Desmopressin for treating nocturia in men

Han, Julia; Jung, Jae Hung; Bakker, Caitlin; Ebell, Mark H.; Dahm, Philipp

doi:10.1111/bju.14183

Cited by 7 publications

(9 citation statements)

References 32 publications

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“…In women, there was a significant reduction in nocturnal voids (on average 0.5 fewer voids/night compared to placebo), and a significant increase in the duration of the first period of sleep by about one hour. 101 The magnitude of effect was quite similar in men, 102 and likely has similar efficacy as alpha-blockers in terms of reducing episodes of nocturia in men. In male patients, randomised trials have demonstrated that Desmopressin may be synergistic with alpha blockers, 103 however this has been questioned by systematic reviews.…”

Section: Pharmacologic Treatment Of Nocturnal Polyuriamentioning

confidence: 85%

Canadian Urological Association best practice report: Diagnosis and management of nocturia

Nguyen

Randhawa

Nadeau

et al. 2022

CUAJ

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relevant articles were also reviewed to identify any other relevant important studies. Quality of evidence was evaluated using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) framework. While there overall was a lack of high-quality evidence to inform aspects of this review, the strength of recommendations was supported by clinical principles, fundamental pathophysiology, and consensus expert opinion. BackgroundThe International Continence Society (ICS) defines nocturia as waking one or more times to void during the hours of sleep, with each void preceded and followed by sleep. 1 Although voiding even once at night is considered nocturia, some literature has shown that fewer than two voids per night does not result in significant patient bother. 2 However, the degree of bother experienced by individual patients will vary according to factors beyond just the number of voids per night. Nocturia is associated with impaired quality of life, 3 and even mortality. 4 This association of nocturia with mortality has been reported to be independent of bother, and should be noted even if patients are not bothered. 5 Patients therefore may benefit from assessment for nocturia even if they don't independently report nocturia, as bother is often what motivates patients to raise nocturia as an issue with their care providers.Depending on the patient population and definition of nocturia used, prevalence varies significantly. [6][7][8] From a Canadian survey of 1000 adults, prevalence, using the ICS definition of one or more episodes per night, was estimated to be 36.4% in all adults and 49.5% in adults over age 65. When defined as two or more episodes per night, prevalence was 9.1% in all adults and 23.8% in adults over the age of 65. 9 Nocturia by any definition increases with age, particularly in men (see Figure 1). 6,7,9 Normal renal function allows for a circadian production of urine, with concentration of urine at night. This function is age-dependent, typically established by age 3 to 5, and leads to decreased nocturnal urine volume. Arginine vasopressin (AVP, or antidiuretic hormone [ADH]) is released from the posterior pituitary and serves as the primary hormone regulating renal water excretion. Factors such as high serum osmolality, hypovolemia and angiotensin II stimulate AVP, leading to water reabsorption, whereas factors such as atrial natriuretic peptide (ANP/ANH), prostaglandin E2 (PGE2) and hypercalcemia inhibit AVP, leading to diuresis. 10 With aging, however, the circadian rhythm of release of these hormones is blunted, which can increase nocturnal urine production.Normal bladder function requires adequate bladder storage and emptying abilities. This requires coordination of multiple components, including the central and peripheral nervous systems, detrusor smooth muscle function, and urethral and pelvic floor function. In addition, the bladder urothelium seems to have a role in regulating urinary function and possibly contributing to AVP-mediated water homeostasis. 10 Important co...

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Section: Pharmacologic Treatment Of Nocturnal Polyuriamentioning

confidence: 85%

Canadian Urological Association best practice report: Diagnosis and management of nocturia

Nguyen

Randhawa

Nadeau

et al. 2022

CUAJ

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“…Frequent laboratory monitoring allows for treatment discontinuation if the sodium level begins to drop and approaches, but does not yet reach, the cutoff for hyponatremia. In addition, the patients included in our real-world cohort were at higher risk for hyponatremia because they were older and had more comorbid conditions than those in the trials included in the meta-analysis [2,11].…”

