Desmopressin (DDAVP) is a synthetic version of vasopressin, the body’s antidiuretic hormone. It tells the kidneys to hold on to water, so urine output falls. At higher doses it also releases clotting factor VIII and von Willebrand factor from blood vessel walls. US labels approve it for central diabetes insipidus, bedwetting in children, and bleeding in hemophilia A and type 1 von Willebrand disease when some factor VIII activity remains. Two low-dose products for nocturia (waking at night to urinate) were approved in 2017 and 2018 and are now listed as discontinued.
It has no anabolic effect. Its relevance to sport is the opposite of performance: it is on the WADA Prohibited List as a masking agent (class S5), because water retention dilutes the blood and urine markers that anti-doping tests rely on. The single most important safety fact is hyponatremia, a drop in blood sodium from retained water, which can cause seizures, coma and death and carries a boxed warning on the newer labels.
This page summarizes what the FDA labels, clinical trials and the WADA list report. It is for education only and is not medical advice.
| Property | Detail |
|---|---|
| Drug class | Vasopressin analog; selective V2-receptor agonist (antidiuretic) |
| Brands | DDAVP (injection, tablets), Desmoda (oral solution, approved 2026), Stimate (high-dose nasal spray); generics. Nocdurna and Noctiva (nocturia) discontinued |
| Routes | Intravenous, subcutaneous, intranasal, oral, sublingual |
| Labeled strengths | Injection 4 mcg/mL; nasal spray 10 mcg or 150 mcg per spray; tablets 0.1 and 0.2 mg; oral solution 0.05 mg/mL |
| Half-life | ≈2.8 h after IV dosing (label); 1.5–2.5 h after tablets; rises to 8.7 h in severe kidney impairment |
| Oral bioavailability | ≈0.16% of an IV dose (tablets); ≈0.25% sublingual |
| Boxed warning | Hyponatremia (DDAVP Injection, Nocdurna, Noctiva) |
| US status | Prescription drug, first approved 1978; labels list no DEA controlled-substance schedule |
| WADA status | Prohibited at all times, S5 Diuretics and masking agents (Specified Substance) |
What it is
Desmopressin is vasopressin with two deliberate changes. The amino group at position 1 is removed (“1-desamino”), and the natural L-arginine at position 8 is replaced with its mirror-image D-arginine. The label gives the chemical name as 1-(3-mercaptopropionic acid)-8-D-arginine vasopressin (DDAVP Injection label). The free peptide has the formula C46H64N14O12S2 and a molecular weight of 1069.2 g/mol (PubChem). The acetate trihydrate salt used in products weighs 1183.34 g/mol.
These changes make the drug last longer and shift its effects. According to the label, desmopressin has a longer duration of action than vasopressin, with much less effect on blood vessels and gut smooth muscle relative to its antidiuretic action. Usual antidiuretic doses therefore stay below the threshold for raising blood pressure.
Two separate actions
- Water retention (V2 receptors). Desmopressin stimulates vasopressin type 2 (V2) receptors in the kidney’s collecting ducts, increasing water reabsorption. Urine volume falls, urine becomes more concentrated, and plasma osmolality (the concentration of dissolved particles in blood) falls.
- Clotting factor release. Higher, weight-based doses raise plasma factor VIII activity. The label reports a dose-related response, with maximal increases of 300–400% from baseline after an infusion of 0.4 mcg/kg. The rise starts within 30 minutes and peaks at 90 minutes to 2 hours.
The hemostatic use was first described in 1977. In that report, 0.3 mcg/kg given before dental surgery produced a two- to threefold rise in factor VIII activity in four patients with moderate or mild hemophilia (Mannucci et al., Lancet 1977).
Pharmacokinetics
Desmopressin is a peptide, so very little survives the gut. That is why oral doses are measured in tenths of a milligram while injected doses are measured in micrograms.
