, water intoxication

Gastrointestinal: Abdominal cramps, diarrhea, sore throat

Hypersensitivity: Anaphylaxis, hypersensitivity reaction (including severe hypersensitivity reaction)

Local: Localized burning

Nervous system: Abnormality in thinking, seizure (hyponatremic)

Respiratory: Cough, upper respiratory tract infection

Miscellaneous: Swelling

Contraindications

Known hypersensitivity to desmopressin or any component of the formulations; hyponatremia or a history of hyponatremia.

Additional product-specific contraindications:

DDAVP (injection): Moderate to severe renal impairment (CrCl <50 mL/minute); syndrome of inappropriate antidiuretic hormone (SIADH) secretion (known or suspected); polydipsia; concomitant use with loop diuretics or glucocorticoids (inhaled or systemic); illnesses that may cause fluid or electrolyte imbalance (eg, gastroenteritis, salt-wasting nephropathies, systemic infection); heart failure; uncontrolled hypertension.

DDAVP (intranasal, oral): Moderate to severe renal impairment (CrCl <50 mL/minute).

Nocdurna, Noctiva: Renal impairment (eGFR <50 mL/minute/1.73 m2); polydipsia; primary nocturnal enuresis; concomitant use with loop diuretics or glucocorticoids (inhaled or systemic); SIADH secretion (known or suspected); illnesses that may cause fluid or electrolyte imbalance (eg, gastroenteritis, salt-wasting nephropathies, systemic infection); heart failure (Noctiva labeling specifies NYHA class II to IV); uncontrolled hypertension.

Stimate: There are no contraindications listed in the Stimate prescribing information.

Significant drug interactions exist, requiring dose/frequency adjustment or avoidance. Consult drug interactions database for more information.

Canadian labeling: Additional contraindications (not in US labeling): Note: May not be applicable to all available dosage forms; refer to manufacturer labeling for further detail. Type 2B or platelet-type (pseudo) von Willebrand disease; habitual or psychogenic polydipsia, cardiac insufficiency or other conditions requiring diuretic therapy; nephrosis or any other condition associated with impaired water excretion, severe hepatic dysfunction; primary nocturnal enuresis; sodium losing conditions; SIADH secretion; lactose intolerance.

Warnings/Precautions

Concerns related to adverse effects:

• Fluid retention: May cause fluid retention, which can worsen underlying conditions susceptible to volume status. Use with caution in patients with heart failure; some products are specifically contraindicated in heart failure or uncontrolled hypertension. Some products are not recommended in patients at risk for increased intracranial pressure or those with a history of urinary retention.

• Hypersensitivity reactions: Severe hypersensitivity reactions have been reported with desmopressin; anaphylactic reactions, including fatalities, have occurred with IV and intranasal administration. Discontinue use if serious reactions occur; do not reinitiate treatment.

• Hyponatremia: Desmopressin use may rarely lead to hyponatremia with associated signs and symptoms (eg, confusion, decreased consciousness, depressed reflexes, disorientation, fatigue, hallucinations, headache, irritability, lethargy, loss of appetite, muscle weakness/spasms/cramps, nausea/vomiting, restlessness, weight gain) and extreme decreases in plasma osmolality, resulting in seizures, coma, respiratory arrest, and death. Other risk factors for hyponatremia with desmopressin use include cystic fibrosis, renal impairment, heart failure, young age, advanced age, inappropriate high fluid intake, a higher than recommended dose, and concomitant use of medications known to either increase thirst or cause syndrome of inappropriate antidiuretic hormone secretion (SIADH). Fluid restriction during use is recommended. Fluid intake in the evening and nighttime hours should be moderated to decrease the risk of hyponatremia. Monitor for signs/symptoms of hyponatremia; more frequent monitoring is recommended for patients on concomitant medications that increase the risk of hyponatremia (eg, TCAs, SSRIs, NSAIDs, chlorpromazine, carbamazepine, thiazide diuretics).

• Hypotension: Severe hypotension may occur with rapid IV infusions.

Disease-related concerns:

• Cardiovascular disease: Injection and high-dose intranasal (used in hemophilia A and von Willebrand disease [VWD]) desmopressin may cause a slight increase or transient decrease in blood pressure, and a compensatory increase in heart rate. Use with caution in patients with coronary artery insufficiency and/or hypertensive cardiovascular disease.

