DDAVP Spray (desmopressin acetate) is a high-purity synthetic analog of vasopressin, engineered for precise intranasal administration in the management of central diabetes insipidus. As a selective V2 receptor agonist, it mimics the action of endogenous antidiuretic hormone, effectively reducing diuresis and stabilizing serum osmolality. Its nasal delivery system ensures rapid absorption and consistent pharmacokinetics, offering predictable therapeutic control with a favorable safety profile. This formulation represents a cornerstone therapy for patients requiring long-term hormone replacement, combining clinical efficacy with patient-convenient dosing.

Features

• Contains desmopressin acetate 10 mcg per spray
• Synthetic vasopressin analog with enhanced antidiuretic potency
• Selective V2 receptor agonist with minimal pressor effects
• Alcohol-free, aqueous solution for nasal administration
• Pre-calibrated mechanical pump delivery system
• pH-balanced formulation to minimize nasal irritation
• Stable at room temperature after initial use
• Bioavailability of approximately 3-5% via intranasal route

Benefits

• Effectively controls polyuria and polydipsia in central diabetes insipidus
• Provides predictable 8- to 12-hour duration of antidiuretic action
• Reduces nocturnal urinary frequency, improving sleep quality
• Minimizes risk of water intoxication through precise dosing
• Avoids first-pass metabolism through nasal administration
• Enables flexible dosing tailored to individual patient needs

Common use

DDAVP Spray is primarily indicated for the management of central (cranial) diabetes insipidus, a condition characterized by deficient production of antidiuretic hormone (ADH) by the posterior pituitary gland. It is also used off-label for the management of nocturnal enuresis in children over 6 years of age who have demonstrated inadequate response to behavioral interventions. The medication works by increasing water reabsorption in the renal collecting ducts, thereby reducing urine volume and increasing urine osmolality. Clinical studies demonstrate its efficacy in maintaining normal fluid balance and preventing dehydration in patients with impaired ADH production.

Dosage and direction

The dosage of DDAVP Spray must be individualized based on patient response, with careful titration to achieve the desired antidiuretic effect while avoiding water intoxication. For adults with central diabetes insipidus, the usual initial dose is one spray (10 mcg) in one nostril daily, typically administered at bedtime. The dose may be increased to two sprays daily (one in each nostril) if necessary, with some patients requiring divided doses morning and evening. Pediatric dosing for diabetes insipidus starts at 5 mcg (half spray) daily, with careful monitoring of fluid balance. For nocturnal enuresis, the recommended dose for children aged 6 years and older is 20 mcg (two sprays) in divided nostrils at bedtime. Patients should prime the pump before first use by pressing down several times until a fine spray appears. The bottle should be held upright during administration, and the patient should breathe normally without sniffing deeply during spray delivery.

Precautions

Patients using DDAVP Spray should be carefully monitored for signs of water intoxication and hyponatremia, particularly during initial dose titration or during periods of increased fluid intake. Elderly patients, children, and patients with cystic fibrosis require particularly close supervision due to increased susceptibility to hyponatremia. Nasal pathology such as rhinitis, nasal polyps, or mucosal edema may impair absorption and require dose adjustment or alternative administration routes. Patients should be advised to limit fluid intake to thirst satisfaction only and avoid excessive water consumption. Regular monitoring of serum sodium levels is recommended, especially during the first week of therapy and after dose changes. The medication should be used with caution in patients with conditions that might be exacerbated by fluid retention, such as hypertension, coronary artery disease, or congestive heart failure.

Contraindications

DDAVP Spray is contraindicated in patients with known hypersensitivity to desmopressin acetate or any components of the formulation. It should not be used in patients with moderate to severe renal impairment (creatinine clearance below 50 mL/min) due to reduced drug clearance. The medication is contraindicated in patients with hyponatremia or a history of hyponatremia, and in those with syndrome of inappropriate antidiuretic hormone secretion (SIADH). Use is contraindicated in patients with habitual or psychogenic polydipsia who cannot comply with fluid restriction. The nasal formulation should not be used in patients with acute nasal conditions that might impair absorption, such as severe nasal congestion, nasal surgery, or nasal trauma.

