From the Guidelines
The recommended dose of desmopressin (DDAVP) for treating nocturnal enuresis is 0.2 to 0.4 mg orally at bedtime, with the option to start with the higher dose and taper down if necessary, as stated in the most recent and highest quality study 1. The 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.
- The anti-enuretic effect is seen immediately, and if there is a positive effect, it is up to the family to choose between daily medication or desmopressin administration before important nights only.
- Important warnings for desmopressin use include the risk of severe hyponatremia and water intoxication, which can lead to seizures or death, as noted in 1.
- Patients must restrict fluid intake from 1 hour before until 8 hours after taking desmopressin to reduce this risk, and the medication should be temporarily discontinued during acute illnesses that might affect fluid balance, such as fever, vomiting, or diarrhea.
- Desmopressin is contraindicated in patients with hyponatremia, polydipsia, or conditions that increase risk of water retention, and it works by mimicking the action of antidiuretic hormone (vasopressin), reducing urine production overnight by increasing water reabsorption in the kidneys, which helps prevent bedwetting episodes in children with nocturnal enuresis, as explained in 1.
- The oral formulation is preferred over the nasal spray due to the risk of water intoxication and hyponatremia associated with the nasal spray, as reported in 1.
- A good rule of thumb for fluid intake is to limit evening intake to 200 ml (6 ounces) or less and avoid drinking until morning, as suggested in 1.
From the Research
Desmopressin Dose for Enuresis
- The recommended dose of desmopressin for treating enuresis is up to 40 microg/day, starting from an initial dosage of 20 microg/day, 1 hour before bedtime 2.
- The dose can be administered in the form of a spray or tablets, with a maximum of 4 puffs/nostril or 2 tablets per day 2.
Warnings for Desmopressin Use
- Desmopressin can cause water intoxication with profound hyponatremia if given without adequate restriction of water intake, leading to serious and potentially fatal complications 3, 4.
- Patients taking desmopressin should be monitored for serum levels of sodium and restricted from excessive fluid intake to prevent hyponatremia 3, 4.
- Severe signs of hyponatremia, such as altered mental status and seizures, can occur in patients taking desmopressin, especially within 14 days of starting treatment and with excess fluid intake or intercurrent illnesses 5.
- Desmopressin is generally considered safe, but patients should be aware of the potential risks and side effects, and medical professionals should carefully monitor patients for any adverse reactions 2.