| Parameter | Value | Source |
|---|---|---|
| Terminal half-life, IV (normal kidneys) | 2.8 h | DDAVP Injection label |
| Plasma half-life, tablets | 1.5–2.5 h, independent of dose | DDAVP Tablets label |
| Oral bioavailability (tablets) | ≈0.16% of IV; ≈5% of intranasal | DDAVP Tablets label |
| Sublingual bioavailability | 0.25% (95% CI 0.21–0.31%) | Nocdurna label |
| Time to peak | 0.9–1.5 h (oral or intranasal) | DDAVP Tablets label |
| Antidiuretic effect, tablets | Onset ≈1 h; maximum at 4–7 h; lasts up to 8 h at 0.1–0.2 mg | DDAVP Tablets label |
| Effect of food (oral solution) | High-fat meal cut peak level by 72% and total exposure by 64% | Desmoda label |
| Metabolism | Not metabolized by liver CYP450 enzymes | DDAVP Injection label |
| Excretion | 52% of a 2 mcg IV dose recovered unchanged in urine within 24 h | DDAVP Injection label |
The kidneys clear the drug, so kidney function matters a great deal. In a label study of 24 people given 2 mcg IV:
| Kidney function | Terminal half-life | Exposure (AUC) vs normal |
|---|---|---|
| Normal | 2.8 h | 1× |
| Mild impairment | 4 h | 1.5× |
| Moderate impairment | 6.6 h | 2.4× |
| Severe impairment | 8.7 h | 3.6× |
This is why the labels contraindicate desmopressin when creatinine clearance is below 50 mL/min.
Approved medical use
US labels split the uses by product. Doses below are as labeled.
| Product | Indication | Labeled dose |
|---|---|---|
| DDAVP Injection, 4 mcg/mL (IV or SC) | Central diabetes insipidus | 2–4 mcg/day in 1–2 doses |
| DDAVP Injection (IV infusion) | Hemophilia A or type 1 von Willebrand disease with factor VIII above 5% | 0.3 mcg/kg (max 20 mcg) over 15–30 min |
| Desmopressin nasal spray, 10 mcg/spray | Central diabetes insipidus, age 4 and older | Adults 10–40 mcg/day; children 10–30 mcg/day |
| DDAVP Tablets, 0.1 and 0.2 mg | Central diabetes insipidus | Start 0.05 mg twice daily; usual 0.1–1.2 mg/day in 2–3 doses |
| DDAVP Tablets | Primary nocturnal enuresis, age 6 and older | 0.2 mg at bedtime, up to 0.6 mg |
| Desmoda oral solution, 0.05 mg/mL | Central diabetes insipidus, adults and children | Start 0.05 mg twice daily, titrated |
| Stimate nasal spray, 150 mcg/spray | Hemophilia A or type 1 von Willebrand disease | 300 mcg (at least 50 kg) or 150 mcg (under 50 kg) |
| Nocdurna sublingual tablets (discontinued) | Nocturia due to nocturnal polyuria | Women 27.7 mcg; men 55.3 mcg, 1 h before bedtime |
| Noctiva nasal spray (discontinued) | Nocturia due to nocturnal polyuria, adults | 0.83 or 1.66 mcg nightly |
Sources: DDAVP Injection; desmopressin nasal spray; DDAVP Tablets; Desmoda; Stimate; Nocdurna; Noctiva.
Key limits stated on the labels:
- Central, not nephrogenic, diabetes insipidus. Desmopressin replaces missing vasopressin. It does not work when the kidneys cannot respond to the hormone (nephrogenic diabetes insipidus).
- Bleeding use needs some factor VIII. It is labeled only when factor VIII activity is above 5%, and not for severe type 1 von Willebrand disease. In type 2B von Willebrand disease it can cause platelet clumping, low platelets and possibly thrombosis.
- Tachyphylaxis. The bleeding response weakens when doses are given more often than every 48 hours.
- Nasal spray is not for bedwetting. The current spray label excludes primary nocturnal enuresis because postmarketing reports showed more hyponatremia and hyponatremic seizures with the spray than with tablets.
Market status (Drugs@FDA)
Drugs@FDA lists DDAVP Injection, DDAVP Tablets and Desmoda (approved February 25, 2026) as prescription products (Drugs@FDA, NDA 219873). It lists Nocdurna (NDA 022517), Noctiva (NDA 201656), the brand DDAVP Nasal Spray and Stimate (NDA 020355) as discontinued. Generic 10 mcg nasal sprays remain on DailyMed.