• Polydipsia (habitual or psychogenic): Use with caution in patients with habitual or psychogenic polydipsia. Patients consuming excessive amounts of water are at greater risk of hyponatremia. Products used for the treatment of nocturia are specifically contraindicated in patients with polydipsia.

• Primary nocturnal enuresis: When using desmopressin for primary nocturnal enuresis, treatment should be interrupted if the patient experiences an acute illness (eg, fever, recurrent vomiting or diarrhea), vigorous exercise, or any condition associated with an increase in water consumption to prevent hyponatremia. Products used for the treatment of nocturia are specifically contraindicated in patients with primary nocturnal enuresis.

• Type 2B von Willebrand disease: Use of desmopressin in patients with type 2B VWD requiring hemostasis should be avoided because use is associated with reduced efficacy and may result in platelet aggregation, thrombocytopenia, and thrombosis (ASH/ISTH/NHF/WFH [Connell 2021]; manufacturer's labeling).

Special populations:

• Older adult: Fluid intake should be adjusted downward in older adults to decrease the possibility of water intoxication and hyponatremia.

• Pediatric: Fluid intake should be adjusted downward in very young patients to decrease the possibility of water intoxication and hyponatremia.

Dosage form specific issues:

• Intranasal: Consider alternative route of administration if changes in the nasal mucosa (scarring, edema) occur leading to unreliable absorption. Some patients may demonstrate a change in response after long-term therapy (>6 months) characterized as decreased response or a shorter duration of response. Discontinue in patients with concurrent nasal conditions that may increase systemic absorption of desmopressin (eg, acute or chronic rhinitis, severe atrophic rhinitis, nasal blockage, nasal mucosal atrophy, recent nasal surgery); may resume desmopressin when conditions resolve.

• Tablet: Consider alternative route of administration (IV or intranasal) with inadequate therapeutic response at maximum recommended oral doses.

Warnings: Additional Pediatric Considerations

The FDA has reviewed 61 postmarketing cases of hyponatremia-related seizures associated with the use of desmopressin acetate. Intranasal desmopressin was used in the majority of cases. Many of the patients were children being treated for primary nocturnal enuresis (PNE). An association with at least one concomitant drug or disease that also may cause hyponatremia and/or seizures was noted. As a result, intranasal desmopressin is no longer indicated for the treatment of PNE.

Product Availability

Noctiva intranasal spray and DDAVP Rhinal tube have been discontinued in the United States for >1 year.

Dosage Forms Considerations

DDAVP and Minirin 5 mL bottles contain 50 sprays.

Stimate 2.5 mL bottles contain 25 sprays.

Dosage Forms: US

Excipient information presented when available (limited, particularly for generics); consult specific product labeling. [DSC] = Discontinued product

Emulsion, Nasal, as acetate:

Noctiva: 1.66 mcg/0.1 mL (3.8 g [DSC])

Solution, Injection, as acetate:

DDAVP: 4 mcg/mL (10 mL) [contains chlorobutanol (chlorobutol)]

DDAVP Pf: 4 mcg/mL (1 mL)

Generic: 4 mcg/mL (1 mL, 10 mL)

Solution, Injection, as acetate [preservative free]:

Generic: 4 mcg/mL (1 mL)

Solution, Nasal, as acetate:

DDAVP: 0.01% (5 mL [DSC]) [contains benzalkonium chloride]

DDAVP Rhinal Tube: 0.01% (2.5 mL [DSC]) [contains chlorobutanol (chlorobutol)]

Stimate: 1.5 mg/mL (2.5 mL [DSC]) [contains benzalkonium chloride]

Generic: 0.01% (5 mL)

Tablet, Oral, as acetate:

DDAVP: 0.1 mg

DDAVP: 0.2 mg [scored]

Generic: 0.1 mg, 0.2 mg

Tablet Sublingual, Sublingual:

Nocdurna: 27.7 mcg, 55.3 mcg

Generic Equivalent Available: US

May be product dependent

Pricing: US

Solution (DDAVP Injection)

4 mcg/mL (per mL): $98.58

Solution (DDAVP Pf Injection)

4 mcg/mL (per mL): $97.37

Solution (Desmopressin Ace Spray Refrig Nasal)

0.01% (per mL): $49.25

Solution (Desmopressin Acetate Injection)

4 mcg/mL (per mL): $23.16 - $71.42

Solution (Desmopressin Acetate PF Injection)

4 mcg/mL (per mL): $38.10 - $70.55

Solution (Desmopressin Acetate Spray Nasal)

0.01% (per mL): $49.25

Sublingual (Nocdurna Sublingual)

