From the Guidelines
For nocturnal enuresis, desmopressin is typically started at 0.2 mg orally at bedtime for children 6 years and older, as recommended by the most recent guidelines 1. The dose can be increased to 0.4 mg if needed after 1-2 weeks if the initial dose is ineffective. For the intranasal formulation, the starting dose is 10 mcg (one spray in one nostril) at bedtime, which can be increased to 20 mcg if necessary. Some key points to consider when treating nocturnal enuresis with desmopressin include:
- Treatment should be continued for 3-6 months, followed by a gradual withdrawal to assess if the condition has resolved.
- Desmopressin works by reducing urine production overnight by mimicking the action of antidiuretic hormone (ADH), which increases water reabsorption in the kidneys.
- Patients should limit fluid intake 1-2 hours before bedtime and avoid excessive fluids in the evening to maximize effectiveness.
- It's essential to monitor for hyponatremia, especially with higher doses or excessive fluid intake, as noted in several studies 1.
- Treatment should be temporarily discontinued during illnesses that might affect fluid balance, such as vomiting, diarrhea, or fever.
- Response to therapy should be assessed after the first few weeks of treatment, and adjustments made as necessary, according to the International Children's Continence Society guidelines 1.
From the Research
Desmopressin Dose for Nocturnal Enuresis
- The optimal dose of desmopressin for nocturnal enuresis is not explicitly stated in the provided studies, but various doses have been investigated:
- 200 micrograms and 400 micrograms oral doses were compared in a study, with no significant differences found between the two doses during the double-blind phase 2.
- A dose of 400 micrograms was found to be effective in reducing the number of wet nights in adolescents with severe monosymptomatic nocturnal enuresis 3.
- A study also mentions that patients who initially received 200 micrograms of desmopressin tablets experienced fewer wet nights after the dose was escalated to 400 micrograms tablets 2.
- It is essential to note that desmopressin should be used with caution and under medical supervision, as it can cause water intoxication and hyponatremia, especially if fluid intake is not restricted 4.
- The safety and efficacy of desmopressin for nocturnal enuresis have been established, but long-term studies are needed to define its role in therapy and predict patient response 5.
Administration and Monitoring
- Desmopressin can be administered orally or intranasally, with oral tablets being an effective and safe alternative for treatment of nocturnal enuresis 2, 3.
- Monitoring of serum sodium levels and restriction of fluid intake are crucial to prevent water intoxication and hyponatremia 4.
- Patients should be closely monitored for response to treatment, and the dose should be adjusted accordingly to minimize adverse effects and maximize efficacy 6, 2, 3.