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Hemophilia and von Willebrand’s disease (VWD) are both inherited bleeding disorders, but have distinct differences in severity and bleeding location. Although VWD is the most common inherited bleeding disorder, they are both associated with an increased risk of bleeding due to low levels of proteins called clotting factors. People with hemophilia have low levels of factor VIII (8) or factor IX (9) while those with von Willebrand disease have low levels of von Willebrand factor (vWF). Desmopressin (brand names: DDAVP, Stimate) is a medication that is used to control bleeding in people with these disorders. In this article, we explore how desmopressin works to stop bleeding and the characteristics associated with this medication.

What is the drug desmopressin used for?

Desmopressin works by mimicking the effects of vasopressin, a natural hormone involved in regulating water balance and controlling blood clotting. Desmopressin is used for the following conditions:

1. Central diabetes insipidus (also known as “water diabetes”): desmopressin promotes the reabsorption of water back into the bloodstream in the kidneys, reducing the amount of urine produced and preventing dehydration.

2. Treat bed wetting (primary nocturnal enuresis): desmopressin reduces nighttime urine production, helping to prevent bedwetting episodes. 

3. Bleeding Disorders: desmopressin stimulates the release of two important substances from the lining of blood vessels, vWF and factor VIII, helping platelets stick together to form a clot. These substances and clotting process are essential in treating hemophilia A and von Willebrand’s disease.

Desmopressin acetate comes in the form of tablets, a nasal spray, and an injection solution for intravenous (into the vein) or subcutaneous (under the skin) use.

How is desmopressin used to treat hemophilia? 

The primary action of desmopressin is to reduce the amount of urine produced by the body and control excessive thirst. Desmopressin is a synthetic form of the natural hormone vasopressin (arginine vasopressin), which plays a key role in the body's water and electrolyte balance. 

In addition to its actions on fluid and electrolyte balance, desmopressin increases the release of stored von Willebrand's antigen from the platelets and lining of the blood vessels. Von Willebrand's antigen is a protein that is a carrier for factor VIII. Desmopressin helps to control bleeding and promote platelet aggregation by increasing von Willebrand's antigen and factor VIII levels.

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How quickly does desmopressin start working?

How quickly a drug begins to work is referred to the onset of action. The onset of action often depends on the route of administration, meaning whether it is given orally, intravenously (IV), or intranasally. It can also be affected by the dose of desmopressin, specifically for the clotting effect. Desmopressin works quickly, usually between 15-45 minutes, again, depending on how it administered. Desmopressin peaks after 1 hour for IV and intranasal administration and 4-7 hours if given orally. The effects of desmopressin last for 6 to as many as 14 hours.

Intravenous administration of desmopressin is done over a period of around 30 minutes in a clinic or hospital. It can be given if bleeding occurs or preventively before surgery. After receiving desmopressin acetate injection, fluid restriction is necessary for 18-24 hours. 

What are the side effects of desmopressin? 

Common side effects of desmopressin are abdominal pain, nausea, and headaches. When given orally, it can cause xerostomia (dry mouth). These side effects usually go away once your body gets used to the medicine. Tell your doctor if they are severe or persistent.

More serious adverse effects of desmopressin include vomiting, loss of appetite, rapid weight gain, irritability, restlessness, confusion, fatigue, muscle weakness, slow reflexes, hallucinations, convulsions, and loss of consciousness. Seek emergency medical attention if you develop these symptoms. 

What are the risks of taking desmopressin?

Desmopressin can cause hyponatremia (low blood sodium levels), which can be life-threatening if sodium levels are low enough. Your doctor will not prescribe desmopressin to you if you are at an increased risk of severe hyponatremia, for example, if you have excessive fluid intake, conditions that can cause electrolyte imbalance, or are taking loop diuretics or systemic or inhaled steroid medications. 

Your doctor will make sure you have normal serum sodium levels before starting desmopressin. They will also measure serum sodium periodically during treatment with this medication. Older adults (age 65 years or older) are at a higher risk of developing low sodium. If you develop hyponatremia, you will have to discontinue desmopressin.

Who should not take desmopressin?

People with the following conditions should not take desmopressin acetate due to an increased risk of hyponatremia (low serum sodium):

• Hyponatremia or a history of hyponatremia 

• Moderate to severe renal impairment

• Known or suspected syndrome of inappropriate antidiuretic hormone secretion (SIADH)

• Polydipsia (excessive thirst)

• Use of loop diuretics 

• Use of systemic or inhaled glucocorticoids 

• During illnesses that can cause fluid or electrolyte imbalance, for example, gastroenteritis, systemic infections, or salt-wasting nephropathies

Desmopressin injection is also contraindicated in patients with heart failure and uncontrolled high blood pressure because it causes fluid retention and can worsen these conditions.

What precautions should I take while on desmopressin tablets or nasal spray?

• Before starting on the desmopressin oral tablet or nasal spray, tell your doctor if you have ever had an allergic reaction to desmopressin. Seek immediate medical care if you develop signs and symptoms of allergic reactions, such as skin rash, hives, itching, swelling, and difficulty breathing or swallowing.

• Give your doctor a list of all the medicines you are taking, including prescription drugs, over-the-counter medications, and dietary supplements. This will help avoid potentially dangerous drug interactions between desmopressin and your other medications. Be sure to mention antidepressants such as tricyclic antidepressants and selective serotonin reuptake inhibitors (SSRIs), antipsychotic medications, nonsteroidal anti-inflammatory drugs, and pain medications.

• Tell your doctor about all your medical conditions, especially a history of low serum sodium levels, severe renal impairment, kidney disease, heart disease, or cystic fibrosis. 

• Read the prescription label carefully and take desmopressin exactly as prescribed. Do not change the dose or dosage frequently without talking to your healthcare professionals. Using desmopressin acetate injection or nasal spray frequently to control bleeding can make it less effective. 

• If you miss a dose of desmopressin tablets, take it as soon as you remember. However, if it is almost time for the next dose, skip the missed dose and go back to your regular dosing schedule. Do not take a double dose of desmopressin to make up for a missed dose.

• In case of an overdose, call the National Poison Control Center at 1-800-222-1222 or go to the nearest emergency room.

• Keep all your healthcare appointments while on desmopressin. Your doctor may order certain lab tests and adjust your dose during treatment.