Desmopressin Ferring
Synthetic vasopressin analogue for diabetes insipidus, bedwetting and nocturia
Desmopressin Ferring contains desmopressin acetate, a synthetic analogue of the natural hormone vasopressin (antidiuretic hormone). It is prescribed for the treatment of central diabetes insipidus, primary nocturnal enuresis (bedwetting) in children aged 6 and over, and nocturia (frequent nighttime urination) in adults. Desmopressin works by acting on the kidneys to increase water reabsorption, thereby reducing urine production. Fluid restriction is essential during treatment to prevent water intoxication and dangerously low sodium levels.
Quick Facts
Key Takeaways
- Desmopressin Ferring is a synthetic replacement for the natural antidiuretic hormone vasopressin, helping the kidneys retain water and reduce urine output.
- It is prescribed for central diabetes insipidus, bedwetting in children aged 6+, and excessive nighttime urination (nocturia) in adults.
- Fluid intake must be strictly limited from 1 hour before to 8 hours after taking the dose to prevent dangerous water retention and low sodium levels (hyponatremia).
- Food may reduce absorption — the tablet should always be taken at the same time relative to meals for consistent effect.
- Patients aged 65 or older, those with low baseline sodium, or those with high daily urine volumes should be closely monitored by their physician.
What Is Desmopressin Ferring and What Is It Used For?
Quick Answer: Desmopressin Ferring is a prescription medication containing desmopressin acetate, a synthetic version of the natural hormone vasopressin. It reduces urine production by acting on the kidneys and is used to treat central diabetes insipidus, bedwetting in children, and excessive nighttime urination in adults.
Desmopressin is a structural analogue of arginine vasopressin (AVP), commonly known as antidiuretic hormone (ADH). Under normal physiological conditions, vasopressin is released from the posterior pituitary gland and binds to V2 receptors on the basolateral membrane of the principal cells in the renal collecting ducts. This triggers the insertion of aquaporin-2 water channels into the apical membrane, increasing water reabsorption from the filtrate back into the bloodstream. The net effect is more concentrated urine and reduced urine volume.
Desmopressin was developed as a modified form of vasopressin with two key advantages: it has a much longer duration of action (6–14 hours compared to the 2–4 hours of natural vasopressin), and it has minimal vasopressor (blood vessel constricting) activity. This means it effectively reduces urine output without significantly raising blood pressure — an important safety consideration for long-term therapy.
Central Diabetes Insipidus
Central diabetes insipidus (CDI) is a condition caused by a deficiency in the production or release of vasopressin from the hypothalamus or posterior pituitary. This can result from pituitary surgery, tumours, head trauma, autoimmune destruction, or genetic factors. Without adequate vasopressin, the kidneys cannot concentrate urine, leading to the excretion of large volumes of dilute urine (polyuria) and compensatory excessive thirst (polydipsia). Patients may produce up to 20 litres of urine per day, severely affecting quality of life. Desmopressin replaces the missing hormone, restoring normal urine concentration and volume.
Primary Nocturnal Enuresis (Bedwetting)
Primary nocturnal enuresis is involuntary urination during sleep in children aged 6 years and older who have never achieved sustained nighttime dryness. It affects approximately 5–10% of 7-year-olds and up to 1–2% of adolescents. One of the underlying mechanisms in many affected children is a relative nocturnal deficiency of vasopressin, meaning the kidneys produce excessive volumes of urine at night. Desmopressin helps by reducing nighttime urine production, thereby reducing bedwetting episodes. The International Children’s Continence Society (ICCS) recognises desmopressin as a first-line pharmacological treatment option alongside alarm therapy.
Nocturia in Adults
Nocturia, defined as waking one or more times at night to urinate, is a common complaint that increases with age. It affects an estimated 30–60% of people over 60 years of age. In cases where nocturia is primarily caused by nocturnal polyuria (excessive urine production during the night), desmopressin can be effective in reducing urine output during sleep, thereby reducing the number of nighttime awakenings and improving sleep quality. The European Association of Urology (EAU) guidelines recognise low-dose desmopressin as a treatment option for nocturia due to nocturnal polyuria.
What Should You Know Before Taking Desmopressin Ferring?
