Recommendations and cautions for desmopressin
New guidelines issued this week recommend desmopressin as one option for treating bedwetting in children over six years. But in separate advice the Drug
and Therapeutics Bulletin says the drug can be difficult to use, with enuresis often returning when it is stopped.
This week’s guidelines come from the International Children's Continence Society. They recognise that treatment should be
reserved for children over six years. In older children, they recommend
the first-line treatments of desmopressin or alarm therapy, or a combination
of the two, as advised by a doctor (Journal of Urology 2004;171:2545).
Although last month’s DTB lists desmopressin as a potential short-term
measure for bedwetting in children aged five years and over, it highlights
difficulties involved with administering the drug. Fluid intake needs
to be limited when it is given and there are several potential side effects. “The
drug should be stopped for a week while the child is reassessed at three-monthly
intervals and a prescription should not be provided for more than three
months at a time,” the DTB states.
In an article on nocturnal enuresis in children, the bulletin says that
this condition can initially be managed in primary care. Once contributory
factors, such as constipation and urinary tract infection, have been
ruled out, treatment may be started. Simple behavioural methods such
as star charts and reward systems may work, although published evidence
on these approaches is weak. The bulletin adds that enuresis alarms can
be effective and helpful for well-motivated families. Complex behavioural
interventions are demanding.
The bulletin adds that the risks of using imipramine, outweigh any potential
benefit in tackling bedwetting. It says that this therapy, if used at
all, should only be initiated by a specialist team (DTB 2004;42:33). |
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