Enuresis in adolescents: value of oral desmopressin - adapted from Pediatrics, December 1994 - Tips

Date: May 15, 1995

Tricyclic antidepressants and intranasal desmopressin are among the pharmacologic agents most widely used for the treatment of nocturnal enuresis. Intranasal desmopressin has a better safety profile and milder side effects than tricyclic antidepressants, but it is somewhat more cumbersome to administer than an oral medication. A tablet form of desmopressin recently has been introduced for the treatment of diabetes insipidus. Stenberg and Lackgren evaluated the efficacy and safety of oral desinopressin for the treatment of nocturnal enuresis in adolescents.

Twenty-five patients were enrolled in the initial phase of the study, a single-blind dose titration phase. The study subjects ranged in age from 11 to 21 years. The starting dose was 200 [mu]g at bedtime, and this dose was increased to 400 [mu]g two weeks later if the reduction in the mean number of wet nights was less than 50 percent. The 200-[mu]g dose was effective in only five patients. After dose titration, 10 patients were randomized to a four-week crossover trial of oral desmopressin versus placebo. The mean number of wet nights decreased from 4.1 during placebo treatment to 1.8 during oral desmopressin treatment.

Two cycles of long-term treatment were also conducted. Each cycle consisted of oral desmopressin use for 12 weeks followed by two weeks without medication. Full response (zero or one wet night per week) was noted in 48 percent and 53 percent of subjects during the two periods. Intermediate response (two or three wet nights per week) occurred in 22 percent and 23.5 percent of the subjects. No response (more than three wet nights per week) occurred in 30 percent and 23.5 percent of the patients during the two periods. The authors noted that most of the intermediate responders had many completely dry weeks punctuated by weeks with wet episodes.

The safety of oral desmopressin was assessed by measurement of patient weight, blood pressure, serum sodium, potassium, creatinine, osmolality, and clinical examination for water retention. One patient withdrew from the study because of mild hypertension. Single episodes of abdominal pain or headache occurred in several patients.

The authors conclude that oral desmopressin is safe and effective for the treatment of nocturnal enuresis in adolescents. The 400-[mu]g dose appears more efficacious than the 200-[mu]g dose. Fifty percent of the study subjects who had previously used antidepressants without success responded to oral desmopressin, and 91 percent of subjects who previously responded to treatment with intranasal desmopressin also responded to the oral form. (Pediatrics, December 1994, vol. 94, p. 841.)

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