Desmopressin Acetate
Desmopressin acetate is a synthetic version of antidiuretic hormone. It enhances reabsorption of water at the renal collecting duct and distal collecting tubule via increasing cyclic adenosine monophosphate in renal tubular cells, so that there is less urine output.
Efficacy
It decreases urine production when given at bedtime and reduces the number of wet nights in 10-65% of children within two weeks, and 48% of these children completely stop bedwetting. Evidence of long-term success is limited. There are more relapses with pharmacological treatment compared to the use of bedwetting alarms. However, it gives a more rapid response. Courses of treatment may be repeated but given for no longer than three months. 80% of children relapse when the drug is stopped; this risk is reduced when the drug is tapered slowly.
A six month randomized controlled trial compared desmopressin, imimpramine, and desmopressin/oxybutynin combined in 145 children (mean age 7.8 years). It found that the combination therapy was the most rapidly effective, but the number of wet nights at six months was similar between the combination group and the group receiving desmopressin alone. These two groups were superior to the imipramine group.
Safety
This medication is contraindicated for patients with a hypersensitivity to desmopressin or any other ingredients of the medication, if the patient is hyponatremic or has a history of hyponatremia, or if the patient has moderate or severe renal impairment (CrCL<50 mL/min). Desmopressin increases von Willebrand factor, factor VIII, and t-PA; patients with type 2B or platelet-type von Willebrand's disease also should not receive desmopressin. Other contraindications include habitual or psychogenic polydipsia, cardiac insufficiency, other conditions requiring diuretic therapy, or nephrosis.
Fluid intake should be restricted from one hour prior to eight hours following taking desmopressin, to prevent hyponatremia. For children aged six or older, the starting dose is 200mcg at bedtime. Doses range from 200-600mcg per day. The duration of action is 10-20 hours, and the child may experience compensatory polyuria after the drug wears off.
Availability
Desmopressin is available in a tablet form and a nasal form. The tablet has a dissolving formulation, which is very convenient for children, and does not require the intake of any liquids since it will dissolve in the mouth. The nasal spray formulation is no longer used for nocturnal enuresis; it has a higher incidence of hyponatremia, which can lead to seizures and/or death.
This medication is available in Canada in various strengths and as the following oral dosage forms:
The generic medications cost around $0.67 per 0.2mg tablet.
Efficacy
It decreases urine production when given at bedtime and reduces the number of wet nights in 10-65% of children within two weeks, and 48% of these children completely stop bedwetting. Evidence of long-term success is limited. There are more relapses with pharmacological treatment compared to the use of bedwetting alarms. However, it gives a more rapid response. Courses of treatment may be repeated but given for no longer than three months. 80% of children relapse when the drug is stopped; this risk is reduced when the drug is tapered slowly.
A six month randomized controlled trial compared desmopressin, imimpramine, and desmopressin/oxybutynin combined in 145 children (mean age 7.8 years). It found that the combination therapy was the most rapidly effective, but the number of wet nights at six months was similar between the combination group and the group receiving desmopressin alone. These two groups were superior to the imipramine group.
Safety
This medication is contraindicated for patients with a hypersensitivity to desmopressin or any other ingredients of the medication, if the patient is hyponatremic or has a history of hyponatremia, or if the patient has moderate or severe renal impairment (CrCL<50 mL/min). Desmopressin increases von Willebrand factor, factor VIII, and t-PA; patients with type 2B or platelet-type von Willebrand's disease also should not receive desmopressin. Other contraindications include habitual or psychogenic polydipsia, cardiac insufficiency, other conditions requiring diuretic therapy, or nephrosis.
Fluid intake should be restricted from one hour prior to eight hours following taking desmopressin, to prevent hyponatremia. For children aged six or older, the starting dose is 200mcg at bedtime. Doses range from 200-600mcg per day. The duration of action is 10-20 hours, and the child may experience compensatory polyuria after the drug wears off.
Availability
Desmopressin is available in a tablet form and a nasal form. The tablet has a dissolving formulation, which is very convenient for children, and does not require the intake of any liquids since it will dissolve in the mouth. The nasal spray formulation is no longer used for nocturnal enuresis; it has a higher incidence of hyponatremia, which can lead to seizures and/or death.
This medication is available in Canada in various strengths and as the following oral dosage forms:
- Apo-desmopressin 0.1mg or 0.2mg tablets by Apotex Inc
- DDAVP Melt 60mcg, 120mcg, or 240mcg by Ferring Inc
- DDAVP Tablets 0.1mg or 0.2mg tablets by Ferring Inc
- Desmopressin 0.1mg or 0.2mg tablets by Meliapharm Inc
- Minirin 0.1mg by Ferring Inc
- Novo-desmopressin 0.1mg or 0.2mg by Novopharm Limited
- PMS-desmopressin 0.1mg or 0.2mg by Pharmascience Inc
The generic medications cost around $0.67 per 0.2mg tablet.
References:Gorodzinsky FP. Genitourinary Disorders: Urinary Incontinence in Children. In: e-Therapeutics+. Ottawa, ON: Canadian Pharmacists Association; 2013. https://www.e-therapeutics.ca/tc.showChapter.action?documentId=c0052. Updated May 2011. Accessed Mar 20, 2013.
Kiddoo DA. Nocturnal enuresis. CMAJ . 2012;184(8):908-11.
O’Flynn N. Nocturnal enuresis in children and young people: NICE clinical guideline. Br J Gen Pract. 2011;61(586):360-62.
Kiddoo DA. Nocturnal enuresis. CMAJ . 2012;184(8):908-11.
O’Flynn N. Nocturnal enuresis in children and young people: NICE clinical guideline. Br J Gen Pract. 2011;61(586):360-62.