Enuresis desmopressin

For nocturnal enuresis, desmopressin, 10-20 Mg (0.1-0.2 mL) intranasally at bedtime, is used. 

OPC-51803 is a highly selective V2R agonist and may prove useful for the treatment of CDI, urinary incontinence, enuresis and pollakiuria. It has a much higher bioavailability after oral application than desmopressin. 

Desmopressin is the first-line drug choice in pediatric enuresis. 

The two primary agents used to treat enuresis are desmopressin and imipramine (Table 50-7). Desmopressin is the drug of choice in pediatric enuresis. Anticholinergics have a limited role (Table 50-7). Other agents have been studied with inconclusive results.28... 

FIGURE 50-1. Preliminary (unvalidated) enuresis protocol proposed by the International Children s Continence Society (2004). DDAVP, desmopressin. 

Desmopressin is used for the therapy of diabetes insipidus (ADH deficiency), nocturnal enuresis, thrombasthe-mia (p. 148), and chronic hypotension (p. 314) it is given by injection or via the nasal mucosa (as snuff ). 

Because it is stable, desmopressin is preferred for treatments especially if pressor effects are not desired. The primary indication for therapy is central diabetes insipidus, a disorder that results when ADH secretion is reduced and that is characterized by polydipsia, polyuria, and dehydration. Desmopressin is also used to reduce primary nocturnal enuresis, or bedwetting, in children. It is useful in people with mild hemophilia A or with some types of von Willebrand s disease, in which von Willebrand s factor is present at low levels. In these cases, desmopressin is given when excessive bleeding occurs or before surgery to help reduce bleeding indirectly by increasing the amounts of coagulation factors. 

Tullus, K., Bergstron, R., Fosdal, I., Winnergard, I., and Hjalmas, K. (1999) Efficacy and safety during long-term treatment of primary monosymptomatic nocturnal enuresis with desmopressin. Acta Paediatr. 88 1274-1278. 

Administration of an AVP analog, such as desmopressin acetate (DDAVP), can produce a 30% to 60% reduction in wet nights in general, and about a 50% resolution of enuresis while on the medication (Norgaard et ah, 1985 Klauber, 1989 Norgaard et al.. 

Glazener, C.M. and Evans, J.H. (2000) Desmopressin for nocturnal enuresis in children. Cochrane Database Syst Rev 2 ... 

Hogg, R.J. and Husmann, D. (1993) The role of family history in predicting response to desmopressin in nocturnal enuresis. / Urol 150 444-445. 

Klauber, G.T. (1989) Clinical efficacy and safety of desmopressin in the treatment of nocturnal enuresis. / Pediatr 114 719-722. 

Natochin YV, Kuznetsova AA. Nocturnal enuresis correction of renal function by desmopressin and diclofenac. Pediatr Nephroi 2000 14 42-47. 

Vasopressin and desmopressin are treatments of choice for pituitary diabetes insipidus. The dosage of desmopressin is 10-40 meg (0.1-0.4 mL) in two to three divided doses as a nasal spray or, as an oral tablet, 0.1-0.2 mg two to three times daily. The dosage by injection is 1-4 meg (0.25-1 mL) every 12-24 hours as needed for polyuria, polydipsia, or hypernatremia. Bedtime desmopressin therapy, by intranasal or oral administration, ameliorates nocturnal enuresis by decreasing nocturnal urine production. Vasopressin infusion is effective in some cases of esophageal variceal bleeding and colonic diverticular bleeding. 

Desmopressin f/V-deamino-8-D-arginine vasopressin, dDAVP) is a longer acting analogue of vasopressin. It has very little vasoactive effect but is antidiuretic by an action on vasopressin V2 receptors in the renal tubule and is used to treat central diabetes insipidus and nocturnal enuresis. 

Intravenous injection is the most common route although subcutaneous injection may also be used. A concentrated nasal spray formulation has been proved to be efficient for home treatment of patients with bleeding episodes or even minor surgical procedures and has also been used prophylacticly (4). The nasal spray used to treat diabetes insipidus (Desmospray) is too dilute for use in disorders of hemostasis. Similarly, desmopressin in tablet form (Desmotabs) is intended for treatment of nocturnal enuresis in children and is of no use in the treatment of hemostatic disorders. 

