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The comparative safety of oral versus intranasal desmopressin for the treatment of children with nocturnal enuresis

Robson, W. L. M.; Leung, A. K. C. and Norgaard, Jens Peter LU (2007) In Journal of Urology 178(1). p.24-30
Abstract
Purpose: Desmopressin is a well established and effective therapy for nocturnal enuresis. Water intoxication leading to hyponatremia is an infrequent but serious adverse event associated with desmopressin. We assessed the safety of desmopressin in children 18 years or younger with nocturnal enuresis with a focus on the relative safety of the oral compared with the intranasal formulation. Materials and Methods: Published data (MEDLINE (R)) from December 1972 to August 2006 and post-marketing safety data from December 1972 to June 2005 were analyzed. Results: A total of 21 clinical trials on desmopressin use in children with nocturnal enuresis were identified. There were no reports of hyponatremia. A total of 21 publications were identified... (More)
Purpose: Desmopressin is a well established and effective therapy for nocturnal enuresis. Water intoxication leading to hyponatremia is an infrequent but serious adverse event associated with desmopressin. We assessed the safety of desmopressin in children 18 years or younger with nocturnal enuresis with a focus on the relative safety of the oral compared with the intranasal formulation. Materials and Methods: Published data (MEDLINE (R)) from December 1972 to August 2006 and post-marketing safety data from December 1972 to June 2005 were analyzed. Results: A total of 21 clinical trials on desmopressin use in children with nocturnal enuresis were identified. There were no reports of hyponatremia. A total of 21 publications were identified that included 48 case reports of hyponatremia in children with nocturnal enuresis. In all case reports patients were treated with intranasal desmopressin. Post-marketing safety data included 151 cases of hyponatremia in children with nocturnal enuresis, of whom 145 were treated with intranasal desmopressin and 6 were treated with the tablet formulation. Prodromal symptoms of hyponatremia were identified as headache, nausea and vomiting. Conclusions: Data suggest that there is a decreased risk of hyponatremia with oral desmopressin compared with intranasal desmopressin. Identifiable and preventable risk factors for hyponatremia are inappropriately high fluid intake, administration of a larger than recommended dose, young age (less than 6 years) and concomitant administration of another medication. When desmopressin is prescribed, patients should be instructed to avoid high fluid intake when the medication is ingested, not ingest a higher than recommended dose and promptly discontinue the medication and seek assessment if headache, nausea or vomiting develops. (Less)
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author
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
complications, hyponatremia, enuresis, bladder, deamino arginine vasopressin
in
Journal of Urology
volume
178
issue
1
pages
24 - 30
publisher
Lippincott Williams & Wilkins
external identifiers
  • wos:000247197000006
  • scopus:34250324701
ISSN
1527-3792
DOI
10.1016/j.juro.2007.03.015
language
English
LU publication?
yes
id
46509377-07c4-4bff-9ab7-9e25b8574bed (old id 648793)
date added to LUP
2007-12-14 12:24:29
date last changed
2017-09-17 07:52:58
@article{46509377-07c4-4bff-9ab7-9e25b8574bed,
  abstract     = {Purpose: Desmopressin is a well established and effective therapy for nocturnal enuresis. Water intoxication leading to hyponatremia is an infrequent but serious adverse event associated with desmopressin. We assessed the safety of desmopressin in children 18 years or younger with nocturnal enuresis with a focus on the relative safety of the oral compared with the intranasal formulation. Materials and Methods: Published data (MEDLINE (R)) from December 1972 to August 2006 and post-marketing safety data from December 1972 to June 2005 were analyzed. Results: A total of 21 clinical trials on desmopressin use in children with nocturnal enuresis were identified. There were no reports of hyponatremia. A total of 21 publications were identified that included 48 case reports of hyponatremia in children with nocturnal enuresis. In all case reports patients were treated with intranasal desmopressin. Post-marketing safety data included 151 cases of hyponatremia in children with nocturnal enuresis, of whom 145 were treated with intranasal desmopressin and 6 were treated with the tablet formulation. Prodromal symptoms of hyponatremia were identified as headache, nausea and vomiting. Conclusions: Data suggest that there is a decreased risk of hyponatremia with oral desmopressin compared with intranasal desmopressin. Identifiable and preventable risk factors for hyponatremia are inappropriately high fluid intake, administration of a larger than recommended dose, young age (less than 6 years) and concomitant administration of another medication. When desmopressin is prescribed, patients should be instructed to avoid high fluid intake when the medication is ingested, not ingest a higher than recommended dose and promptly discontinue the medication and seek assessment if headache, nausea or vomiting develops.},
  author       = {Robson, W. L. M. and Leung, A. K. C. and Norgaard, Jens Peter},
  issn         = {1527-3792},
  keyword      = {complications,hyponatremia,enuresis,bladder,deamino arginine vasopressin},
  language     = {eng},
  number       = {1},
  pages        = {24--30},
  publisher    = {Lippincott Williams & Wilkins},
  series       = {Journal of Urology},
  title        = {The comparative safety of oral versus intranasal desmopressin for the treatment of children with nocturnal enuresis},
  url          = {http://dx.doi.org/10.1016/j.juro.2007.03.015},
  volume       = {178},
  year         = {2007},
}