Quick Answer: You should not take Desmopressin Ferring if you have habitual excessive water intake (polydipsia), heart failure requiring diuretics, kidney impairment, low blood sodium, or a condition called SIADH. Fluid restriction is essential to prevent the serious complication of hyponatremia (low sodium).
Contraindications
Several conditions absolutely preclude the use of Desmopressin Ferring. Your doctor will assess you for these before prescribing:
- Allergy to desmopressin acetate or any excipient in the formulation
- Polydipsia — habitual or psychogenic excessive water drinking, as the combination with desmopressin’s antidiuretic effect creates a high risk of water intoxication
- Heart failure or other conditions requiring treatment with diuretic medications, as desmopressin causes fluid retention that would worsen cardiac congestion
- Renal impairment — reduced kidney function (GFR below 50 mL/min) diminishes the drug’s effectiveness and increases the risk of fluid overload
- Hyponatremia — known low sodium levels in the blood (below 135 mmol/L)
- SIADH (Syndrome of Inappropriate Antidiuretic Hormone Secretion) — a condition where the body already produces too much antidiuretic hormone
Warnings and Precautions
Speak with your doctor before starting Desmopressin Ferring in the following circumstances:
- Age 65 or older: Elderly patients have a higher risk of developing hyponatremia due to age-related changes in fluid regulation. Serum sodium should be measured before initiating treatment and monitored regularly, particularly during dose titration.
- Low baseline sodium levels: Even sodium values at the lower end of the normal range may indicate vulnerability to hyponatremia with desmopressin treatment.
- High 24-hour urine volume: Patients who produce large volumes of urine may be at increased risk of water retention when antidiuretic therapy is initiated.
- Risk of raised intracranial pressure: Desmopressin should be used with caution in patients at risk for increased pressure within the skull, as water retention could exacerbate this condition.
- Acute illness: During acute illnesses (particularly those involving fever, vomiting, or diarrhoea), fluid and electrolyte balance may be disrupted. Consult your physician about whether to temporarily discontinue treatment.
When treating bedwetting or nocturia, you must limit fluid intake to the minimum necessary to quench thirst from 1 hour before taking the tablet until at least 8 hours afterwards. Failure to restrict fluids can lead to water intoxication and hyponatremia, which in severe cases may cause headache, nausea, vomiting, seizures, and even coma.
Pregnancy and Breastfeeding
If you are pregnant, think you may be pregnant, or are planning to have a baby, consult your doctor or pharmacist before taking this medicine. Clinical experience with desmopressin during pregnancy is limited. Data from a small number of pregnancies in women with diabetes insipidus have not demonstrated increased risk of malformations, but the evidence base remains insufficient for a definitive safety assessment. Your physician will carefully weigh the therapeutic benefit against any potential risk.
Desmopressin does pass into breast milk, but at concentrations unlikely to have a clinically significant antidiuretic effect in the nursing infant. Studies measuring desmopressin levels in breast milk after maternal doses have found very low concentrations. Nevertheless, nursing mothers should discuss the benefits and risks with their doctor.
Effects on Driving and Machine Operation
Desmopressin Ferring has no known or negligible effect on the ability to drive a car or operate machinery. However, if you experience side effects such as dizziness or headache, exercise caution until these effects resolve.
Lactose Content
Desmopressin Ferring tablets contain lactose monohydrate (124 mg per tablet). Patients with rare hereditary conditions such as galactose intolerance, total lactase deficiency, or glucose-galactose malabsorption should not take this medicine. Discuss with your doctor if you have a known intolerance to any sugars.
How Does Desmopressin Ferring Interact with Other Drugs?
Quick Answer: Several medications can enhance the antidiuretic effect of desmopressin, increasing the risk of water retention and low sodium levels. These include tricyclic antidepressants, SSRIs, carbamazepine, chlorpromazine, NSAIDs, and loperamide. Dimethicone (simeticone) may reduce desmopressin’s effectiveness.
Drug interactions with desmopressin are clinically important because they can alter the drug’s antidiuretic potency, either increasing the risk of dangerous water retention and hyponatremia or reducing therapeutic efficacy. Always inform your doctor or pharmacist about all medications you are taking, including over-the-counter medicines, herbal preparations, and supplements.
