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DDAVP (desmopressin) is used to treat central diabetes insipidus (it is not effective for nephrogenic diabetes insipidus), bed wetting in children, nighttime urination in adults, uremia, in mild to moderate cases of hemophilia A or von Willebrand disease, and to treat temporary polyuria and/or polydipsia following head trauma or surgery near the pituitary area of the brain.

In simpler terms, in most situations DDAVP reduces the need to urinate and excessive thirst. It also helps control certain blood clotting disorders, though it's not particularly effective in severe cases.

DDAVP is available as tablets, a nasal spray, tablets that dissolve under the tongue, and in injections, which are typically reserved for healthcare settings.

Patients will need to regulate fluid intake during treatment with DDAVP. Those prone to fluid or electrolyte imbalances may want to consider alternatives.

Treating Diabetes Insipidus with DDAVP

DDAVP should only be used to treat central diabetes insipidus, though it is sometimes used to test between central and nephrogenic diabetes and will not cause harm when used in that respect.

The medication is a synthetic version of the naturally-occurring hormone vasopressin, which is responsible for increasing water permeability in renal tubular cells. When permeability is increased, the need for excessive urination and excessive thirst decreases.

Treatment with DDAVP is highly individualized and will likely change several times during treatment according to patient response. The general goal is to use the lowest dose possible that produces effective results, with effective results being adequate duration of sleep (not needing to get up to urinate) and adequate (not excessive) turnover of water. In otherwise healthy patients age 13 and up, treatment is typically:

• Start with 0.05 mg twice per day (1/2 of the 0.1 mg tablet; tablets can be split)
• Dosage may be increased according to patient response.
• The majority of patients find 0.1 to 0.8 mg per day to be sufficient.

Effects should be noticeable a few days after starting treatment. A doctor may recommend adjusting fluid intake, particularly before bed. It's important to work with a doctor, at least at the start of treatment, to determine the ideal dosage and monitor for side effects.

DDAVP can be used in patients much younger than 13, but a doctor will need to consider the correct dosage. Patients under age 6 may require different formulas, such as nasal spray, as young children are not inclined to swallow tablets.

Treatment may continue indefinitely.

Treating Nocturnal Urination with DDAVP

In treating bedwetting---in both adults and children as young as 6---DDAVP does produce positive results significantly greater than placebo, but is not 100 percent effective. On average, both children and adults have 2 to 3 fewer incidents per week than those on placebo. About 25 to 60 percent of children see improvement.

For children under 6 years old a doctor should be consulted for dosage. In patients age 6 and up:

• Start with 0.2 mg before bedtime.
• Dosage may be increased to 0.4 or 0.6 mg before bedtime if needed.
• Do not exceed 0.6 mg in children. If it doesn't produce results at this dosage, alternatives should be considered.

Fluids should be restricted one hour before DDAVP is administered, and maintained throughout the night (8 hours). Treatment should generally not exceed three to six months. Some individuals will continue to stay dry, though others, particularly children, may relapse.

DDAVP tablets can be used as-needed now and then, such as for a sleepover, but should not be taken daily for more than three to six months at a time.

Other DDAVP Uses

With respect to polyuria or polydipsia, as brought on by head trauma or surgery, dosage and duration of treatment is highly variable and will be determined by a doctor.

With respect to hemophilia A and von Willebrand disease, DDAVP stimulates release of clotting factor VIII from cells in blood vessels. DDAVP is used prior to minor surgery in patients who have mild to moderate hemophilia A or von Willebrand disease to help control bleeding. It should be administered, in general, 1 to 2 hours prior to surgery. Effectiveness varies from person to person, and this may be tested first.

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DDAVP Nasal Spray Pump (desmopressin) offers an alternative to DDAVP tablets, in that the nasal spray version is administered via the nasal passages. This product is used to reduce excessive thirst and excessive urination in patients who have central diabetes insipidus. It's also used to prevent bedwetting, urination and thirst following head trauma or surgery near the pituitary region, and to help with blood clotting prior to surgery in patients who have mild to moderate hemophilia A or von Willebrand disease.