What the research shows
Bedwetting in children
In the two placebo-controlled trials behind the tablet label, 340 children aged 5–17 with primary nocturnal enuresis were randomized to placebo or 0.2, 0.4 or 0.6 mg of DDAVP for two weeks (DDAVP Tablets label):
| Arm | n | Wet nights per 2 weeks at baseline | Reduction from baseline |
|---|---|---|---|
| Placebo | 85 | 10 | 10% |
| 0.2 mg/day | 79 | 11 | 27% |
| 0.4 mg/day | 82 | 10 | 30% |
| 0.6 mg/day | 83 | 10 | 40% |
All three doses were significantly better than placebo. A 2025 Cochrane review pooled 95 trials with 8,473 children (Hahn et al., Cochrane 2025). Compared with placebo, desmopressin:
- may reduce wet nights by about 1.8 per week (MD −1.81, 95% CI −2.24 to −1.39; 16 trials; low-certainty evidence);
- probably makes 14 consecutive dry nights about three times more likely (RR 3.18, 95% CI 1.75–5.80; 11 trials; moderate certainty).
It may make little or no difference compared with a bedwetting alarm in achieving 14 dry nights (RR 0.98, 95% CI 0.88–1.09; 15 trials; low certainty).
Nocturia in adults
The nocturia products used much lower doses than the older forms. In the Nocdurna trials, two 3-month randomized, double-blind studies enrolled women (n = 237) and men (n = 230) who woke at least twice a night because of nocturnal polyuria, defined as over one-third of daily urine being made at night (Nocdurna label):
| Measure | Women, placebo | Women, 27.7 mcg | Men, placebo | Men, 55.3 mcg |
|---|---|---|---|---|
| Night-time voids at baseline | 2.9 | 2.9 | 3.0 | 3.0 |
| Change from baseline | −1.2 | −1.5 | −0.9 | −1.3 |
| Difference from placebo (95% CI) | — | −0.3 (−0.5 to −0.1) | — | −0.4 (−0.6 to −0.2) |
| At least 33% fewer voids (probability) | 0.62 | 0.78 | 0.50 | 0.67 |
The Noctiva trials in adults aged 50 and over showed a similar size of effect. The 1.66 mcg spray reduced night-time voids by 0.3–0.4 per night more than placebo (Noctiva label).
So the drug works, but placebo does most of the work and the extra benefit is less than half a void per night. A Cochrane review of 14 trials in 2,966 men reached a similar conclusion. Over 3–12 months, desmopressin may reduce night-time voids by 0.85 per night (95% CI 0.53–1.17; low-quality evidence). The review found no added benefit from combining it with an alpha-blocker or an anticholinergic (Han et al., Cochrane 2017).
Bleeding during surgery in people without bleeding disorders
Desmopressin is sometimes tried to reduce blood loss in surgery. A Cochrane review of 65 trials (3,874 participants) found the benefit was small (Desborough et al., Cochrane 2017):
| Outcome vs placebo | Result |
|---|---|
| Red cells transfused, adult cardiac surgery | −0.52 units (95% CI −0.96 to −0.08); judged unlikely to be clinically important |
| Number of people transfused | RR 0.96 (95% CI 0.86–1.06); little or no difference |
| All-cause mortality | Peto OR 1.09 (95% CI 0.51–2.34) |
| Thrombotic events | Peto OR 1.36 (95% CI 0.85–2.16) |
The surgical use is not an FDA-labeled indication. The labeled bleeding uses are limited to hemophilia A and type 1 von Willebrand disease.
Hydration and exercise performance
Desmopressin does not improve performance. In a crossover study, 8 male triathletes took 20 mcg intranasally before a strenuous exercise test. It produced neither hyperhydration nor any gain in performance compared with control (Inder et al., Med Sci Sports Exerc 1998).
Side effects and risks
Boxed warning: hyponatremia
The DDAVP Injection label (revised in 2022), Nocdurna and Noctiva carry a boxed warning. In short, it states that:
- desmopressin can cause hyponatremia, and severe hyponatremia can be life-threatening, leading to seizures, coma, respiratory arrest or death;
- the drug is contraindicated in people at increased risk of severe hyponatremia, such as those with excessive fluid intake, illnesses that upset fluid or electrolyte balance, or those taking loop diuretics or systemic or inhaled glucocorticoids;
- serum sodium must be normal before starting, checked within 7 days and about 1 month after starting, and periodically afterward, more often in people aged 65 and older;
- the drug may need to be stopped temporarily or permanently if hyponatremia occurs.
The older-format tablet label and the current nasal spray, Stimate and Desmoda labels have no box, but all warn that hyponatremia “can be fatal” if not properly diagnosed and treated.
