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

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 mu g desmopressin and titrated to 40 mu g (maximum 50 mu g) 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 mu g initially, and after each additional 4 dry weeks, by a further 10 mu g; medication was stopped only after 4 dry weeks at 10 mu g. 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 mu g 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.