Medication adherence in the management of nocturia: challenges and solutions

Abstract

ObjectiveNocturia affects millions of men and women. No prior reviews or meta-analyses have explored the issue of adherence in nocturia patients. The objective of our study was to examine the attributes and their interaction that might impact pharmacological adherence in nocturia care using a conceptual model of adherence.Materials and methodsA literature search of the Medline, PubMed, Embase, PsycInfo, and CINAHL databases for studies published between January 1990 and June 2014 was conducted. We developed a conceptual model in order to facilitate our review.ResultsCurrently, multiple treatment options for nocturia exist, depending on the underlying cause. Adherence to nocturia treatment and outcomes are complex and intertwined, and nonadherence to nocturia treatment is common. In 15 studies meeting eligibility criteria, behavioral and pharmacologic interventions for nocturia were associated with reduced nocturia symptoms. Urinary symptoms that are associated with nocturia need individualized management depending on renal and hepatic function, medical comorbidities, and ongoing medication use in a patient. Another important factor related to adherence is the bother. Although nocturia is defined as nighttime-voiding frequency of one or more, not all persons may find this bothersome. The degree of bother is subjective, and may change from person to person. However, there is no information related to the association between bother and adherence to medication or behavioral treatments for nocturia. Medication dosing convenience, preference, and cost play important roles in adherence. We present a patient-centered conceptual model that brings together the various dimensions of medication adherence for nocturia.ConclusionFew studies have explored adherence to medication and related factors in the care of nocturia. Our conceptual model can aid development of interventions to improve adherence to nocturia medications.

A practical approach to the management of nocturia

“…Patients who undergo uvulopalatopharyngoplasty for their OSA have also seen an improvement in nocturia symptoms Treatment should be tailored to the cause(s) of nocturia in the individual patient. Some medications can precipitate nocturia and, therefore, change of the drug or timing of drug use may be warranted. Lifestyle and behavioural modifications should be attempted before instigating other treatments, with a trial of up to 3 months, a reasonable time period over which to assess treatment response, unless bother is increasing and intolerable. Pharmacological therapies should be introduced after lifestyle modifications have failed or as adjuncts. Patients on diuretic therapy should take diuretics during the mid‐late afternoon, taking into consideration the half‐life of the specific agent. Desmopressin is the pharmacologic treatment for nocturia due to nocturnal polyuria with the highest quality evidence to support its use, with a once‐daily, low‐dose, gender‐specific formulation indicated for nocturia due to nocturnal polyuria. Diuretics, α1‐blockers, 5α‐reductase inhibitors, PDE5i, plant extracts, antimuscarinics and the β3‐agonist mirabegron all have potential utility to reduce nocturnal voiding frequency in patients with different causes of decreased functional bladder capacity, although the clinical impact of such treatments appears to be limited. Educating patients on the available treatment options and involving them in the decision‐making process can help to increase adherence to medication and thereby improve patient functioning and QoL After implementing therapy, its efficacy and effect on patients should be assessed, with consideration given to combining therapies/interventions in the light of an inadequate response. Patients with nocturia of undetermined cause not responding to lifestyle and medical therapy should be considered for specialist assessment. …”

Nocturia and frailty in older adults: a scoping review

“…This is partly due to the fact, that the cause of nocturia often appears obscure, there is no straight-forward and standardized diagnostic approach, treatment options are limited, and its signi cance to clinicians is relatively low. This creates therapeutic nihilism and makes nocturia an unmet medical need [12]. However, nocturia is far from being a minor inconvenience.…”

‘Nocturomics’: transition to omics‐driven biomarkers of nocturia, a systematic review and future prospects

“…Several pathologies may be intertwined in the aetiopathogenesis of nocturia including obstructive sleep apnea (OSA), congestive heart failure, diabetes, peripheral oedema, and excessive fluid intake prior to night‐time [3]. On the other hand, these conditions have different characteristics, unique molecular profiles, and responses to therapeutic agents; therefore, not all patients respond to the same treatment protocols in the same way, as existing treatment options are determined according to the underlying cause [4]. Based on the complex physiopathology, several trials have been carried out in the search for biomarkers of nocturia, from blood or urine samples to brain natriuretic peptide (BNP), atrial natriuretic peptide (ANP), and melatonin.…”

“…However, there has been no applicable clinical translation. Hence, while adherence to treatment and outcomes are complex and closely related, non‐adherence to treatment of nocturia is common [4]. Therefore, there is an urgent need to detect accurate biomarkers that will facilitate the diagnosis, prognosis, and management of nocturia and to develop personalised medicine modalities.…”