Section: Discussionmentioning

confidence: 99%

“…As a sensitivity analysis, we used an alternate comparator to oxybutynin because the clinical indications for oxybutynin and desmopressin only partially overlap. Tamsulosin was selected as the alternate comparator because it is prescribed for benign prostatic hypertrophy, which is a common cause of nocturia, and it is not known to cause hyponatremia [11],…”

Section: Methodsmentioning

confidence: 99%

“…Nocturia is often multifactorial in etiology and may be due to an underlying sleep disorder, impaired bladder storage (including reduced bladder capacity or bladder overactivity), urinary factors (including global or nocturnal polyuria), or other factors, including medication or alcohol use [10]. Meta-analyses have identified that desmopressin slightly reduces the absolute number of nocturnal voids per night (i.e., about 0.5 fewer nocturnal voids) compared to placebo but not compared to alpha-blockers (for example, tamsulosin) [2,11].…”

Section: Introductionmentioning

confidence: 99%

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Desmopressin and the risk of hyponatremia: A population-based cohort study

et al. 2019

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BackgroundDesmopressin was approved by the Food and Drug Administration (FDA) in 1978 for use in diabetes insipidus and bleeding disorders, but it is also prescribed off-label for patients with nocturia. Quantifying the potential risks facing adult patients taking desmopressin has taken on added importance because a new intranasal formulation of desmopressin was approved by the FDA in 2017. Like the old formulation, the main active ingredient is desmopressin acetate, but the new formulation also contains an excipient designed to enhance absorption. Our objective was to quantify the rate of hyponatremia in routine clinical care for patients prescribed the older formulation of desmopressin.Methods and findingsWe conducted a population-based new-user cohort study from 1 February 2006 to 1 February 2017 using a nationwide commercial health plan database. Patients newly prescribed the older formulation of desmopressin were propensity-score (PS)–matched to patients newly prescribed oxybutynin. As a sensitivity analysis, tamsulosin was used as the comparator rather than oxybutynin. The primary outcome was a primary position diagnosis of hyponatremia. Proportional hazard models after 1:1 PS matching were used to estimate hazard ratios (HRs) and 95% confidence intervals (CI). We identified 3,137 adults who were newly prescribed desmopressin and matched them to 3,137 adults who were newly prescribed oxybutynin. Mean age was 70, 55% were male, 13% filled a prescription for a diuretic during the baseline time period, and the mean baseline sodium prior to receiving either study drug was 140 mmol/L (normal: 135–145). The rate of hyponatremia was 146 per 1,000 person-years for adults prescribed desmopressin compared to 11 per 1,000 person-years for adults prescribed oxybutynin, corresponding to a 13-fold higher rate (HR 13.19; 95% CI 6.69, 26.01; p < 0.01). When follow-up was truncated at 30 days, a similar increased rate was observed (HR 19.41; 95% CI 7.11, 52.99; p < 0.01). A higher rate of hyponatremia was also observed with desmopressin when tamsulosin was the comparator (HR 12.10; 95% CI 6.54, 22.37; p < 0.01). Important limitations of our study include unmeasured confounding (for example, over-the-counter medication use, dietary intake), missing data (i.e., only 20% of patients had a baseline serum sodium), and a lack of data on the newer formulation of desmopressin.ConclusionsUse of an older formulation of desmopressin was associated with a marked increased rate of subsequent hyponatremia compared to use of other medications indicated for lower urinary tract symptoms. Such risks should be clearly communicated to patients prescribed this formulation of desmopressin.

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“…Ham et al onderzochten de effecten van desmopressine op nycturie bij mannen. 1 De auteurs includeerden 14 onderzoeken, waarin 2966 mannen gerandomiseerd werden behandeld. Zij beschrijven vijf verschillende vergelijkingen.…”

Section: Nieuwsunclassified

Desmopressine helpt niet bij nycturie

Hofmeester

Blanker

2018

Huisarts Wet

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Desmopressin for treating nocturia in men

Cited by 7 publications

References 32 publications

Canadian Urological Association best practice report: Diagnosis and management of nocturia

Canadian Urological Association best practice report: Diagnosis and management of nocturia

Desmopressin and the risk of hyponatremia: A population-based cohort study

Desmopressine helpt niet bij nycturie

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