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Metabolic & endocrine

Desmopressin

A V2-selective vasopressin analogue approved in nasal, oral and injectable formulations — each tied to its own specific indications.

L5Practice-changingApproved medicineApprovedHigh confidenceLast reviewed 2026-08-23
NasalOralIVSC injection

Also known as: DDAVP, desmopressin acetate, Stimate, Nocdurna

Evidence passport

Last reviewed 2026-08-23

Evidence level
L5Practice-changing
Confidence
High confidence
Human efficacy
85/100
Human safety
80/100
Regulatory status
Approved medicine
Development
Approved
Routes
NasalOralIVSC injection
Evidence base
Includes human data
Furthest stage
Approved
Source curation
Sources fully curated
Clinical maturity
Long-established approved medicine family (multiple formulations)

Overview

Human evidence85/100
Preclinical evidence75/100
Human safety evidence80/100

Clinical maturity: Long-established approved medicine family (multiple formulations)

Routes & formulations

Studied / approved routes

NasalOralIVSC injection

Nasal, oral and injectable desmopressin products exist with different approved indications; a formulation approved for one use is not evidence for another. The haemostatic (clotting-factor-releasing) use belongs to specific injectable and high-concentration nasal products, not to every desmopressin formulation.

Route availability is not evidence of efficacy, and evidence from one route does not transfer to another. The Registry never provides dosing or sourcing information.

Peptide lifecycle

  1. Discovery

  2. Preclinical

  3. Phase I

  4. Phase II

  5. Phase III

  6. Approved

Approved

What it is

A synthetic analogue of the natural antidiuretic hormone vasopressin, modified to act selectively on V2 receptors — reducing urine output and, via a separate endothelial effect, raising certain clotting factors.

What people claim

  • Controls excessive urination in central diabetes insipidus
  • Reduces night-time urine production in specific labelled indications
  • Supports haemostasis in certain mild bleeding disorders

What the evidence actually says

One of the clearest demonstrations that peptide medicines can work by nasal, oral and injectable routes — but each formulation was approved on its own evidence, for its own indications. Hyponatraemia (low blood sodium) is the key labelled risk and the reason fluid-management advice sits in its labelling.

Human evidence

  • Decades of controlled trials and post-marketing use across approved indications.
  • Randomised trials support specific nocturia and central diabetes insipidus indications for specific products.

Preclinical evidence

  • Receptor pharmacology establishing V2 selectivity over V1 pressor effects.

Animal and cell findings are Level 1–2 evidence.

Mechanism and pathways

  • V2-receptor agonism in the kidney collecting duct increases water reabsorption.
  • Endothelial V2 stimulation releases von Willebrand factor and factor VIII, underpinning labelled haemostatic uses.

Safety and unknowns

  • Hyponatraemia, sometimes severe, is the central labelled risk; fluid advice accompanies treatment.
  • Formulation and indication matter: contraindications and monitoring differ between products.

Cancer relevance

No concern identified

No established human cancer signal within approved use.

Regulatory status

Approved in the US and many other markets, but approvals are formulation- and indication-specific: for example products for central diabetes insipidus and certain nocturia indications, and specific injectable and high-concentration nasal products for haemostatic use in certain bleeding disorders. No single product covers every indication.

Evidence grade

L5Practice-changingHigh confidence

Replicated large randomised trials, pivotal Phase 3 programmes, or a major regulatory decision.

What would change our rating?

  • Not applicable at this evidence tier.

References and sources

Sources fully curated

Source hierarchy: regulatory documents and trial registries first, peer-reviewed work next, sponsor material flagged as non-independent. We never use supplier or clinic marketing as evidence, and where a verified source has not yet been curated we say so rather than inventing one.

Evidence change history

No recorded changes yet. Baseline position set on 2026-08-23.