UK Clinical Pharmacy Association



This drug record relates to oral, sublingual, inhaled, intranasal, and parenteral desmopressin.

The use of desmopressin prior to surgery for patients with mild to moderate haemophilia and von Willebrand’s disease is outside the scope of this drug record.

Issues for surgery

For diabetes insipidus – severe harm or death (due to dehydration and hypernatraemia) have been reported in patients with cranial diabetes insipidus if doses are delayed or omitted (see Further information).

For primary nocturnal enuresis, idiopathic nocturnal polyuria, nocturia associated with multiple sclerosis – loss of symptomatic relief if omitted.

For primary nocturnal enuresis – change in sodium levels if continued during episodes of diarrhoea and vomiting.

Advice in the perioperative period

Elective and emergency surgery 


Establish indication for desmopressin. For patients with diabetes insipidus, desmopressin is a critical medication and must be continued. 

Check serum sodium pre-operatively, especially in elderly patients due to increased risk of hyponatraemia.

Post-operative advice

Restart post-operatively when next dose due, but also see below. 

Check serum sodium post-operatively, especially in elderly patients due to increased risk of hyponatraemia, particularly when intravenous (IV) fluids are being administered. 

Patients with diabetes insipidus

If patients with diabetes insipidus are unable to take their regular oral medication post-operatively it is essential that desmopressin is prescribed and administered via an alternative route (consult British National Formulary for dosing details). 

Patients with primary nocturnal enuresis

Avoid fluid overload. Fluid intake should be limited to a minimum for one hour before until eight hours after a dose; if this is not clinically appropriate consider temporarily discontinuing desmopressin to reduce the risk of hyponatraemia. 

If vomiting or diarrhoea occur post-operatively temporarily discontinue desmopressin until fluid balance returns to normal.

Interactions with common anaesthetic agents


Interactions with other common medicines used in the perioperative period


Concomitant administration of desmopressin with the following may increase the risk of fluid overload and/or hyponatraemia: 

  • non-steroidal anti-inflammatory drugs (NSAIDs)
  • cyclo-oxygenase-2 (COX-2) inhibitors
  • trimethoprim

This increased risk is likely to be small, and severe complications rare, however it would be prudent to exercise caution and monitor serum sodium a minimum of once daily. If serum sodium level is below the usual reference range, consider an increase in the frequency of monitoring e.g., 12-hourly. 


Loperamide is predicted to markedly increase the absorption of oral and sublingual desmopressin. For patients with primary nocturnal enuresis withhold desmopressin until diarrhoea resolves, but for all other indications monitor closely with concomitant use as the dose and/or frequency of oral and sublingual desmopressin may need to be reduced. No interaction is expected with intranasal and parenteral desmopressin.

Further information

Patient Safety Alert: Risk of severe harm or death when desmopressin is omitted or delayed in patients with cranial diabetes insipidus (April 2016) 

Cranial diabetes insipidus is a rare disorder of the pituitary gland characterised by an inability to produce antidiuretic hormone; this results in the production of large volumes of dilute urine. Left untreated, patients with cranial diabetes insipidus will develop life-threatening dehydration and hypernatraemia. 

Desmopressin is available in many formulations, including a nasal spray, and is considered a life sustaining medication; however, there is a common misconception that it is not a critical medication as nasal sprays are commonly used to treat minor conditions. Symptoms of omitted desmopressin can include confusion, agitation, hostile and uncooperative behaviour therefore patients who would usually be aware of how vital their medication is are not always able to emphasise this to staff. Delayed or omitted doses of desmopressin have been associated with at least 4 deaths and 76 episodes of harm.


NHS England. Patient Safety Alert, stage 1 warning: Risk of severe harm or death when desmopressin is omitted or delayed in patients with cranial diabetes insipidus (February 2016). Accessed via 26th February 2022

Joint Formulary Committee. British National Formulary (online) London: BMJ Group and Pharmaceutical Press. [Accessed on 26th February 2022]

Summary of Product Characteristics – DDAVP® (desmopressin) Tablets 0.1mg. Ferring Pharmaceuticals. Accessed via 26/02/2022 [date of revision of the text June 2011]

Summary of Product Characteristics – Desmopressin Spray 10 micrograms/dose Nasal Spray solution. Aspire Pharma Ltd. Accessed via 26/02/2022 [date of revision of the text January 2019]

Summary of Product Characteristics – Noqdirna® (desmopressin) 25mcg Oral Lyophilisate. Ferring Pharmaceuticals. Accessed via 26/02/2022 [date of revision of the text May 2016]

Baxter K, Preston CL (eds), Stockley’s Drug Interactions (online) London: Pharmaceutical Press. [Accessed on 26th February 2022]