From the Guidelines
The most effective treatment for nocturnal enuresis includes desmopressin (DDAVP) as the first-line medication, with tricyclic antidepressants like imipramine and anticholinergics such as oxybutynin as alternative options. The choice of medication depends on the individual child's condition and response to treatment. Desmopressin is available as tablets (0.2-0.6 mg at bedtime) or oral lyophilisate, and works by reducing nighttime urine production 1. Imipramine (25-75 mg at bedtime) can be effective but has more side effects, including cardiac concerns, making it a second-line option 1. Anticholinergics like oxybutynin (5 mg at bedtime) are particularly useful for children with daytime urgency or frequency alongside nighttime wetting, as they increase bladder capacity by relaxing the detrusor muscle 1. These medications are typically used after behavioral interventions (like bedwetting alarms and fluid restriction) have been tried, or in conjunction with them. Some key points to consider when treating nocturnal enuresis include:
- Monitoring for side effects, such as fluid restriction to prevent hyponatremia with desmopressin, and dry mouth, constipation, and blurred vision with anticholinergics
- Encouraging sound voiding habits and regular bowel movements to prevent constipation
- Considering combination treatment with desmopressin and anticholinergics for children with refractory enuresis
- Gradually withdrawing medication after 3-6 months of treatment to assess for sustained response. Overall, the goal of treatment is to manage symptoms and improve quality of life for children with nocturnal enuresis, while also addressing any underlying conditions that may be contributing to the condition 1.
From the FDA Drug Label
DOSAGE AND ADMINISTRATION ... Childhood Enuresis Initially, an oral dose of 25 mg/day should be tried in children aged 6 and older. The drug approved for nocturnal enuresis is imipramine (PO), specifically for children aged 6 and older, with a recommended initial oral dose of 25 mg/day given one hour before bedtime 2.
From the Research
Approved Drugs for Nocturnal Enuresis
- Desmopressin is the only FDA approved pharmacologic treatment for nocturnal enuresis, as stated in the study 3.
- It reduces urine production and can be used in combination with anticholinergic agents like oxybutynin to allow the bladder to store more urine 3.
Combination Therapies
- Combination therapy of desmopressin + oxybutynin or desmopressin + imipramine has been used for patients who are non-responsive to desmopressin alone 4.
- A study found that the combination of desmopressin and imipramine was more effective in reducing wet nights compared to desmopressin and oxybutynin 4.
- Another study found that low-dose imipramine combined with desmopressin was effective in treating patients with primary nocturnal enuresis who were non-responders to desmopressin alone 5.
Safety and Efficacy
- Desmopressin has been found to be a safe drug for the treatment of enuresis with a low incidence of side-effects 6.
- A study found that desmopressin was effective in reducing the number of wet nights in patients with monosymptomatic enuresis, with a complete response rate of 71.4% in the first month of treatment 3.