Drugs That Increase Risk of Water Retention
The following medication classes can potentiate the antidiuretic effect of desmopressin, meaning the kidneys retain even more water than expected. This synergistic effect increases the risk of dilutional hyponatremia:
| Drug / Drug Class | Effect on Desmopressin | Clinical Significance |
|---|---|---|
| Tricyclic antidepressants (e.g. amitriptyline, imipramine) | Enhances antidiuretic effect | Increased risk of water retention and hyponatremia |
| SSRIs (e.g. fluoxetine, sertraline, paroxetine) | Enhances antidiuretic effect via SIADH-like mechanism | Significantly increased risk of hyponatremia; monitor sodium closely |
| Carbamazepine (antiepileptic) | Enhances antidiuretic effect | Both drugs independently cause hyponatremia; combined risk is substantial |
| Chlorpromazine (antipsychotic) | Enhances antidiuretic effect | Increased risk of water retention |
| NSAIDs (e.g. ibuprofen, naproxen, diclofenac) | Enhances antidiuretic effect by reducing renal prostaglandin synthesis | Increased risk of water retention and hyponatremia |
| Loperamide (antidiarrhoeal) | Enhances antidiuretic effect | Increased risk of water retention |
| Sulfonylureas (e.g. chlorpropamide, glibenclamide) | Enhances antidiuretic effect | Particularly chlorpropamide; increased risk of water retention |
Drugs That Reduce Desmopressin’s Effectiveness
Certain substances may reduce the antidiuretic effect of desmopressin, potentially leading to inadequate symptom control:
- Dimethicone (simeticone): This over-the-counter anti-flatulence medication may reduce the intestinal absorption of oral desmopressin, thereby diminishing its antidiuretic effect. If you need to take a product containing dimethicone, discuss timing with your doctor to minimise the interaction.
Food Interactions
Taking desmopressin tablets with food may reduce the bioavailability of the drug. Clinical studies have shown that co-administration with a meal can decrease desmopressin absorption by up to 40%. For consistent therapeutic effect, the tablet should always be taken at the same time relative to meals — either consistently with food or consistently on an empty stomach. Most prescribers recommend taking desmopressin on an empty stomach for optimal absorption.
What Is the Correct Dosage of Desmopressin Ferring?
Quick Answer: Dosage varies by indication. For diabetes insipidus, the usual adult and child dose is 0.1–0.2 mg three times daily. For bedwetting in children 6+, the usual dose is 0.2–0.4 mg at bedtime. For nocturia in adults, the usual starting dose is 0.1 mg at bedtime. Always follow your doctor’s individual prescription.
Always take Desmopressin Ferring exactly as your doctor has told you. The dose is individualised based on your specific condition, response, and clinical monitoring. Do not change your dose without consulting your physician.
| Indication | Patient Group | Usual Dose | Administration |
|---|---|---|---|
| Central diabetes insipidus | Adults and children | 0.1–0.2 mg (1–2 tablets of 0.1 mg) three times daily | Take at consistent times relative to meals |
| Bedwetting (enuresis) | Children aged 6 years and older | 0.2 mg (1 tablet of 0.2 mg) at bedtime; may be increased to 0.4 mg if needed | At bedtime; restrict fluids 1 hour before to 8 hours after |
| Nocturia | Adults | 0.1 mg (1 tablet of 0.1 mg) at bedtime | At bedtime; restrict fluids 1 hour before to 8 hours after |
Adults
For adults with central diabetes insipidus, treatment is initiated with 0.1 mg three times daily and adjusted based on urine output and thirst. The dose may be increased to 0.2 mg three times daily or higher if necessary, guided by clinical response and serum sodium monitoring. Most adults require between 0.2–1.2 mg per day in divided doses.
For nocturia, the recommended starting dose is 0.1 mg taken at bedtime. The physician may adjust the dose based on response, typically after monitoring for at least one week. Serum sodium should be checked at baseline, within 3 days of initiation or dose increase, and periodically thereafter.
Children
Children with central diabetes insipidus receive the same dose range as adults (0.1–0.2 mg three times daily), with titration guided by urine output and clinical response. For bedwetting, the usual starting dose is 0.2 mg (one 0.2 mg tablet) taken at bedtime. If response is insufficient after 1–2 weeks, the dose may be increased to 0.4 mg at bedtime. Treatment periods of 3 months are recommended, followed by a treatment-free interval of at least one week to reassess whether the condition persists.
