From the Guidelines
Clomipramine is not typically recommended as a first-line treatment for nocturnal enuresis, and its use should be considered with caution due to potential side effects and the availability of safer alternatives. The most recent and highest quality study, 1, suggests that behavioral interventions and other medications, such as desmopressin, should be tried first. According to 1, imipramine, a tricyclic antidepressant similar to clomipramine, is only relevant as third-line therapy due to safety concerns and side effects. Key considerations for treating nocturnal enuresis include:
- Behavioral interventions, such as bedwetting alarms and fluid restriction, should be tried first
- Desmopressin is a safer alternative with a better safety profile
- Clomipramine may be considered in select cases, but its use should be carefully weighed against potential risks and benefits
- Treatment should be individualized and based on the specific needs and circumstances of the child.
From the Research
Clomipramine in Treating Nocturnal Enuresis
- There is no direct evidence in the provided studies that clomipramine is helpful in treating nocturnal enuresis.
- However, imipramine, which is a similar medication, has been studied as a treatment option for nocturnal enuresis 2, 3, 4.
- A 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 4.
- Another study mentioned imipramine as a treatment option for therapy-resistant cases of nocturnal enuresis, but noted that it carries a risk of cardiotoxicity 2.
- Clonidine, an α2-adrenoceptor agonist, has also been studied as a potential treatment for refractory nocturnal enuresis, and may be an alternative to imipramine 5.
Treatment Options for Nocturnal Enuresis
- The first-line treatment for nocturnal enuresis is often the enuresis alarm, which has a definite curative potential but requires motivation and work 2, 6.
- Desmopressin is also a common treatment option, and may be used in combination with other medications or therapies 2, 6, 3, 4.
- In cases where these treatments are not effective, other options such as anticholinergic treatment, imipramine, or clonidine may be considered 5, 2, 3, 4.