Child Health/Nocturnal enuresis agent

Nocturnal enuresis drugs

also: desmopressin · oxybutynin · bedwetting

Overview

Drug treatment of bedwetting — after an enuresis alarm and lifestyle measures (the non-drug first-line).

Mechanism

Desmopressin is a synthetic vasopressin (ADH) analogue → acts on renal V2 receptors → ↑water reabsorption → reduced overnight urine volume. Oxybutynin (antimuscarinic) is added if there is daytime overactive-bladder component.

Indications

Nocturnal enuresis (≥5 years, after alarm/lifestyle, or for rapid short-term cover e.g. sleepovers)

The agents

DesmopressinADH analogue

oral/sublingual at night

Restrict evening fluids; risk of hyponatraemia/water intoxication if not.

Oxybutyninantimuscarinic

Added for daytime urgency/overactive bladder component.

Adverse effects

Desmopressin: hyponatraemia / water intoxicationserious

Counsel to restrict fluids from 1 h before to 8 h after the dose; stop during vomiting/diarrhoea.

Headache, nauseacommon

Oxybutynin: anticholinergic effectscommon

Cautions & contraindications

Desmopressin with high fluid intake / hyponatraemia / D&Vall

Water retention → hyponatraemic seizures.

Interactions

Drugs increasing ADH / fluid load

Monitoring & kinetics

Response (dry nights); fluid-restriction adherence

Oral at night. Enuresis alarm is the first-line (highest long-term cure); desmopressin for rapid/short-term control.

Source: NICE CG111 — Nocturnal enuresis · BNF for Children — Desmopressin