Desmopressin for bed-wetting

Examples

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Brand Name	Chemical Name
Stimate	desmopressin acetate

Desmopressin can be in the form of a pill or a nasal spray.

How It Works

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Desmopressin acts on the kidneys to reduce the amount of urine produced at night. Its effects last between 7 and 12 hours.

Why It Is Used

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Desmopressin is used in the treatment of bed-wetting (primary nocturnal enuresis) in children age 6 and older. Desmopressin may be used for some children when other treatments have been unsuccessful. It is usually not used until other treatments have been tried first. It may also be used on a temporary basis, such as when a child has a special overnight event.

How Well It Works

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Desmopressin is usually effective when used for a short period of time, such as during times of emotional stress or during overnight trips or camping trips.

Children who wet the bed 4 nights a week or more can expect to have fewer wet nights when they take desmopressin.

Desmopressin seems to work best in children older than 9.¹

Children with a family history of bed-wetting seem to have more success with desmopressin than with other treatments.

Desmopressin usually does not cure bed-wetting.

• Most children have fewer nights with accidental wetting when taking desmopressin. However, only about 25% stop wetting completely for 14 or more days in a row while taking the drug.^{2, 1}
• When treatment with desmopressin is stopped, 50% to 90% of children return to their usual pattern of bed-wetting (relapse).²

Side Effects

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Side effects of desmopressin are not common but may include:

• Headache.
• Abdominal pain.
• Nausea.
• A slight rise in blood pressure and sudden redness (flushing) of the face.
• Nasal discomfort or stuffiness and nosebleeds, when taken in the nasal spray form.

A very rare but serious side effect of desmopressin is severe water retention that causes an imbalance of sodium and water in the body (called water intoxication, or hyponatremia). Water intoxication can lead to coma or death. Some signs of water intoxication are drowsiness (lethargy), vomiting, and nausea. To avoid this serious side effect, children taking desmopressin should not drink more than 8 ounces of liquids during the 2 to 3 hours just before bedtime.

See Drug Reference for a full list of side effects. (Drug Reference is not available in all systems.)

What To Think About

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Desmopressin often is used along with behavioral training to treat accidental wetting.

The pill form of desmopressin has been shown to be as effective as the nasal form.² The pill form is often easier to give to children.

If the nasal spray form of desmopressin is used, a child with a stuffy or runny nose caused by allergies may need to take an antihistamine along with desmopressin. This will improve absorption of desmopressin. However, most children with stuffy or runny noses can take the pill form instead.

Desmopressin is not recommended for:

• Any child younger than 4.
• Any child who may be prone to a serious water and sodium imbalance (hyponatremia).
• Children with high blood pressure (hypertension), heart disease, or other conditions that affect the release of urine from the kidneys.

Children who are taking desmopressin need to drink less liquid in the evening to prevent water retention.

Desmopressin is more expensive than other forms of treatment for bed-wetting.

Complete the new medication information form (PDF) (What is a PDF document?) to help you understand this medication.

References

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Citations

1. Mikkelson EJ (2001). Enuresis and encopresis: Ten years of progress. Journal of the American Academy of Child and Adolescent Psychiatry, 40(10): 1146–1158.

2. Koff SA, Jayanthi VR (2002). Nocturnal enuresis. In PC Walsh et al., eds., Campbell's Urology, 8th ed., vol. 3, pp. 2273–2283. Philadelphia: W.B. Saunders.

Credits

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Author	Amy Fackler, MA
Author	Debby Golonka, MPH
Editor	Susan Van Houten, RN, BSN, MBA
Associate Editor	Pat Truman
Primary Medical Reviewer	Michael J. Sexton, MD - Pediatrics
Specialist Medical Reviewer	Peter Anderson, MD, FRCS(C) - Pediatric Urology
Last Updated	November 14, 2006