What is the comparison between desmopressin (DDAVP) and oxybutynin (Ditropan) for the treatment of pediatric nocturnal enuresis?

From the Guidelines

Desmopressin is generally recommended as first-line pharmacological therapy for pediatric nocturnal enuresis, while oxybutynin (Ditropan) is typically considered a second-line option. Desmopressin works by reducing urine production overnight and is available as oral tablets (0.2-0.6 mg at bedtime) or melt tablets (120-240 mcg at bedtime) 1. It shows efficacy in 60-70% of children, works quickly, and is particularly useful for sleepovers or camps. Side effects are minimal but include headache and rare hyponatremia, so fluid restriction is advised after the evening dose. Oxybutynin (Ditropan), an anticholinergic medication, increases bladder capacity by relaxing the bladder muscle at doses of 5-10 mg at bedtime for children over 5 years. It's more effective for children with daytime symptoms or small functional bladder capacity but carries more side effects including dry mouth, constipation, facial flushing, and potential cognitive effects 1. For optimal results, either medication should be used alongside behavioral strategies like fluid management, regular voiding schedules, and bedwetting alarms. Treatment typically continues for 3-6 months before attempting gradual withdrawal to assess if the child has outgrown the condition.

Some key points to consider when choosing between desmopressin and oxybutynin include:

• The presence of nocturnal polyuria, which may respond better to desmopressin 1
• The presence of daytime symptoms or small functional bladder capacity, which may respond better to oxybutynin 1
• The child's ability to comply with treatment and the family's preferences 1
• The potential side effects of each medication and the need for monitoring 1

Overall, desmopressin is a safe and effective first-line treatment for pediatric nocturnal enuresis, while oxybutynin may be considered as a second-line option for children who do not respond to desmopressin or have specific indications for its use.

From the Research

Comparison of Desmopressin and Ditropan for Pediatric Nocturnal Enuresis

• Desmopressin is a commonly used medication for the treatment of nocturnal enuresis in children, with a response rate of 40-50% 2, 3.
• Ditropan (oxybutynin) is an anticholinergic medication that can be used in combination with desmopressin to treat nocturnal enuresis, with a response rate of 75.0% when used in combination with desmopressin 2.
• A study comparing desmopressin monotherapy with desmopressin plus oxybutynin combination therapy found that the combination therapy had a higher response rate (75% vs 71.4%) and a lower non-response rate (6.52% vs 19.8%) 4.
• The optimal dose of desmopressin for the treatment of nocturnal enuresis is not well established, but a study found that a lower dose of 0.2 mg was effective in 86.2% of patients, with 32.3% achieving complete response and 37.6% achieving partial response 5.
• A systematic review of 41 randomized trials found that desmopressin was effective in reducing bedwetting in children, with a reduction of at least one night per week during treatment compared to placebo, but there was no difference after treatment was finished 6.

Efficacy and Safety of Desmopressin and Ditropan

• Desmopressin has been shown to be safe and effective in the treatment of nocturnal enuresis in children, with a low risk of side effects 3, 5.
• The combination of desmopressin and oxybutynin has been shown to be safe and effective, with no reported adverse events or side effects in one study 2.
• Oxybutynin has been shown to be effective in reducing symptoms of overactive bladder, but its use in combination with desmopressin for nocturnal enuresis is not well established 2.

Predictive Factors for Response to Treatment

• A study found that patients with attention deficit disorder/attention-deficit hyperactivity disorder (ADD/ADHD) and controlled daytime voiding symptoms (CDVS) were more likely to fail monotherapy with desmopressin 2.
• Another study found that patients who required lower doses of desmopressin to achieve response were more likely to experience complete response during the maintenance period 5.