From the Guidelines
For bed wetting (nocturnal enuresis), the most effective medication approach is to use Desmopressin (DDAVP) as the first-line treatment, given its ability to reduce urine production overnight with a success rate of 10% to 65% 1. When considering medication for bed wetting, it's essential to weigh the benefits and risks, especially since behavioral approaches are often the first line of treatment. Key points to consider include:
- DDAVP can be administered orally in 0.2-mg tablets in doses of 0.2 to 0.6 mg nightly or intranasally as a spray in doses of 10 to 40 μg (one to four sprays) nightly, with the lowest effective dose determined empirically for each child 1.
- Imipramine, a tricyclic antidepressant, is another option but has a higher risk of side effects, including cardiac arrhythmias, and is generally considered after DDAVP due to its effectiveness in 40% to 60% of cases but with a relapse rate as high as 50% 1.
- The combination of DDAVP with a sustained-release anticholinergic agent may offer increased effectiveness over DDAVP alone, particularly for children with specific bladder capacity issues or daytime urgency symptoms 1.
- It's crucial to monitor for potential side effects, such as water intoxication with DDAVP, and to adjust treatment based on individual response and tolerance 1.
- Medication should be used in conjunction with behavioral strategies like fluid restriction, scheduled bathroom visits, and the use of bedwetting alarms to maximize effectiveness and improve quality of life for the patient 1.
From the Research
Medications for Bed Wedding (Benzodiazepine) Discontinuation
- The quality of evidence on medications for benzodiazepine discontinuation is overall low 2
- Cognitive behavioral therapy has shown the most benefit in terms of behavioral treatments for benzodiazepine discontinuation 2
- Options for discontinuing long-term benzodiazepine use include an outpatient benzodiazepine taper or inpatient withdrawal management at a hospital or detoxification facility 2
Benzodiazepine Use and Dependence
- Benzodiazepines have neurobiological and pharmacologic properties that result in a high potential for misuse and physical dependence 2
- Regular use of benzodiazepines can cause severe, harmful psychological and physical dependence, leading to withdrawal symptoms similar to that of alcohol withdrawal 3
- The dependence on benzodiazepines generally leads to withdrawal symptoms, requiring careful tapering of the medication when prescribed 3
Alternative Therapies for Benzodiazepine Discontinuation
- Nonpharmacological approaches such as sleep restriction-sleep compression therapy and cognitive behavioral therapy for anxiety or insomnia can be used as alternatives for treating insomnia and anxiety in older adults 4
- Alternative pharmacological agents can also be used as alternatives for treating insomnia and anxiety in older adults 4