What is the optimal dose of Desmopressin (DDAVP) for nocturnal enuresis in a 5-year-old child?

From the Guidelines

For a 5-year-old child with nocturnal enuresis, the recommended starting dose of DDAVP (desmopressin) is typically 0.2 mg orally at bedtime, as stated in the most recent guideline 1. This dose is not influenced by body weight or age, and the prescribing physician may choose to start with the higher dose and taper down in cases of good effect or use the opposite strategy 1. The medication should be taken approximately 1 hour before bedtime, and fluid intake should be limited from 1 hour before until 8 hours after administration to prevent water intoxication. Key points to consider when prescribing DDAVP include:

• The dose may be increased to 0.4 mg if needed after 1-2 weeks if the initial dose is ineffective, but should not exceed this maximum 1
• DDAVP works by reducing urine production overnight by mimicking the action of antidiuretic hormone (ADH), which helps the kidneys retain water
• Before starting medication, it's essential to rule out other causes of bedwetting and try behavioral interventions first, as DDAVP is typically not first-line therapy for a child this young 1
• Treatment should be intermittent with drug holidays to assess continued need, and the medication should be discontinued after 3-6 months to evaluate if the child has outgrown the condition 1
• Side effects to monitor include headache, nausea, and hyponatremia (especially if excessive fluids are consumed) 1

From the Research

Dose of Desmopressin for Nocturnal Enuresis in a 5-Year-Old

• The optimal dose of desmopressin for nocturnal enuresis in children is not clearly established, but studies suggest that it can be effective in reducing bedwetting in a variety of doses and forms 2.
• A study published in 2002 found that desmopressin reduced bedwetting by at least one night per week during treatment compared with placebo, with a dose of 20 microg resulting in 1.34 fewer wet nights per week 2.
• Another study published in 2009 found that long-term desmopressin treatment was consistently well-tolerated across all ages, with 41% of patients experiencing a reduction of > or = 50% in the mean number of wet nights after 6 months of treatment 3.
• The strength of treatment response was associated with nocturnal diuresis and age, with compliance and dosage also associated with response 3.
• It is recommended that children should be advised not to drink more than 240 ml (8 oz) fluid during desmopressin treatment in order to avoid the possible risk of water intoxication 2.

Comparison with Other Treatments

• Desmopressin has been compared with other treatments, including alarms and tricyclic drugs, with some studies suggesting that alarms may produce more sustained benefits 2.
• A study published in 2022 found that enuresis alarm therapy is more likely to produce long-term success, while desmopressin yields earlier symptom improvement 4.
• Another study published in 2025 found that combination therapies, particularly desmopressin and anticholinergics, have demonstrated superior efficacy and faster results compared to monotherapy 5.

Safety and Efficacy

• Desmopressin has been shown to be safe and effective in the treatment of nocturnal enuresis in children, with few and mostly insignificant adverse reactions 6.
• A study published in 1993 found that desmopressin had an exceptional safety margin, with only 21 patients experiencing serious adverse reactions (water intoxication) and no fatalities occurring between 1974 and 1992 6.
• Long-term desmopressin treatment has been found to be consistently well-tolerated across all ages, with 5% of patients experiencing any treatment-related adverse events 3.