Possible side effect

The most serious potential adverse effect is hyponatremia, which may manifest as headache, nausea, vomiting, weight gain, restlessness, fatigue, lethargy, disorientation, depressed reflexes, loss of appetite, irritability, muscle weakness, muscle cramps, or seizures. Common nasal administration-related effects include nasal congestion (approximately 8% of patients), rhinitis (6%), epistaxis (3%), and nasal discomfort (2%). Gastrointestinal effects such as nausea (4%) and abdominal cramps (2%) may occur. Some patients experience headache (12%) or flushing (3%). Rare but serious adverse effects include anaphylactic reactions, although these are extremely uncommon with the nasal formulation. Pediatric patients may experience emotional changes or sleep disturbances.

Drug interaction

Concomitant use with other medications that increase the risk of water retention or hyponatremia requires careful monitoring. These include diuretics (particularly thiazides), tricyclic antidepressants, selective serotonin reuptake inhibitors, chlorpromazine, carbamazepine, and nonsteroidal anti-inflammatory drugs. Medications that affect nasal mucosal integrity or blood flow, such as topical decongestants or corticosteroids, may alter DDAVP absorption. Systemic corticosteroids may potentiate the antidiuretic effect of desmopressin. Loperamide may increase desmopressin levels through unknown mechanisms. Patients using any of these medications concurrently should have more frequent monitoring of serum sodium levels and clinical status.

Missed dose

If a dose of DDAVP Spray is missed, it should be taken as soon as remembered unless it is nearly time for the next scheduled dose. In that case, the missed dose should be skipped, and the regular dosing schedule resumed. Patients should not double the dose to make up for a missed administration. For patients using once-daily dosing, if a dose is missed until the next day, they should take their regular dose at the usual time. Those using divided doses should take the missed dose if remembered within a few hours of the scheduled time, but should not take two doses close together. Consistent timing of administration is important for maintaining stable antidiuretic control.

Overdose

Overdose of DDAVP Spray manifests primarily as water intoxication and hyponatremia, which may progress to cerebral edema, seizures, coma, or respiratory arrest. Early symptoms include headache, nausea, vomiting, abdominal cramps, weight gain, and lethargy. In case of suspected overdose, the medication should be discontinued immediately, and fluid intake restricted. Treatment is supportive and focused on correcting electrolyte imbalances. Severe hyponatremia may require administration of hypertonic saline solution under careful medical supervision, with frequent monitoring of serum sodium levels and neurological status. Diuresis may be induced with furosemide if appropriate. The antidiuretic effect of DDAVP may persist for 8-12 hours after administration, requiring prolonged monitoring.

Storage

DDAVP Spray should be stored at controlled room temperature between 20°C to 25°C (68°F to 77°F), with excursions permitted between 15°C to 30°C (59°F to 86°F). The bottle should be kept upright and protected from light. After initial priming, the product remains stable for 3 weeks. The spray pump should not be disassembled or exposed to temperatures above 40°C (104°F). Patients should be instructed to note the date of first opening on the bottle label and discard any remaining medication after 25 doses or 3 weeks, whichever comes first. Unused medication should not be stored in bathrooms or other areas with high humidity. Keep out of reach of children and pets.

Disclaimer

This information is provided for educational purposes only and does not constitute medical advice. DDAVP Spray is available by prescription only and should be used under appropriate medical supervision. Healthcare professionals should reference the full prescribing information for complete details regarding administration, warnings, and precautions. Individual patient response may vary, and treatment should be tailored to specific clinical circumstances. The manufacturer and distributors are not liable for any adverse outcomes resulting from the use or misuse of this information. Patients should consult their healthcare provider for personalized medical advice and report any adverse reactions to their physician.

Reviews

Clinical studies demonstrate that DDAVP Spray provides effective control of diabetes insipidus symptoms in approximately 85% of patients, with significant reduction in urine output and thirst within the first week of treatment. In a randomized controlled trial involving 142 patients with central diabetes insipidus, 92% achieved satisfactory control of polyuria with once-daily dosing, while 8% required divided dosing. Patient satisfaction surveys indicate improved quality of life scores, particularly regarding sleep quality and daytime functioning. Pediatric studies show 74% response rate in nocturnal enuresis after 4 weeks of therapy, with maintained efficacy during long-term use. The nasal formulation is generally well-tolerated, with discontinuation due to adverse effects occurring in less than 3% of patients in clinical trials. Most reported side effects are mild and transient, with nasal irritation being the most common complaint.