Primary nocturnal enuresis

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. 

Ornitz, E.M., Russell, A.T., Gabikian, R, Gehricke, J.G., and Guthrie, D. (2000) Prepulse inhibition of startle, intelligence and familial primary nocturnal enuresis. Acta Paediatr 89 475-481. 

About 900 000 children with primary nocturnal enuresis are treated with tablets and 400 000 with spray annually. Hyponatremia is rare (42), possibly as low as 1 per 20 000 patients exposed. 

Desmopressin is used for the therapy of diabetes insipidus (AVP deficiency), primary nocturnal enuresis and von Willebrand disease (p. 152) it is given by injection or via the nasal mucosa (as snuff ). 

Indications Primary nocturnal enuresis Category Antidiuretic hormone analog Half-life 75 minutes... 

Monda JM, Husmann DA. Primary nocturnal enuresis A comparison among observation, imipramine, desmopressin acetate and bedwetting alarm systems. J Urol 1995 154 745-748. 

Ginrpel GA, Warzak WJ, Kuhn BR, Walburn JN. Clinical perspectives in primary nocturnal enuresis. CUn Pediatr 1998 37 23—30. 

Janknegt RA, Zweers HM, Delaere KP, et al. Oral desmopressin as a new treatment modaUty for primary nocturnal enuresis in adolescents and... 

Desmopressin is a posterior pituitary hormone that has antidiuretic effects that decrease urinary volume and inaease urine osmolality. It is indicated in control of primary nocturnal enuresis control of central aanial diabetes insipidus and maintenance of hemostasis in patients with hemophilia A and type 1 von Willebrand disease during surgery and postoperatively. 

Another Vj receptor-mediated application is the use of desmopressin for primary nocturnal enuresis. Bedtime administration of desmopressin intranasal spray or tablets provides a high response rate that is sustained with long-term use, that is safe, and that accelerates the cure rate. Desmopressin also relieves post-lumbar puncture headache, probably by causing water retention and thereby facditating rapid fluid equilibration in the CNS. 

Vasopressin 1 Desmopressin (V2 selective) Neurogenic (pituitary) diabetes insipidus Hemophilia A (T factor VIII from liver) von Willebrand disease (T vW factor from endothelium) Primary nocturnal enuresis... 

We do not perform VCU for monosymptomatic, primary nocturnal enuresis or initially in children with daytime and nighttime wetting in the absence of severe urge, urge incontinence or UTI. 

Five to seven million children and adolescents in the United States suffer from nocturnal enuresis. Primary enuresis is twice as common as secondary enuresis. Enuresis is twice as common in boys as compared to girls. The incidence of enuresis varies as a function of age24,25 ... 

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. 

Klackenberg, G. (1981) Nocturnal enuresis in a longitudinal perspective. A primary problem of maturity and/or a secondary environmental reaction Acta Paediatr Scand 70 453-457. 

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. 

Nervous system The safety of desmopressin in children with primary monosjmiptomatic nocturnal enuresis has been reviewed [86 ]. After 61 cases of seizures, including two deaths, the FDA asked that the prescribing information be changed in 2007 to state that desmopressin spray is no longer indicated for monosymptomatic nocturnal enuresis or in patients at risk of hyponatremia. The authors of the review concluded that hyponatremia often resulted from inappropriately high doses of desmopressin and usually occurs in the elderly people they supported continuing the use of desmopressin to treat monosymptomatic nocturnal enuresis imder appropriate medical supervision. Hyponatremia has been reported more commonly with the spray than with the oral formulation this may reflect differences in pharmacokinetics or more extensive evaluation of the spray. 

Van de Walle J, Van Herzeele C, Raes A. Is there still a role for desmopressin in children with primary monosymptomatic nocturnal enuresis A focus on safety issues. Drug Saf 2010 33(4) 261-71. 

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