Oral formulations may be used to manage primary nocturnal enuresis in adults and vasopressin sensitive diabetes insipidus, and for control of temporary polyuria and polydipsia following head trauma or surgery in the pituitary region. Intranasal and parenteral formulations may be used to manage spontaneous or trauma-induced bleeds (e.g. hemarthrosis, intramuscular hematoma, mucosal bleeding) in patients with hemophilia A or von Willebrand's disease Type I. May also be used parenterally to prevent or treat bleeding in patients with uremia.
Desmopressin emulates the actions of endogenous human ADH (refer to Pharmacology section above). Desmpressin is a structural analogue of ADH modified by deamination of 1-cysteine and substitution of 8-L-arginine by 8-D-arginine. Compared to natural ADH, desmopressin elicits a great antidiuretic response on weight basis.
Overdose may lead to increased duration of action and lead to symptoms such as fluid retention, headaches, abdominal cramps, nausea, and facial flushing. Adverse effects include headache, nausea, abdominal pain, facial flushing, dizziness, dry mouth, and hyponatremia. Nasal congestion and rhinitis have been reported with nasal spray formulations.
Minimally absorbed from the GI tract (average absolute bioavailability = 0.08-0.16%). 10-20% absorbed from nasal mucosa.
Oral t<sub>1/2</sub>=1.5-2.5 hours. Intranasal t<sub>1/2</sub>=3.3-3.5 hours. IV t<sub>1/2</sub> is biphasic: initial t<sub>1/2</sub>=7.8 minutes, terminal t<sub>1/2</sub>=0.4-4 hours.