Long-Term Treatnent of Nocturnal Enuresis withi Desmopressin Intranasal Spray

Abstract

The purpose of this study was to determine the efficacy and safety of long-term treatment of nocturnal enuresis with desmopressin intranasal spray. Sixty-five children with primary nocturnal enuresis with a mean age of 11.3 years (range 7-17) underwent a 2-week observation period followed by dose titration period of 1 week. Those children completely dry with desmopressin entered a randomized, placebo-controlled, double-blind phase lasting 2 weeks, followed by a 6-month open treatment. The enuretic status of the children was documented for 2 weeks after the treatment was stopped. Eleven children had no change from baseline wetting with desmopressin. Thirty-two children receiving 20 mg and 9 children with 40 mg desmopressin were completely dry. Thirteen children were wet 1-2 nights per week, which was better than in the pretreatment period. During the 6-month open-treatment period, the effect of desmopressin was found to be stable. No side effects or adverse reactions were encountered. Two weeks after the treatment was stopped, 25 children were still completely dry (38% of the initial study population, 50% of the responders). The cure rate appeared to continue beyond 18 months after discontinuation of the treatment.

Experience with the long‐term use of desmopressin for nocturnal enuresis in children and adolescents

“…Usually, 50–85% of patients who entered the study showed at least a halving in the number of wet nights and 40–70% became almost completely dry during treatment. In five studies the patients were evaluated at regular intervals (0.5–6 months) [18–21,24]. In all studies it became evident that the efficacy of desmopressin continued or improved throughout the treatment period, indicating that the enuretics did not develop tolerance to desmopressin.…”

“…Long‐term treatment with desmopressin induced no clinically significant changes in mean values of blood chemistry (including serum sodium, potassium and osmolality) [7,15,18–22], nor significantly affected mean haematology [7,15,20,21] and urine analysis values [7,18,21,22]. Seven patients (1%) developed hyponatraemia with no clinical symptoms [21,22].…”

“…Mean BP values were not significantly changed during prolonged desmopressin treatment [7,15,18–22]. In two patients (0.3%) there was mild hypertension which may have been related to desmopressin treatment (Table 3).…”

“…In four studies there was an increase in mean body weight [15,18–20] or body mass index (BMI) [18] during desmopressin treatment. In two other studies the mean body weight did not change throughout treatment [7,21].…”

Treatment of childhood nocturnal enuresis: an examination of clinically relevant principles

“…Headaches were reported in four children (of a total of 689) and stomach ache in three. Even during long-term treatment with desmopressin, side-effects are rarely reported [19,48,49]. However, there are rare reported cases of hyponatraemia with desmopressin treatment [50].…”