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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.