27.7 mcg (per each): $19.86

55.3 mcg (per each): $19.86

Tablets (DDAVP Oral)

0.1 mg (per each): $9.35

0.2 mg (per each): $13.47

Tablets (Desmopressin Acetate Oral)

0.1 mg (per each): $3.02 - $5.29

0.2 mg (per each): $4.35 - $7.62

Disclaimer: A representative AWP (Average Wholesale Price) price or price range is provided as reference price only. A range is provided when more than one manufacturer's AWP price is available and uses the low and high price reported by the manufacturers to determine the range. The pricing data should be used for benchmarking purposes only, and as such should not be used alone to set or adjudicate any prices for reimbursement or purchasing functions or considered to be an exact price for a single product and/or manufacturer. Medi-Span expressly disclaims all warranties of any kind or nature, whether express or implied, and assumes no liability with respect to accuracy of price or price range data published in its solutions. In no event shall Medi-Span be liable for special, indirect, incidental, or consequential damages arising from use of price or price range data. Pricing data is updated monthly.

Dosage Forms: Canada

Excipient information presented when available (limited, particularly for generics); consult specific product labeling. [DSC] = Discontinued product

Solution, Injection:

Octostim: 15 mcg/mL (1 mL)

Solution, Injection, as acetate:

Bipazen: 4 mcg/mL (1 mL)

DDAVP: 4 mcg/mL (1 mL)

Solution, Nasal, as acetate:

DDAVP: 0.01% ([DSC]) [contains benzalkonium chloride]

DDAVP Rhinyle: 0.01% ([DSC]) [contains chlorobutanol (chlorobutol)]

Octostim: 1.5 mg/mL ([DSC])

Generic: 0.01% (2.5 mL, 5 mL)

Tablet, Oral, as acetate:

DDAVP: 0.1 mg [DSC], 0.2 mg [DSC]

Generic: 0.1 mg, 0.2 mg

Tablet Disintegrating, Sublingual:

DDAVP Melt: 60 mcg, 120 mcg, 240 mcg [DSC]

Nocdurna: 50 mcg [DSC]

Tablet Disintegrating, Sublingual, as acetate:

Nocdurna: 25 mcg [DSC]

Administration: Adult

IV push:

Central diabetes insipidus, deceased organ donor management (off-label use), and prevention of overly rapid sodium correction in patients with chronic severe hyponatremia (off-label use): Administer as direct injection; dilution is not required (Ref).

IV infusion:

Hemophilia A, von Willebrand disease, and uremic bleeding (off-label use in United States): Infuse over 10 to 30 minutes, depending on urgency. If used preoperatively, administer 30 to 60 minutes prior to procedure (Ref).

Intranasal: Ensure that nasal passages are intact, clean, and free of obstruction prior to administration.

DDAVP: Nasal pump spray: Delivers 0.1 mL (10 mcg); for doses <10 mcg or for other doses which are not multiples, use rhinal tube. DDAVP Nasal spray delivers fifty 10 mcg doses. For 10 mcg dose, administer in one nostril. Any solution remaining after 50 doses should be discarded. Pump must be primed prior to first use by pressing down on pump 4 times; if pump not used for ≥1 week, re-prime by pressing down on pump once.

DDAVP Rhinal tube: Insert top of dropper into tube (arrow marked end) in downward position. Squeeze dropper until solution reaches desired calibration mark. Disconnect dropper. Grasp the tube 3/4 inch from the end and insert tube into nostril until the fingertips reach the nostril. Place opposite end of tube into the mouth (holding breath). Tilt head back and blow with a strong, short puff into the nostril. Reseal dropper after use.

Noctiva: Do not shake. Prime before using for the first time by pumping 5 actuations into the air away from the face. Re-prime by pumping 2 actuations into the air if the product has not been used for more than 3 days. Note: 2 sprays of 0.83 mcg/0.1 mL are not interchangeable with 1 spray of 1.66 mcg/0.1 mL; do not administer 2 sprays of the 0.83 mcg/0.1 mL product.

Stimate: Press pump down 4 times to prime prior to initial use. Once ready, tilt pump, place nozzle tip in nostril, then spray. If pump has not been used for one week it must be primed again by pressing down once or until a fine mist is present. Discard after 25 sprays (excluding priming sprays). Note: A test dose to measure response is recommended prior to initiating therapy.

Oral: Tablets: May administer with or without food. Food may reduce/delay absorption although does not affect antidiuretic activity (Ref).

