Desmopressin Acetate (DDAVP)

Desmopressin is a synthetic octapeptide analog of the natural antidiuretic hormone vasopressin. It has potent antidiuretic action and stimulates the activity of factor VIII and plasminogen activator. It is used in cranial diabetes insipidus, nocturnal enuresis, in renal function tests, in post-dural puncture headache, and in hemophilia and type I von Willebrand disease. Oral, sublingual, intranasal, or injectable administration.

It is excreted in negligible amounts into breast milk. ^{(Burrow 1981)}. Its pharmacokinetic data (very high molecular weight and moderately large volume of distribution) hinder excretion in breast milk.

Its low oral bioavailability makes it difficult for it to pass to the infant’s plasma via ingested breast milk as, due to its protein nature, it degrades in the gastrointestinal tract and is not absorbed.

No problems have been reported in breastfeeding or in infants of mothers treated with desmopressin. ^{(Wallia 2013, Hadi 1985, Hime 1978)}

Diabetes insipidus worsens during pregnancy and improves with breastfeeding, decreasing desmopressin requirements. ^{(Hime 1978)}. Nipple suckling doubles maternal plasma vasopressin levels. ^{(Hawker 1957)}

Expert authors consider the use of this medication compatible with breastfeeding ^{(Hale, LactMed, Briggs 2015)}. Recommendations for Drugs in the Eleventh WHO Model List of Essential Drugs: compatible with breastfeeding. ^{(WHO-UNICEF 2002)}