Desmopressin for the treatment of primary nocturnal enuresis

Abstract

Primary nocturnal enuresis (PNE) affects a large proportion of children aged 5 years and over, and can persist into adolescence if left untreated. To patients and families, the condition is extremely distressing and embarrassing, as well as inconvenient owing to the increased washing of bedclothes required, and the difficulties surrounding socializing, such as planning sleepovers or holidays. PNE is caused by a mismatch between the capacity of the bladder to store urine and the volume of urine produced at night, which is frequently excessive in children with PNE. Excessive urine production at night can be caused by an impairment of the circadian rhythm of antidiuretic hormone secretion. Treatment for PNE is primarily by means of behavioral conditioning or pharmacological therapy. Desmopressin is a synthetic analogue of naturally occurring antidiuretic hormone, and is the only pharmacological therapy with a Grade A, level 1 recommendation from the International Consultation on Incontinence as a first-line treatment for PNE. Desmopressin is a well-established and generally well-tolerated treatment for nocturnal enuresis. The only potentially serious adverse effect of desmopressin is hyponatremia, which is rare and has predominantly been observed with the intranasal form of the drug – this formulation has now been withdrawn for the PNE indication in most countries. This review will explore the pharmacology, clinical efficacy and tolerability of desmopressin and its oral formulations in PNE, including the tablet and the more recent oral lyophilisate.