Elderly Patients
Elderly patients (aged 65 years and over) are at significantly increased risk of developing hyponatremia when taking desmopressin. This is due to age-related impairment of the kidneys’ ability to excrete free water, lower baseline sodium levels, and potential concurrent medications that affect sodium balance. Serum sodium should be measured before starting treatment, within 3 days of initiation, at 1 month, and regularly thereafter. The lowest effective dose should be used, and treatment should be discontinued if sodium levels fall below 130 mmol/L.
Missed Dose
If you forget to take a dose, take it as soon as you remember, unless it is nearly time for your next scheduled dose. In that case, skip the missed dose and take the next one at the usual time. Never take a double dose to make up for a missed dose, as this significantly increases the risk of water retention and hyponatremia.
Overdose
An overdose of desmopressin can lead to prolonged excessive water reabsorption, resulting in severe hyponatremia, water intoxication, headache, nausea, vomiting, weight gain, and in serious cases, seizures, confusion, and coma. If you suspect an overdose, or if a child has accidentally ingested this medicine, contact your local emergency services or a poison control centre immediately. Treatment in hospital may include fluid restriction, intravenous hypertonic saline (in severe cases), and close monitoring of serum sodium and fluid balance.
What Are the Side Effects of Desmopressin Ferring?
Quick Answer: The most common side effect is headache. Other common effects include low sodium levels, dizziness, raised blood pressure, gastrointestinal symptoms, and swelling. The most serious potential side effect is hyponatremia (low blood sodium), which can occur if fluid intake is not properly restricted.
Like all medicines, Desmopressin Ferring can cause side effects, although not everybody gets them. The risk and nature of side effects differ somewhat between adults and children. The single most important factor influencing side effect risk is adherence to fluid restriction guidelines — if fluid intake is not limited as directed, abnormal water retention can occur, potentially leading to life-threatening hyponatremia.
Side Effects in Adults
Very Common
Affects more than 1 in 10 people
- Headache
Common
Affects 1 to 10 in 100 people
- Hyponatremia (low blood sodium)
- Dizziness
- Raised blood pressure (hypertension)
- Abdominal pain
- Nausea
- Diarrhoea
- Constipation
- Vomiting
- Bladder and urinary tract symptoms
- Peripheral oedema (swelling of hands, arms, feet, or legs)
- Fatigue
Uncommon
Affects 1 to 10 in 1,000 people
- Insomnia
- Somnolence (drowsiness)
- Paraesthesia (tingling or numbness)
- Visual disturbances
- Vertigo
- Palpitations
- Orthostatic hypotension (low blood pressure on standing)
- Dyspnoea (shortness of breath)
- Dyspepsia, flatulence, abdominal bloating
- Sweating, itching, rash, urticaria (hives)
- Muscle spasms, muscle fatigue
- Malaise, chest pain, influenza-like symptoms
- Weight gain
- Elevated liver enzymes
- Hypokalaemia (low blood potassium)
Rare
Affects fewer than 1 in 1,000 people
- Confusional state
- Allergic dermatitis
Not Known
Frequency cannot be estimated from available data
- Anaphylactic reaction (severe allergic reaction)
- Dehydration
- Hypernatremia (high blood sodium)
- Seizures
- Asthenia (weakness)
- Coma
Side Effects in Children
The side effect profile in children differs from that in adults. Children generally tolerate desmopressin well, with headache being the most commonly reported side effect:
Common
Affects 1 to 10 in 100 children
- Headache
Uncommon
Affects 1 to 10 in 1,000 children
- Emotional lability (mood swings)
- Aggression
- Abdominal pain, nausea, vomiting, diarrhoea
- Bladder and urinary tract symptoms
- Peripheral oedema (swollen hands and feet)
- Fatigue
Rare
Affects fewer than 1 in 1,000 children
- Anxiety symptoms
- Nightmares
- Mood swings
- Somnolence (drowsiness)
- Raised blood pressure
- Irritability
Not Known
Frequency cannot be estimated from available data
- Anaphylactic reaction
- Hyponatremia (low blood sodium)
- Abnormal behaviour, emotional disturbance, depression, hallucination
- Insomnia, attention disorder
- Increased involuntary movements, seizures
- Epistaxis (nosebleeds)
- Rash, allergic dermatitis, sweating, urticaria
Contact your doctor or go to the emergency department immediately if you experience: severe headache, confusion, seizures, unexplained weight gain, persistent nausea and vomiting, or signs of a severe allergic reaction (difficulty breathing, facial or throat swelling, widespread rash). These may be signs of serious hyponatremia or anaphylaxis requiring urgent treatment.