Note that, in the USA, the nasal spray version has been associated with low sodium levels, particularly in children, and the DDAVP Nasal Spray Pump is no longer approved for use in children in the US. Other locations do not restrict its use. Deciding to use this product in children is between the parents and their doctor. However, there are orally-dissolving tablets available on the DDAVP tablets page (sold as MesmoMelt) which children may take more readily than plain tablets, a suitable alternative to the nasal spray.

Patient of any age who are prone to electrolyte imbalances may want to consider alternative products.

What DDAVP Nasal Spray Pump Is

Instructions for using the DDAVP Nasal Spray Pump will be included with each product. It's very simple; a vial with finger-holds and the applicator built in. With fingers on the fingerholds, simply press down and a metered dose of medication comes out the applicator. The applicator should be inserted into a nostril for administration.

The DDAVP Nasal Spray Pump is designed to deliver 0.1 mL (10 mcg) per pump. The pump must be primed before first use, by pressing down four times. This does not need to be repeated unless the medication is unused for several weeks.

In trials, the medication worked fine for some patients who had nasal congestion, but not so well for others. Alternative products may be needed for heavily congested patients, including other DDAVP administration methods.

Using DDAVP Nasal Spray Pump for Diabetes Insipidus

One of the primary uses for this product is treating central diabetes insipidus. Dosage starts out low, gradually increased if needed for optimal results---adequate sleep (not getting up to urinate) and adequate fluid turnover.

DDAVP Nasal Spray Pump can be used in patients as young as 3 months old (if one wishes to ignore USA warnings), though doses for younger patients are heavily modified and best determined by a doctor. Patients age 13 and up can generally use adult doses.

The correct dosage strength will also be determined by a doctor, and may change. The amount of medication taken---nasal inhalations---or frequency of administration will likely change at least once near the start of treatment.

To reduce urination and excessive thirst in patients 13 and up:

• Start with 0.1 mL (10 mcg, or one spray), administered in a single dose.
• Dosage may be increased up to 0.4 mL (40 mcg, or four sprays) three or four times per day according to patient response.
• The majority of patients find 0.2 mL (20 mcg, or two sprays) taken twice per day to be sufficient.

There is some evidence that, for at least some patients, the medication begins to lose effectiveness after at least six months of regular use. Many patients don't notice any such reduction. Among those who do, it's unclear if switching to another formula---tablets, rapidly-dissolving tablets, or injections---resumes full effect or if another medication will need to be tried.

Treatment may continue indefinitely provided the medication continues to work and no adverse effects develop.

DDAVP Nasal Spray Pump for Bedwetting

DDAVP Nasal Spray Pump can be used in ages 6 and up, including the elderly, for bedwetting. First other problems---physical injury, for example---should be ruled out. Bedwetting under age 6 is quite common and children are generally not expected to be able to fully control urination; it's rare that bedwetting medication will be given to children below age 6.

Fluid intake should be minimized an hour prior to using DDAVP Nasal Spray Pump, and for the 8 hours following administration; if the mouth becomes very dry, a few sips of water may be consumed.

The medication should be administered shortly before bed:

• Start with 0.1 mL (10 mcg, or one spray) before bed.
• This may be increased up to 0.4 mL (40 mcg, or four sprays) according to patient response.
• If 0.4 mL does not produce desired results, alternative products should be considered.

Treatment should continue for three months, after which it should be stopped for at least one week to see if bedwetting continues. Note that this medication isn't effective for everyone, and relapse after treatment ends is common. If relapse occurs after three months, treatment may continue for another three months.

DDAVP Nasal Spray Pump can also be used as-needed, such as during sleepovers, to prevent bedwetting, once an effective dose is known.