Long-term use and tapered dose reduction of intranasal desmopressin in the treatment of enuretic children

Abstract

Objective: To determine the time taken to achieve complete dryness, the management of desmopressin dosage to reduce the relapse rate, the mean dosage in those responding and any side effects of long-term treatment.

Patients and methods: Enuretic children (155, 68% boys and 32% girls, mean age 8 years, range 5-19) were treated with desmopressin and assessed. Treatment (intranasal spray) was started with 20 microg desmopressin and titrated to 40 microg (maximum 50 microg) after 2 days if the child did not become dry within 48 h. The maximum dosage was maintained for at least 4-6 weeks. After 4 weeks of complete dryness, the dosage was reduced by 10 microg initially, and after each additional 4 dry weeks, by a further 10 microg; medication was stopped only after 4 dry weeks at 10 microg.

Results: Of the children, 85% responded to intranasal desmopressin therapy; 71% achieved complete dryness with no relapses, remaining dry with no further treatment, 7% achieved dryness after relapses during or after therapy, 7% improved (no more than two wet nights per week) and 15% did not respond to therapy or improved only slightly (> 2 wet nights per week). The mean duration of therapy was 28 weeks, the mean dose of desmopressin was 30 microg and the median follow-up 18 months. There were no significant side-effects.

Conclusion: This study indicates that rapid titration until dryness within 1-3 days, a long maintenance therapy of at least 4-6 weeks and a slow stepwise reduction of dose decreases the frequency of relapse and improves the outcome.