Children with nocturnal enuresis treated with desmopressin have fewer wet nights per week, but this effect does not persist after therapy is stopped. A meta-analysis showed an overall rate of 7.1 adverse events per 100 children (17). These were almost all local nasal reactions, including nasal irritation and epistaxis. 

Cerebral infarction has also been reported in association with the use of desmopressin in children (31,32). One of these cases involved a 7-month-old child with congenital nephrotic syndrome who developed a cerebral infarction after surgery (31). One child developed cerebral ischemia after Varicella infection and desmopressin for enuresis (32). 

An 11-year-old girl was given desmopressin 10 micrograms by nasal spray per nostril for nocturnal enuresis (46). On the second night she took 3 puffs and at 3 a.m. awoke with a tonic-clonic fit. Her serum sodium concentration was 115 mmol/1. 

A 37-year-old woman with primary enuresis continued her customary daily fluid intake (2 liters) when she started intranasal desmopressin 30 micrograms at night. Within 2 days she became severely hyponatre-mic, with loss of consciousness, generalized seizures, and cerebral edema. 

Fluid balance and plasma electrolytes should be monitored to prevent this complication, particularly if repeated doses are required. Children seem to be particularly vulnerable to this complication (55). In a longterm, open study of 245 Swedish children given intranasal desmopressin 20-40 micrograms at night for enuresis, five had an asymptomatic fall in plasma sodium (36). Mild hyponatremia, which did not cause symptoms, was found in five of 399 children in an open, multicenter trial (56). 

In a 12-year-old boy taking desmopressin for nocturnal enuresis, hyponatremia and cerebral edema developed after high fluid intake before a urodynamic procedure... 

There have been several reports of seizures in association with hyponatremia after intravenous administration of desmopressin to cover surgery in young children with congenital bleeding disorders such as mild hemophilia A or von Willebrand s disease (58-60). Hyponatremia and convulsions have occurred in children without congenital bleeding disorders who received desmopressin for urine concentration tests or to treat nocturnal enuresis (54,61,62). 

Wieting JM, Dykstra DD, Ruggiero MP, Robbins GB, Galusha K. Central nervous system ischemia after Varicella infection and desmopressin therapy for enuresis. J Am Osteopath Assoc 1997 97(5) 293-5. 

Del Gado R, Del Gaizo D, Cennamo M, Auriemma R, Del Gado G, Verni M. Desmopressin is a safe drug for the treatment of enuresis. Scand J Urol Nephrol 2005 39 308-12. 

Passi GR, Shad R. Seizures and coma after desmopressin for nocturnal enuresis. Indian Pediatr 2004 41 1276-7. 

Odeh M, Oliven A. Coma and seizures due to severe hyponatremia and water intoxication in an adult with intranasal desmopressin therapy for nocturnal enuresis. J Clin Pharmacol 2001 41(5) 582-4. 

Hjalmas K, Hanson E, Hellstrom AL, Kruse S, Sillen U. Long-term treatment with desmopressin in children with primary monosymptomatic nocturnal enuresis an open multicentre study. Swedish Enuresis Trial (SWEET) Group. Br J Urol 1998 82(5) 704-9. 

Brodzikowska-Pytel A, Giembicki J. Hyponatremia as a complication of nocturnal enuresis treatment with desmopressin in a child. Pediatr Pol 1999 74 79-83. 

Apakama DC, Bleetman A. Hyponatraemic convulsion secondary to desmopressin treatment for primary enuresis. J Accid Emerg Med 1999 16(3) 229-30. 

Vasopressin and desmopressin are the alternative treatments of choice for pituitary diabetes insipidus. Bedtime desmopressin therapy ameliorates nocturnal enuresis by decreasing nocturnal urine production. Vasopressin infusion is effective in some cases of esophageal variceal bleeding and colonic diverticular bleeding. 

The synthetic vasopressin peptide, desmopressin, has been extensively investigated and shown to be effective as tricyclic antidepressants in the control of nocturnal enuresis and to enhace the enuretic night alarm treatment. The side effects are relatively few (nasal pain, conjunctivitis) when given by nasal spray. The precise mechanism of action of this peptide is unknown. 

Because of the pressor properties of vasopressin, this compound has been modified to desmopressin [dez moe PRESS in] (1-desamino-8-D-arginine vasopressin). This analog is now preferred for diabetes insipidus and nocturnal enuresis because it is largely free of pressor effects and is longer-acting than vasopressin. Desmopressin is conveniently administered intranasally. However, local irritation may occur. 

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