How Should You Store Desmopressin Ferring?
Quick Answer: Store at or below 25°C (77°F) in the original packaging. The desiccant capsule in the lid must not be removed. Keep out of sight and reach of children. Do not use after the expiry date.
Proper storage of Desmopressin Ferring is essential to maintain the potency and safety of the medication. Desmopressin is a peptide compound that is sensitive to moisture and heat, which is why specific storage conditions are required.
- Temperature: Store at a temperature not exceeding 25°C (77°F). Do not freeze. Avoid storing in areas prone to temperature fluctuations, such as bathrooms or near windows.
- Moisture protection: Keep the tablets in their original packaging. The container lid includes a desiccant capsule that absorbs moisture — this must never be removed or discarded, as exposure to moisture can degrade the active ingredient.
- Child safety: Store out of the sight and reach of children. Accidental ingestion by a child could cause serious water retention and hyponatremia.
- Expiry date: Do not use the medicine after the expiry date printed on the label. The expiry date refers to the last day of the stated month.
- Disposal: Do not dispose of unused medicines via household waste or wastewater. Return unused or expired medicine to your local pharmacy for safe disposal in accordance with environmental regulations.
What Does Desmopressin Ferring Contain?
Quick Answer: Each tablet contains desmopressin acetate as the active ingredient (0.1 mg or 0.2 mg). Other ingredients include lactose monohydrate, potato starch, povidone, and magnesium stearate.
Active Ingredient
The active substance is desmopressin acetate. Each tablet contains either 0.1 mg or 0.2 mg of desmopressin acetate, corresponding to the equivalent amount of the free base desmopressin. Desmopressin (chemical name: 1-desamino-8-D-arginine vasopressin, abbreviated DDAVP) is a synthetic nine-amino-acid peptide analogue of vasopressin. Compared to the native hormone, it has two structural modifications: deamination at position 1 and substitution of L-arginine with D-arginine at position 8. These changes confer enhanced antidiuretic potency, prolonged duration of action, and markedly reduced vasopressor activity.
Inactive Ingredients (Excipients)
- Lactose monohydrate (124 mg per tablet) — a filler and binder commonly used in tablet formulations
- Potato starch — a disintegrant that helps the tablet break apart for dissolution in the gastrointestinal tract
- Povidone — a binding agent that holds the tablet components together
- Magnesium stearate — a lubricant used in manufacturing to prevent the tablet from sticking to equipment
Appearance and Pack Sizes
The 0.1 mg tablets are white, oval, and convex with a score line and marked “0.1” on one side. The 0.2 mg tablets are white, round, and convex with a score line and marked “0.2” on one side. The score line is intended to facilitate swallowing only and not to divide the tablet into equal doses.
Available pack sizes: 0.1 mg tablets in packs of 30 and 100; 0.2 mg tablets in packs of 15, 30, and 100. Not all pack sizes may be marketed in all countries.
Frequently Asked Questions About Desmopressin Ferring
Desmopressin Ferring is a synthetic vasopressin analogue used to treat three main conditions: central diabetes insipidus (a pituitary disorder causing excessive thirst and urination), primary nocturnal enuresis (bedwetting) in children aged 6 years and older, and nocturia (frequent nighttime urination) in adults. It works by mimicking the natural antidiuretic hormone to help the kidneys concentrate urine and reduce urine output.
No, when treating bedwetting or nocturia, fluid intake must be strictly restricted. Limit fluid consumption to the minimum necessary to quench thirst from 1 hour before taking the tablet until at least 8 hours afterwards. Excessive fluid intake during this period can lead to water retention and dangerously low sodium levels (hyponatremia), which in severe cases can cause seizures or coma. For diabetes insipidus, your doctor will provide specific guidance on fluid intake based on your individual needs.