Diabetes insipidus: Fluid restriction should be observed.

Primary nocturnal enuresis: Fluid intake should be limited a minimum of 1 hour prior to dose until at least 8 hours after administration.

Sublingual:

Nocturia (Nocdurna, DDAVP Melt [Canadian product]): Tablet should be kept under the tongue until completely dissolved without water. Administer 1 hour prior to bedtime. Fluid intake should be limited a minimum of 1 hour prior to dose until at least 8 hours after administration.

SUBQ:

Central diabetes insipidus and prevention of overly rapid sodium correction in patients with chronic severe hyponatremia (off-label use): Administer as direct injection; dilution is not required (Ref).

Hemophilia A, von Willebrand disease, and uremic bleeding (off-label use in United States): If administered SUBQ, the high-concentration injectable formulation (Octostim [Canadian product], 15 mcg/mL) should be used if available; if using the 4 mcg/mL formulation, must administer as separate smaller injections (eg, ≤1.5 to 3 mL per injection) due to total dose volume. Administer as direct injection; dilution not required (Ref).

Administration: Pediatric

Intranasal: Ensure that nasal passages are intact, clean, and free of obstruction prior to administration.

DDAVP (100 mcg/mL): Nasal pump spray: Delivers 0.1 mL (10 mcg); for doses <10 mcg or for other doses which are not multiples, use rhinal tube. DDAVP nasal spray delivers fifty 10 mcg doses in the 5 mL bottle. For 10 mcg dose, administer in one nostril. Any solution remaining after 50 doses should be discarded. Pump must be primed prior to first use by pressing down on pump 4 times; if pump not used for ≥1 week, re-prime by pressing down on pump once.

DDAVP Rhinal tube (100 mcg/mL): Insert top of dropper into tube (arrow marked end) in downward position. Squeeze dropper until solution reaches desired calibration mark. Disconnect dropper. Grasp the tube 3/4-inch from the end and insert tube into nostril until the fingertips reach the nostril. Place opposite end of tube into the mouth (holding breath). Tilt head back and blow with a strong, short puff into the nostril (for very young patients, an adult should blow solution into the child's nose). Reseal dropper after use.

Stimate (1.5 mg/mL): Nasal pump spray: Delivers 0.1 mL (150 mcg); for doses <150 mcg, injection is recommended. Stimate nasal spray delivers twenty-five 150 mcg doses. For 150 mcg dose, administer in one nostril. Any solution remaining after 25 doses should be discarded. Pump must be primed prior to first use or if not used for ≥1 week.

Oral: Tablets: May administer with or without food. In adults, food may reduce/delay absorption although does not affect antidiuretic activity (Ref).

Diabetes insipidus: Fluid restriction should be observed.

Primary nocturnal enuresis: Fluid intake should be limited to a minimum of 1 hour prior to dose and until at least 8 hours after administration.

Sublingual: Primary nocturnal enuresis (DDAVP Melt [Canadian product]): Tablet should be kept under the tongue until completely dissolved. Fluid restriction should be observed. Fluid intake should be limited to a minimum of 1 hour prior to dose and until at least 8 hours after administration.

Parenteral:

Central diabetes insipidus: IV push or SUBQ: Administer as direct injection; dilution is not required.

Hemophilia A and von Willebrand disease (type 1): IV infusion: Infuse diluted solution over 15 to 30 minutes.

Medication Guide and/or Vaccine Information Statement (VIS)

An FDA-approved patient medication guide, which is available with the product information and as follows, must be dispensed with this medication:

Nocdurna sublingual tablets: https://www.accessdata.fda.gov/drugsatfda_docs/label/2018/022517s000lbl.pdf#page=14

Use: Labeled Indications

Injection:

Diabetes insipidus, central: Antidiuretic replacement therapy in the management of central (cranial) diabetes insipidus; management of the temporary polyuria and polydipsia following head trauma or surgery in the pituitary region.

Limitations of use: Not indicated and ineffective for the treatment of nephrogenic diabetes insipidus.

Hemophilia A, mild: For use in patients with mild hemophilia A with factor VIII coagulant activity levels >5% of normal to maintain hemostasis during surgical procedures and postoperatively and to also reduce bleeding due to spontaneous or trauma-induced injuries, such as hemarthroses, intramuscular hematomas, or mucosal bleeding.

