From the Guidelines
Desmopressin is a recommended treatment for children with bedwetting (nocturnal enuresis) who have not responded to behavioral interventions, particularly those with nocturnal polyuria and normal bladder reservoir function, as evidenced by a study published in The Journal of Urology in 2010 1. The standard starting dose of desmopressin is 0.2 mg taken orally at bedtime, which can be increased to 0.4 mg if needed after 1-2 weeks. Some key points to consider when using desmopressin for bedwetting in children include:
- Restricting fluid intake from 1 hour before taking desmopressin until the morning to prevent water intoxication, as suggested by a study published in The Journal of Urology in 2010 1.
- Monitoring for side effects, which are generally mild but can include headache, nausea, and rarely hyponatremia (low sodium levels), as reported in a study published in the Journal of the American Academy of Child and Adolescent Psychiatry in 2004 1.
- Temporarily stopping the medication during illnesses with vomiting or diarrhea, as recommended by a study published in The Journal of Urology in 2010 1.
- Continuing positive reinforcement and considering combining desmopressin with a bedwetting alarm for better long-term results, as suggested by a study published in The Journal of Urology in 2010 1. It's also important to note that desmopressin is most efficient in children with nocturnal polyuria (nocturnal urine production greater than 130% of expected bladder capacity for age) and normal bladder reservoir function (maximum voided volume greater than 70% of expected bladder capacity for age), as evidenced by a study published in The Journal of Urology in 2010 1.
From the Research
Desmopressin for Children's Bed Wetting
- Desmopressin is a commonly used medication for the treatment of primary nocturnal enuresis in children, with studies showing its efficacy in reducing the number of wet nights 2, 3.
- The medication works by decreasing urine production, and its effectiveness has been demonstrated in various doses and forms, including oral and nasal administration 2, 3.
- A study comparing desmopressin with other interventions, including alarms and tricyclic drugs, found that desmopressin was effective in reducing bedwetting, but its effects were not sustained after treatment stopped 3.
- Another study found that desmopressin was more effective when combined with oxybutynin, an anticholinergic agent, in treating children with monosymptomatic nocturnal enuresis 4.
Response to Desmopressin Treatment
- The response to desmopressin treatment can vary depending on several factors, including the child's age, number of baseline wet nights, and functional bladder capacity 5.
- A study found that children with a functional bladder capacity greater than 70% predicted bladder capacity were more likely to respond to desmopressin 5.
- The effectiveness of desmopressin can also be influenced by the presence of other predictors, such as family history and urine osmolality parameters, although these factors were not found to be significant in all studies 5.
Comparison with Other Treatments
- Desmopressin has been compared with other treatments, including imipramine, alarm therapy, and observation, with varying results 3, 6.
- A study found that alarm therapy was more effective than desmopressin in achieving long-term continence, with 56% of patients remaining dry at 12 months compared to 10% of those treated with desmopressin 6.
- Another study found that desmopressin was more effective than imipramine and observation, but its effects were not sustained after treatment stopped 6.
Safety and Side Effects
- Desmopressin is generally well-tolerated, with most side effects being mild to moderate in severity and resolving before the study was completed 2.
- However, children should be advised not to drink more than 240 ml (8 oz) fluid during desmopressin treatment to avoid the possible risk of water intoxication 3.