The most common side effect in adults is headache (very common, affecting more than 1 in 10 people). Common side effects include low sodium levels, dizziness, raised blood pressure, abdominal pain, nausea, diarrhoea, constipation, vomiting, urinary symptoms, swelling of hands or feet, and fatigue. In children, headache is the most frequently reported side effect. The most serious potential side effect is hyponatremia, which is preventable with proper fluid restriction.
Desmopressin Ferring is approved and widely used for children aged 6 years and older for bedwetting, and for children of any age for diabetes insipidus. It has an established safety profile in paediatric use. However, strict fluid restriction from 1 hour before to 8 hours after taking the medication is essential. Parents should monitor for signs of water retention such as headache, nausea, or unexplained weight gain. Treatment should be periodically reassessed with treatment-free intervals to determine if the condition has resolved.
Clinical experience with desmopressin during pregnancy is limited. Small studies in women with diabetes insipidus have not shown increased risk of birth defects, but the evidence is insufficient for definitive conclusions. Desmopressin passes into breast milk at very low concentrations and is unlikely to affect nursing infants. If you are pregnant, think you may be pregnant, or are breastfeeding, consult your doctor who will carefully weigh the benefits against potential risks.
Take the tablet exactly as prescribed by your doctor. It should always be taken at the same time relative to food intake for consistent absorption, as food can reduce its effectiveness. For diabetes insipidus, the usual dose is 1–2 tablets of 0.1 mg three times daily. For bedwetting, take 1–2 tablets of 0.2 mg at bedtime with restricted fluids. For nocturia, take 1 tablet of 0.1 mg at bedtime with restricted fluids. Never double the dose if you miss one.
References
- European Medicines Agency (EMA). Desmopressin – Summary of Product Characteristics. Available at: www.ema.europa.eu
- World Health Organization (WHO). WHO Model List of Essential Medicines – 23rd List, 2023. Geneva: WHO; 2023.
- Fjellestad-Paulsen A, Hoglund P, Lundin S, Paulsen O. Pharmacokinetics of 1-deamino-8-D-arginine vasopressin after various routes of administration in healthy volunteers. Clin Endocrinol (Oxf). 1993;38(2):177–182.
- Vande Walle J, Stockner M, Raes A, et al. Desmopressin 30 years in clinical use: a safety review. Curr Drug Saf. 2007;2(3):232–238. doi:10.2174/157488607781668891
- Neveus T, Eggert P, Evans J, et al. Evaluation of and treatment for monosymptomatic enuresis: a standardization document from the International Children’s Continence Society. J Urol. 2010;183(2):441–447.
- Weiss JP, Blaivas JG, Blanker MH, et al. The New England Research Institutes, Inc. (NERI) Nocturia Advisory Conference 2012: focus on outcomes of therapy. BJU Int. 2013;111(5):700–716.
- European Association of Urology (EAU). Guidelines on the Management of Non-neurogenic Male Lower Urinary Tract Symptoms (LUTS), incl. Benign Prostatic Obstruction (BPO). 2024.
- British National Formulary (BNF). Desmopressin – Indications, Dose, Contra-indications, Side-effects. Available at: bnf.nice.org.uk
- Rembratt A, Riis A, Norgaard JP. Desmopressin treatment in nocturia; an analysis of risk factors for hyponatraemia. BJU Int. 2006;97(6):1275–1278.
- U.S. Food and Drug Administration (FDA). Desmopressin Acetate – Prescribing Information. Available at: www.fda.gov
Medical Editorial Team
This article has been medically reviewed and fact-checked by the iMedic Medical Editorial Team, consisting of licensed physicians with specialisations in endocrinology, nephrology, and clinical pharmacology.
iMedic Medical Review Board — specialists in endocrinology and pharmacology with clinical experience in the management of diabetes insipidus and related conditions.
All medical claims follow the GRADE evidence framework. Sources include WHO, EMA, FDA, BNF, and peer-reviewed journals. Evidence Level 1A.
iMedic maintains complete editorial independence. No pharmaceutical company sponsorship or advertising influences our content.
This article is reviewed regularly and updated when new evidence, guidelines, or safety information becomes available.