Limitations of use: Not indicated for the treatment of moderate or severe hemophilia A with factor VIII coagulant activity levels ≤5% of normal, for the treatment of hemophilia B, or in patients who have factor VIII antibodies. In certain clinical situations (eg, patients who demonstrated an adequate response to a therapeutic trial), it may be justified to try desmopressin with careful monitoring in patients with factor VIII levels between 2% and 5% of normal (Hoots 2020a).

von Willebrand disease, mild to moderate (type 1): For use in patients with mild to moderate classic von Willebrand disease (VWD) (type 1) with factor VIII coagulant activity levels >5% of normal to maintain hemostasis during surgical procedures and postoperatively and to reduce bleeding due to spontaneous or trauma-induced injuries, such as hemarthroses, intramuscular hematomas, or mucosal bleeding.

Limitations of use: Not indicated for the treatment of severe classic VWD (type I) or when there is evidence of an abnormal molecular form of factor VIII antigen.

Uremic bleeding (Octostim [Canadian product]): Prevention or treatment of bleeding in patients with uremia.

Intranasal:

Diabetes insipidus, central:

DDAVP Nasal Spray: Antidiuretic replacement therapy in the management of central diabetes insipidus in adults and children ≥4 years of age.

DDAVP Rhinal tube: Antidiuretic replacement therapy in the management of central diabetes insipidus; management of the temporary polyuria and polydipsia following head trauma or surgery in the pituitary region.

Limitation of use: Treatment of primary nocturnal enuresis.

Hemophilia A, mild (Stimate): For use in patients with mild hemophilia A with factor VIII coagulant activity levels >5% of normal and to stop bleeding due to spontaneous or trauma-induced injuries, such as hemarthroses, intramuscular hematomas, or mucosal bleeding.

Limitations of use: Not indicated for the treatment of hemophilia A with factor VIII coagulant activity levels ≤5% of normal, for the treatment of hemophilia B, or in patients who have factor VIII antibodies.

Nocturia, refractory (Noctiva): Treatment of nocturia due to nocturnal polyuria in adults who awaken at least 2 times per night to void.

Limitations of use: Has not been studied in patients <50 years of age.

von Willebrand disease, mild to moderate (type 1) (Stimate): For use in patients with mild to moderate classic VWD (type 1) with factor VIII coagulant activity levels >5% of normal and to stop bleeding due to spontaneous or trauma-induced injuries, such as hemarthroses, intramuscular hematomas, mucosal bleeding, or menorrhagia.

Limitations of use: Not indicated for the treatment of severe classic VWD (type 1) or when there is evidence of an abnormal molecular form of factor VIII antigen.

Oral:

Diabetes insipidus, central: Antidiuretic replacement therapy in the management of central diabetes insipidus; management of the temporary polyuria and polydipsia following head trauma or surgery in the pituitary region.

Nocturia, refractory (Nocdurna): Treatment of nocturia due to nocturnal polyuria in adults who awaken at least 2 times per night to void.

Primary nocturnal enuresis: Management of primary nocturnal enuresis, either alone or as an adjunct to behavioral conditioning or other nonpharmacologic intervention.

Use: Off-Label: Adult

Deceased organ donor management (hormonal replacement therapy); Intracranial hemorrhage associated with antiplatelet agents; Prevention of overly rapid sodium correction in patients with chronic severe hyponatremia (adjunct to hypertonic saline infusion); Uremic bleeding; von Willebrand disease, mild to moderate (type 2)

Medication Safety Issues
Sound-alike/look-alike issues:

Desmopressin may be confused with vasopressin

Older Adult: High-Risk Medication:

Beers Criteria: Desmopressin is identified in the Beers Criteria as a potentially inappropriate medication to be avoided in patients 65 years and older for the treatment of nocturia or nocturnal polyuria due to its high risk of causing hyponatremia; safer alternatives exist (Beers Criteria [AGS 2023]).

Metabolism/Transport Effects

None known.

Drug Interactions

Note: Interacting drugs may not be individually listed below if they are part of a group interaction (eg, individual drugs within “CYP3A4 Inducers [Strong]” are NOT listed). For a complete list of drug interactions by individual drug name and detailed management recommendations, use the Lexicomp drug interactions program by clicking on the “Launch drug interactions program” link above.

