Pharmacology

Desmopressin (DDAVP)

Desmopressin (DDAVP, antidiuretic hormone) is a synthetic analog of vasopressin which can be administered IV, IM, subQ, and orally. Compared to vasopressin (generally regarded as a potent vasoconstrictor), DDAVP has less efficacy as a pressor, a longer duration, and is a much more potent antidiuretic (hence its use for bedwetting) by means of increasing permeability to water and subsequent reabsorption in the distal nephron’s collecting ducts.

As an intensivist, I’ve used DDAVP following neurotrauma in patients who develop central diabetes insipidus (DI). In this condition, there’s a decrease in the production of endogenous ADH by the hypothalamus and/or release by the pituitary gland leading to excessive, dilute urination. DDAVP basically replaces this hormone deficiency to normalize free water retention.

As a cardiothoracic anesthesiologist, I most frequently use DDAVP in patients with severe renal impairment who have coagulopathy following cardiopulmonary bypass. Most patients will have some degree of qualitative/quantitative platelet impairment, but in those with longstanding kidney disease, a component of uremia must be considered. I’ll transfuse platelets with a trial of 0.3 mcg/kg IV DDAVP over ~ 30 minutes to increase the endogenous release of factor VIII and von Willebrand factor (vWF) while using other assays (PFA, TEG, CBC, etc.) to guide further transfusions. Remember that this dose of DDAVP is higher than that used for central DI.

Drop me a comment below with questions!

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2 Comments

  1. Hi Rishi,

    Thank you for a great post. Following cardiopulmonary bypass, does it matter if the DDAVP going in to a central or peripheral line? Sometimes post bypass I have heard not to give protamine via a central line, but not sure about DDAVP. Do you usually give DDAVP over 30 mins as well? Thank you in advance.

    1. For cardiac surgery, I give almost everything (including DDAVP and protamine) through my central line. And yeah, I run it over 20–30 minutes.

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