The mechanism is simple: the drug blocks the kidney’s ability to get rid of excess water. If a person keeps drinking normally, the water stays in the body and dilutes the blood’s sodium. The labels therefore restrict fluid intake from 1 hour before a dose until 8 hours after (24 hours for Stimate). The tablet label (for bedwetting) and the Desmoda label say to pause treatment during fever, vomiting or diarrhea, and in extreme heat, vigorous exercise or other conditions with high water intake.
Warning signs listed on the labels include headache, nausea or vomiting, weight gain, restlessness, fatigue, confusion, muscle cramps and weakness.
How often it happens
In the pooled Nocdurna trials, low sodium was more common with the drug, and more common in men on the higher dose and in older adults (Nocdurna label):
| Serum sodium | Women, placebo (n = 171) | Women, 27.7 mcg (n = 191) | Men, placebo (n = 207) | Men, 55.3 mcg (n = 192) |
|---|---|---|---|---|
| 130–134 mmol/L | 4% | 7% | 3% | 17% |
| 126–129 mmol/L | 0% | 4% | 0% | under 1% |
| 125 mmol/L or lower | under 1% | 0% | 0% | 2% |
Among men aged 65 and over on 55.3 mcg, 23% had sodium of 130–134 mmol/L and 3% fell to 125 mmol/L or lower. The label sets a lower dose for women because women are more sensitive to the drug.
Outside trials, the rate was much higher. A US cohort study matched 3,137 adults (mean age 70) newly prescribed older desmopressin formulations with 3,137 starting oxybutynin (Fralick et al., PLoS Med 2019). Hyponatremia occurred at 146 vs 11 per 1,000 person-years, a 13-fold higher rate (HR 13.19, 95% CI 6.69–26.01). Only 20% of patients had a baseline sodium measured.
Other risks
- Blood pressure changes. It can lower blood pressure with a faster heart rate, or raise it. The injection label advises monitoring during IV use.
- Fluid retention. This can worsen heart failure and uncontrolled hypertension, both of which are contraindications on the injection label.
- Allergic reactions. Anaphylaxis has been reported with IV and intranasal desmopressin, including fatal cases with IV use.
- Nasal problems. Scarring, swelling or other nasal disease can make absorption from sprays erratic.
- Common effects. These include headache, nausea, flushing and mild abdominal cramps. The nasal spray label adds congestion, rhinitis and nosebleeds.
Interactions and contraindications
The DDAVP Injection label contraindicates use in people with:
- creatinine clearance below 50 mL/min;
- current or past hyponatremia;
- known or suspected syndrome of inappropriate antidiuretic hormone secretion (SIADH);
- polydipsia (habitual excessive drinking);
- concurrent loop diuretics, such as furosemide, or systemic or inhaled glucocorticoids;
- illnesses that disturb fluid or electrolyte balance, such as gastroenteritis or systemic infection;
- heart failure or uncontrolled hypertension.
Drugs that require closer sodium monitoring include tricyclic antidepressants, SSRIs, chlorpromazine, opioid painkillers, thiazide diuretics, NSAIDs, lamotrigine, carbamazepine, sulfonylureas (particularly chlorpropamide) and oxybutynin. The tablet label notes rare hyponatremic seizures with oxybutynin and imipramine. Desmopressin is not metabolized by CYP450 enzymes, so classic liver-enzyme interactions are not expected.
Anti-doping status
The WADA 2026 Prohibited List names desmopressin under S5 Diuretics and masking agents, alongside diuretics, vaptans, IV plasma expanders and probenecid (WADA 2026 Prohibited List). Key points from the list:
- It is prohibited at all times, in and out of competition.
- All S5 substances are Specified Substances.
- Felypressin is exempt only when given locally in dental anesthesia.
- The same class covers diuretics such as furosemide, hydrochlorothiazide and spironolactone.
- Detecting a masking agent alongside any amount of a threshold substance (formoterol, salbutamol, cathine, ephedrine, methylephedrine or pseudoephedrine) counts as an adverse finding, unless the athlete has a therapeutic use exemption covering both.
The reason is hemodilution. In a crossover study, 8 physically active men took desmopressin with 1.5 L of water on one occasion and the water alone on another (Sanchis-Gomar et al., Int J Sports Med 2010). Desmopressin significantly lowered hematocrit, hemoglobin and the OFF-hr score, which are markers used to detect blood doping. It also lowered albumin, glucose, creatinine and total protein concentrations. The authors concluded that it had a “very effective hemodilution effect.”