ChlorproMAZINE: May enhance the hyponatremic effect of Desmopressin. Risk C: Monitor therapy

Corticosteroids (Orally Inhaled): May enhance the hyponatremic effect of Desmopressin. Risk X: Avoid combination

Corticosteroids (Systemic): May enhance the hyponatremic effect of Desmopressin. Risk X: Avoid combination

Demeclocycline: May diminish the therapeutic effect of Desmopressin. Risk C: Monitor therapy

Hyponatremia-Associated Agents: May enhance the hyponatremic effect of Desmopressin. Risk C: Monitor therapy

Lithium: May diminish the therapeutic effect of Desmopressin. Desmopressin may increase the serum concentration of Lithium. Risk C: Monitor therapy

Loop Diuretics: Desmopressin may enhance the hyponatremic effect of Loop Diuretics. Risk X: Avoid combination

Loperamide-Loperamide Oxide: May increase the serum concentration of Desmopressin. Risk C: Monitor therapy

Nonsteroidal Anti-Inflammatory Agents: May enhance the hyponatremic effect of Desmopressin. Risk C: Monitor therapy

Opioid Agonists: May enhance the hyponatremic effect of Desmopressin. Risk C: Monitor therapy

Tolvaptan: May diminish the therapeutic effect of Desmopressin. Risk X: Avoid combination

Tricyclic Antidepressants: May enhance the hyponatremic effect of Desmopressin. Risk C: Monitor therapy

Pregnancy Considerations

In vitro studies demonstrate poor placental transfer of desmopressin.

Pregnant carriers of hemophilia A and those with von Willebrand disease may have an increased bleeding risk following invasive procedures, spontaneous miscarriage, termination of pregnancy, and delivery; close surveillance is recommended. Factor VIII concentrations may increase in pregnant patients; changes in von Willebrand factor (VWF) levels may vary during pregnancy depending on type. Patients should be monitored at the first antenatal visit, once or twice during the third trimester, prior to surgical or invasive procedures, and at delivery. Desmopressin may be used to increase factor VIII and VWF if concentrations are <50 units/dL and any of the following occur: need for invasive procedures (including delivery), spontaneous miscarriage, insertion and removal of epidural catheters, or active bleeding. Use should be limited to those patients who had a known response to desmopressin prior to pregnancy. Use with caution during labor and delivery. Due to the antidiuretic properties of desmopressin, restrict fluids and avoid use in patients with pre-eclampsia and eclampsia when used antenatally. BP should also be monitored (RCOG [Pavord 2017]; WFH [Srivastava 2020]).

Pregnant patients previously treated with desmopressin for diabetes insipidus should continue treatment, adjusting doses if needed (ES [Fleseriu 2016]). Desmopressin is also the treatment of choice for gestational diabetes insipidus; close monitoring is recommended (Aleksandrov 2010; Ananthakrishnan 2020).

Desmopressin is not recommended for nocturia caused by normal physiologic changes that occur during pregnancy

Breastfeeding Considerations

Desmopressin is present in breast milk.

In a study conducted in 6 lactating women >4 months postpartum, breast milk concentrations of desmopressin were <1% of the maternal dose, collected over 8 hours following nasal administration. Analyses of milk from breastfeeding mothers receiving high-dose intranasal desmopressin indicate that the amount of desmopressin transferred to a breastfeeding child are considerably less than that required to influence diuresis.

According to the manufacturer, the decision to breastfeed during therapy should consider the risk of infant exposure, benefits of breastfeeding to the infant, and benefits of treatment to the mother. Desmopressin is considered acceptable for use in patients who are breastfeeding (ES [Fleseriu 2016]).

Monitoring Parameters

BP and pulse should be monitored during IV infusion.

Note: For all indications, fluid intake, urine volume, serum sodium, and signs and symptoms of hyponatremia should be closely monitored especially in high-risk patient subgroups (eg, young children, elderly, patients with heart failure, patients with kidney impairment).

Diabetes insipidus: Prior to treatment: Serum sodium, urine volume, and specific gravity; reassess during treatment in addition to plasma and urine osmolality.

Hemophilia A: Prior to treatment: Verify factor VIII coagulant activity is >5%; evaluate presence of factor VIII autoantibodies; serum sodium and aPTT; factor VIII ristocetin cofactor activity, and factor VIII antigen levels, aPTT.

von Willebrand disease: Prior to treatment: Verify factor VIII coagulant activity levels >5%; exclude type I disease, factor VIII von Willebrand antigen levels. During treatment evaluate bleeding time, factor VIII coagulant activity, factor VIII ristocetin cofactor activity, and von Willebrand activity (eg, immediately prior to administration, ~30 to 60 minutes after administration, and ~4 hours after administration) (ASH/ISTH/NHF/WFH [Connell 2021]).

