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Desmopressin

Also known as ddavp, 1‑deamino‑8‑d‑arginine vasopressin, ddavp · Wikipedia

Desmopressin (DDAVP, 1-deamino-8-D-arginine vasopressin) is an FDA-approved synthetic analog of arginine vasopressin (ADH) with selective V2-receptor agonism and minimal V1a (pressor) activity. It has multiple approved indications: central diabetes insipidus, primary nocturnal enuresis (oral tablet), nocturia due to nocturnal polyuria in adults (intranasal Noctiva), haemostatic management of mild haemophilia A and type 1 von Willebrand disease, and certain uraemic-bleeding situations. Severe, occasionally fatal hyponatraemia is the single most important safety hazard, especially in older patients and with concomitant SSRIs, NSAIDs, thiazide or loop diuretics. Multiple formulations exist: intranasal, oral tablet, sublingual ODT, subcutaneous, and intravenous.

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Mechanism of action

Desmopressin (1-deamino-8-D-arginine vasopressin, dDAVP) is a synthetic analog of arginine vasopressin with two key modifications: deamination of the N-terminal cysteine, which extends half-life and resistance to vasopressinase, and D-arginine substitution at position 8, which strongly shifts selectivity toward the renal V2 receptor and away from vascular V1a (pressor) activity (DDAVP FDA label). V2 agonism in renal collecting-duct principal cells signals through Gs/cAMP/PKA to translocate aquaporin-2 water channels to the apical membrane, increasing free-water reabsorption and concentrating urine.

Desmopressin (1-deamino-8-D-arginine vasopressin, dDAVP) is a synthetic analog of arginine vasopressin with two key modifications: deamination of the N-terminal cysteine, which extends half-life and resistance to vasopressinase, and D-arginine substitution at position 8, which strongly shifts selectivity toward the renal V2 receptor and away from vascular V1a (pressor) activity (DDAVP FDA label). V2 agonism in renal collecting-duct principal cells signals through Gs/cAMP/PKA to translocate aquaporin-2 water channels to the apical membrane, increasing free-water reabsorption and concentrating urine. V2 agonism on vascular endothelium also triggers release of von Willebrand factor and factor VIII from Weibel-Palade bodies, supporting its use in mild haemophilia A and type 1 vWD. Minimal V1a activity means little pressor or smooth-muscle effect at therapeutic doses.

Pharmacokinetic properties

Half-life

Plasma ~1.5-3.5 hours; biological antidiuretic effect 6-14 hours

Routes

intranasal · oral · subcutaneous · intravenous

Bioavailability

Oral bioavailability is very low (~0.1-0.16%); intranasal ~3-5%; SC/IV essentially 100%. Sublingual orally disintegrating tablet (ODT) preferred over older oral tablet for more predictable absorption.

Amino-acid sequence

deamino-Cys-Tyr-Phe-Gln-Asn-Cys-Pro-D-Arg-Gly-NH2 (disulfide Cys1-Cys6)

Use & research dosing

Nocturnal UrinationWater BalanceHealthy AgingSleep Improvement

FDA-approved dosing (clinical, for context only): central diabetes insipidus - 2-4 mcg/day SC or IV in divided doses, 10-40 mcg/day intranasal divided, or 0.1-0.8 mg/day oral divided (DDAVP label). Primary nocturnal enuresis - 0.2-0.6 mg oral at bedtime. Nocturia (Noctiva intranasal) - 0.83 mcg in women, 1.66 mcg in men, ~30 minutes before bedtime. Haemostatic use (mild haemophilia A, type 1 vWD) - 0.3 mcg/kg IV or SC. Self-experimentation outside approved indications is not advisable given the hyponatraemia hazard.

Research-use framing only. SavePeptides sells nothing for human consumption. Doses above reflect reported research / self-experimentation ranges, not clinical recommendations.

Editorial perspective

Desmopressin is a well-established pharmaceutical with decades of clinical use across multiple specialties (endocrinology, urology, haematology, paediatrics). Hyponatraemia is the single most important safety landmine - particularly dangerous in older adults and with concomitant SSRIs, NSAIDs, or thiazide diuretics. Serum sodium should be checked at baseline, after dose titration, and periodically during chronic use. The 2007 withdrawal of the intranasal indication for primary nocturnal enuresis after seizure reports remains a key clinical lesson.

— SavePeptides editorial desk · last updated 2026-05-25

Cautions & contraindications

Before researching this compound, note:

  • Severe hyponatraemia and water intoxication - especially in elderly; can cause seizures, coma, death (warning emphasised across DDAVP labels)
  • Contraindicated in current or prior hyponatraemia
  • Contraindicated in moderate-to-severe renal impairment (CrCl <50 mL/min)
  • Use with extreme caution with SSRIs, SNRIs, tricyclics, NSAIDs, thiazide/loop diuretics, carbamazepine, chlorpropamide (all increase hyponatraemia risk)
  • Fluid restriction required during therapy; counsel patient on water intake
  • Avoid in uncontrolled hypertension and known congestive heart failure (volume retention)
  • Avoid in habitual or psychogenic polydipsia
  • Intranasal route for primary nocturnal enuresis was withdrawn in 2007 due to seizure reports - use oral instead
  • Anaphylactoid/hypersensitivity reactions reported (rare)
  • Increased risk in children and elderly - extra monitoring required

Research foundation

The papers behind the page.

  1. [01]https://www.accessdata.fda.gov/drugsatfda_docs/label/2022/018938s039lbl.pdf
  2. [02]https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6802819/

Facts verified

2026-05-25

Confidence

high

What this means

  • FDA-approved drug with multiple indications
  • severe hyponatraemia is the dominant safety hazard - elderly, SSRIs, NSAIDs, thiazides increase risk
  • intranasal indication for primary nocturnal enuresis withdrawn in 2007 due to seizures

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Desmopressin · SavePeptides