Anti-doping laboratories screen urine for desmopressin with liquid chromatography–mass spectrometry. One published initial-testing assay that includes desmopressin reported detection limits of 50–200 pg/mL (Görgens et al., Drug Test Anal 2018).
Use outside medicine
There is no evidence that desmopressin builds muscle or improves performance. The only sport-related effects documented are water retention and dilution of blood markers. Taking a drug that blocks water excretion while drinking heavily or exercising hard is the situation the labels flag as dangerous.
Key takeaways
- An antidiuretic, not an anabolic. Desmopressin is a modified vasopressin that makes the kidneys retain water. At higher IV or nasal doses it also raises factor VIII.
- Labeled for three areas. These are central diabetes insipidus, bedwetting in children (tablets), and bleeding in hemophilia A and type 1 von Willebrand disease with factor VIII above 5%. The two nocturia products are now discontinued.
- Hyponatremia is the main danger. Severe cases can cause seizures and death. Labels require fluid restriction and sodium checks, and some carry a boxed warning. Real-world rates in older adults were 13 times higher than with a comparator drug.
- Short half-life, long-lasting risk. The plasma half-life is about 2–3 hours, but it triples in severe kidney impairment. Labels contraindicate it when creatinine clearance is below 50 mL/min.
- Modest benefit for nocturia. Trials showed less than half a void per night more than placebo.
- Banned at all times in sport. WADA lists desmopressin in S5 as a masking agent because it dilutes blood markers used to detect blood doping.
Sources
- Ferring Pharmaceuticals. DDAVP (desmopressin acetate) injection, prescribing information. DailyMed.
- Ferring Pharmaceuticals. DDAVP (desmopressin acetate) tablets, prescribing information. DailyMed.
- Apotex Corp. Desmopressin acetate nasal spray 10 mcg, prescribing information. DailyMed.
- Ferring Pharmaceuticals. Stimate (desmopressin acetate) nasal spray, prescribing information. DailyMed; Drugs@FDA, NDA 020355.
- Eton Pharmaceuticals. Desmoda (desmopressin acetate) oral solution, prescribing information. DailyMed; Drugs@FDA, NDA 219873.
- Ferring Pharmaceuticals. Nocdurna (desmopressin acetate) sublingual tablets, prescribing information, 2018. FDA; Drugs@FDA, NDA 022517.
- Noctiva (desmopressin acetate) nasal spray, prescribing information, 2017. FDA; Drugs@FDA, NDA 201656.
- National Center for Biotechnology Information. Desmopressin, PubChem CID 5311065. PubChem.
- Mannucci PM, Ruggeri ZM, Pareti FI, Capitanio A. 1-Deamino-8-d-arginine vasopressin: a new pharmacological approach to the management of haemophilia and von Willebrands’ diseases. Lancet. 1977;1(8017):869–872. PubMed.
- Hahn D, Stewart F, Raman G. Desmopressin for nocturnal enuresis in children. Cochrane Database Syst Rev. 2025;7(7):CD002112. PubMed.
- Han J, Jung JH, Bakker CJ, Ebell MH, Dahm P. Desmopressin for treating nocturia in men. Cochrane Database Syst Rev. 2017;10(10):CD012059. PubMed.
- Desborough MJ, Oakland K, Brierley C, et al. Desmopressin use for minimising perioperative blood transfusion. Cochrane Database Syst Rev. 2017;7(7):CD001884. PubMed.
- Fralick M, Schneeweiss S, Wallis CJD, Jung EH, Kesselheim AS. Desmopressin and the risk of hyponatremia: a population-based cohort study. PLoS Med. 2019;16(10):e1002930. PubMed.
- Inder WJ, Swanney MP, Donald RA, Prickett TC, Hellemans J. The effect of glycerol and desmopressin on exercise performance and hydration in triathletes. Med Sci Sports Exerc. 1998;30(8):1263–1269. PubMed.
- Sanchis-Gomar F, Martinez-Bello VE, Nascimento AL, et al. Desmopresssin and hemodilution: implications in doping. Int J Sports Med. 2010;31(1):5–9. PubMed.
- Görgens C, Guddat S, Thomas A, Thevis M. Recent improvements in sports drug testing concerning the initial testing for peptidic drugs (under 2 kDa) - sample preparation, mass spectrometric detection, and data review. Drug Test Anal. 2018;10(11-12):1755–1760. PubMed.
- World Anti-Doping Agency. The 2026 Prohibited List, International Standard. WADA 2026 Prohibited List.