Nocturnal enuresis: Serum electrolytes if used for >7 days.

Nocturia: Serum sodium concentrations at baseline, within 7 days, ~1 month after initiating/resuming therapy or increasing the dose, and periodically during therapy. More frequent monitoring in patients ≥65 years of age and those at increased risk of hyponatremia.

Mechanism of Action

Synthetic analogue of the antidiuretic hormone arginine vasopressin. In a dose dependent manner, desmopressin increases cyclic adenosine monophosphate (cAMP) in renal tubular cells which increases water permeability resulting in decreased urine volume and increased urine osmolality; increases plasma levels of von Willebrand factor, factor VIII, and t-PA contributing to a shortened activated partial thromboplastin time (aPTT) and bleeding time.

Pharmacokinetics (Adult Data Unless Noted)

Onset of action:

Intranasal: Antidiuretic: 15 to 30 minutes; Increased factor VIII and von Willebrand factor (vWF) activity (dose related): 30 minutes

Peak effect: Antidiuretic: 1 hour; Increased factor VIII and vWF activity: 1.5 hours; Nocturia: 0.25 to 0.75 hour

IV infusion: Increased factor VIII and vWF activity: 30 minutes (dose related)

Peak effect: 1.5 to 2 hours

Oral tablet: Antidiuretic: ~1 hour

Peak effect: 4 to 7 hours

Sublingual: Antidiuretic: ~30 minutes

Duration: Intranasal, Injection, Oral tablet, Sublingual: ~6 to 14 hours

Absorption: Sublingual: Rapid

Bioavailability: Intranasal: ~3.5%; Oral tablet: 5% compared to intranasal, 0.16% compared to IV; Sublingual: 0.25%

Half-life elimination: 2 to 4 hours; Severe renal impairment: ~9 hours

Excretion: Urine (primarily; IV: 52%).

Pharmacokinetics: Additional Considerations (Adult Data Unless Noted)

Altered kidney function: AUC and T1/2 are ~3- to 4-fold higher in patients with eGFR <50 mL/minute/1.73 m2.

Brand Names: International
International Brand Names by Country
For country code abbreviations (show table)

  • (AE) United Arab Emirates: Minirin | Noctissin;
  • (AR) Argentina: Desmopresin | Dinadom | Dpa Chobet | Nocdurna | Presinex;
  • (AT) Austria: Desmopressin actavis | Minirin | Nocdurna | Nocutil | Octostim;
  • (AU) Australia: Minirin | Nocdurna;
  • (BE) Belgium: Minirin | Minurin | Nocdurna;
  • (BF) Burkina Faso: Minirinmelt;
  • (BG) Bulgaria: Adiuretin | Minirin | Miram;
  • (BR) Brazil: D void | Ddavp | Furp desmopressina;
  • (CH) Switzerland: Minirin | Nocdurna | Nocutil | Octostim;
  • (CI) Côte d'Ivoire: Minirinmelt;
  • (CL) Chile: Ddavp | Minirin;
  • (CN) China: Minirin;
  • (CO) Colombia: D void | Desmopresin | Desmopresina | Dicpresina | Genopresin | Minirin;
  • (CZ) Czech Republic: Adiuretin sd | Desmotabs | Minirin | Nocdurna;
  • (DE) Germany: Desmogalen | Desmopressin | Desmopressin Teva | Desmospray | Desmotabs | Minirin | Minirin Csl | Minrin | Nictur | Nocdurna | Nocturin | Nocutil | Octostim;
  • (DO) Dominican Republic: Minirin;
  • (EC) Ecuador: Minirin;
  • (EE) Estonia: Adiuretin SD | Desmopressine acetaat sandoz | Minirin;
  • (EG) Egypt: Apo desmopressin | Minirin;
  • (ES) Spain: Desmopresina teva | Minurin | Minurin Flas | Octostim | Presinex | Wetirin;
  • (ET) Ethiopia: Minirin melt;
  • (FI) Finland: Minirin | Nocdurna | Octostim;
  • (FR) France: Desmopressine Dci | Minirin | Minurin | Nocdurna | Octim;
  • (GB) United Kingdom: Ddavp | Desmomelt | Desmopressin | Desmopressin cox | Desmopressin Galen | Desmopressin kent | Desmospray | Desmotabs | Nocutil | Noqdirna | Octim | Presinex;
  • (GR) Greece: Defirin | Minirin | Nictur;
  • (HK) Hong Kong: Apo desmopressin | Minirin | Pms desmopressin;
  • (HR) Croatia: Minirin;
  • (HU) Hungary: Minirin | Nocdurna | Nocutil | Octostim;
  • (ID) Indonesia: Minirin;
  • (IE) Ireland: Ddavp | Desmospray | Desmotabs | Noqturina | Nordurine;
  • (IL) Israel: Minirin;
  • (IN) India: Adiuretin | D pressin | D void | Minirin;
  • (IT) Italy: Desmopressina Ph&t | Desmopressina Teva | Minirin ddavp;
  • (JO) Jordan: Minirin | Noctissin;
  • (JP) Japan: Desmopressin;
  • (KR) Korea, Republic of: Demorin | Desmin | Desmopressinamede | Desonic | Desrin | Deturine | Diturin | Jw desmopressin | Minimopressin | Miniressin | Minirin | Minirin melt | Minis | Minurin | Monarin | Newlitan | Nocdurna | Octostim | Renissin | Unirin | Uremin | Urimo q;
  • (KW) Kuwait: Ddavp | Minirin | Noctissin | Octostim;
  • (LB) Lebanon: Minirin | Nocdurna;
  • (LT) Lithuania: Adiuretin SD | D pressin | Minirin;
  • (LU) Luxembourg: Desmopressine | Minirin | Nocdurna;
  • (LV) Latvia: Adiuretin SD | Minirin;
  • (MA) Morocco: Minirin;
  • (MX) Mexico: Desmopresina | Insipidex | Leavdid | Minirin | Minirin melt | Nafiset | Niserpol | Noctrisen | Prefhin;
  • (MY) Malaysia: Desmopressina Ph&t | Minirin;
  • (NG) Nigeria: Minirin melt;
  • (NL) Netherlands: Desmopressine | Desmopressine A | Desmopressine acetaat PCH | Desmopressine Fisher | Desmopressine-acetaat Mylan | Desmospray | Minirin | Minrin | Minrin melt | Minurin | Nocdurna | Octostim;
  • (NO) Norway: Desmogalen | Desmopressin | Desmopressine acetaat sandoz | Desmopressine-acetaat Mylan | Minirin | Minirin/ddavp | Nocdurna | Nocutil | Octostim;
  • (NZ) New Zealand: Aft desmopressin | Minirin | Octostim;
  • (PE) Peru: Minirin | Mopresin;
  • (PH) Philippines: Minirin;
  • (PK) Pakistan: Minirin | Presinex;
  • (PL) Poland: Adiuretin SD | Minirin | Noqturina | Octostim;
  • (PR) Puerto Rico: Ddavp | Nocdurna | Noctiva;
  • (PT) Portugal: Ddavp desmopressin | Desmopressina | Desmopressina Generis | Desmopressina Teva | Desmospray | Minirin | Minurin | Nocdurna | Octostim;
  • (PY) Paraguay: Desmopresina cellofarm | Desmopresina fides | Minirin;
  • (RO) Romania: Desmopresina teva | Nocdurna;
  • (RU) Russian Federation: Adiurecrin | Adiuretin SD | Antique rapid | Apo-desmopressin | Desmopressin | Minirin | Minirin melt | Nativa | Nourem | Presinex;
  • (SA) Saudi Arabia: Apo desmopressin | Minirin;
  • (SE) Sweden: Desmopressin | Desmopressin actavis | Desmopressin ferring | Minirin | Nocdurna | Nocturin | Nocutil | Nordurine | Octostim;
  • (SG) Singapore: Minirin | Nocdurna | Presinex;
  • (SI) Slovenia: Adiuretin SD | Desmogalen | Dezmopresinijev acetat Teva | Minirin | Nocdurna | Octostim;
  • (SK) Slovakia: Adiuretin sd | Desmopressin Teva | Minirin | Nocdurna;
  • (TH) Thailand: Minirin | Minirin melt;
  • (TN) Tunisia: Minirin;
  • (TR) Turkey: Desmovital | Minirin | Pridesmo;
  • (TW) Taiwan: Minirin | Pms desmopressin;
  • (UA) Ukraine: Adiupresin | Adiurecrin | Adiuretin SD | Minirin | Minirin melt | N-Desmopressin | Uropress;
  • (UY) Uruguay: Desmopresin | Desmopresina | Desmopresina fides | Desmopresina Winph | Dinadom;
  • (ZA) South Africa: Ddavp | Minirin
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