title: Desmopressin in the treatment of nocturia and enuresis in patients with multiple sclerosis. Desmopressin in the treatment of nocturnal polyuria in the male Efficacy of desmopressin (Minirin) in the treatment of nocturia: a double-blind placebo-controlled study in women. Oral desmopressin for nocturnal polyuria in elderly subjects: a double‐blind, placebo‐controlled randomized exploratory study The pharmacokinetics of 400 µg of oral desmopressin in elderly patients with nocturia, and the correlation between the absorption of desmopressin and clinical effect Low dose oral desmopressin for nocturnal polyuria in patients with benign prostatic hyperplasia: a double-blind, placebo controlled, randomized study. Efficacy of desmopressin in the treatment of nocturia: a double‐blind placebo‐controlled study in men An open, in-patient incremental safety and efficacy study of desmopressin in women with multiple sclerosis and nocturia. Desmopressin in the treatment of nocturia: a double-blind, placebo-controlled study. Desmopressin in the management of nocturia in patients with multiple sclerosis. A double-blind, crossover trial. The relationship between the action of arginine vasopressin and responsiveness to oral desmopressin in older men: a pilot study. Reducing nocturia in the elderly: a randomized placebo-controlled trial of staggered furosemide and desmopressin. Desmopressin in the treatment of daytime urinary frequency in patients with multiple sclerosis A longitudinal population-based survey of urinary incontinence, overactive bladder, and other lower urinary tract symptoms in women.
abstract: OBJECTIVES To assess whether the synthetic vasopressin analogue desmopressin [ 1-desamino 8-D-arginine vasopressin ] is efficacious and safe in the management of nocturia + /- enuresis in patients with multiple sclerosis . PATIENTS AND METHODS Twenty-two women and 11 men , under 65 years of age , with clinical ly definite multiple sclerosis and nocturnal frequency + /- enuresis were entered into the study . A two week placebo run-in , to establish normal voiding patterns , followed by a double-blind , placebo-controlled , cross-over study of 20 micrograms intranasal desmopressin at night-time was carried out . RESULTS Desmopressin caused a significant decrease in nocturnal urinary frequency , nocturnal urinary volume and the percentage of total daily urine passed at night . There was no significant fall in plasma sodium with desmopressin although there were two cases of asymptomatic hyponatraemia . CONCLUSION Desmopressin is an efficacious and safe treatment for nocturia + /- enuresis in patients with multiple sclerosis To assess whether desmopressin ( 1‐desamino 8‐d‐arginine vasopressin ) is safe and effective in the treatment of nocturnal polyuria in elderly men OBJECTIVE The purpose of this study was to investigate the efficacy and safety of oral desmopressin in the treatment of nocturia in women . STUDY DESIGN Women aged 18 years or older with nocturia ( > or=2 voids per night with a nocturia index score > 1 ) received desmopressin ( 0.1 mg , 0.2 mg , or 0.4 mg ) during a 3-week dose-titration period . After a 1-week washout period , patients who responded in this period received desmopressin or placebo in a double-blind fashion for 3 weeks . RESULTS In double-blind phase , 144 patients were r and omly assigned to groups  ( desmopressin , n=72 ; placebo , n=72 ) . For desmopressin , 33 ( 46 % ) patients had a 50 % or greater reduction in nocturnal voids against baseline levels compared with 5 ( 7 % ) patients receiving placebo ( P<.0001 ) . The mean number of nocturnal voids , duration of sleep until the first nocturnal void , nocturnal diuresis , and ratios of nocturnal per 24 hours and nocturnal per daytime urine volumes changed significantly in favor of desmopressin versus placebo ( P<.0001 ) . In the dose-titration phase headache ( 22 % ) , nausea ( 8 % ) , and hyponatremia ( 6 % ) were reported . Two deaths occurred , although neither could be directly associated with the study drug . CONCLUSION Oral desmopressin is an effective and well-tolerated treatment for nocturia in women To evaluate the decrease in nocturnal diuresis , nocturnal polyuria and the safety of oral desmopressin in elderly subjects with nocturia To investigate the pharmacokinetic profile of oral desmopressin in elderly patients with nocturia , and to analyse any possible correlation between the absorption and clinical effect PURPOSE We evaluated the long-term efficacy and safety of low dose oral desmopressin in elderly patients with benign prostatic hyperplasia with more than nocturnal voids and nocturnal polyuria more than 30 % of total daily urine volume . MATERIAL S AND METHODS Eligible patients with benign prostatic hyperplasia older than 65 years with nocturia , nocturnal polyuria and International Prostate Symptom Score 14 or greater were included in the study . All patients received placebo or 0.1 mg desmopressin orally at bedtime . Patients were required to visit the outpatient clinic from the first visit , and after 1 , 3 , 6 and 12 months of treatment . Patients maintained flow volume charts and used diaries to record voiding data throughout the study . During followup urinalysis , urine sodium , urine osmolality , serum electrolytes , prostate specific antigen , International Prostate Symptom Score , quality of life , transrectal ultrasonography of prostate , uroflowmetry and post-void residual urine volume were performed at each visit . RESULTS A total of 115 patients were enrolled in the study and r and omized as 58 in the placebo group and 57 in the desmopressin group . Desmopressin significantly decreased nocturnal urine output and the number of nocturia episodes , and prolonged the first sleep period ( p < 0.01 ) . Compared to before treatment desmopressin gradually decreased serum sodium and induced statistically but not clinical ly significant hyponatremia after 12 months of treatment . No serious systemic complications were found during medication . CONCLUSIONS Low dose oral desmopressin is an effective and well tolerated treatment for nocturnal polyuria in the lower urinary tract symptoms of patients with benign prostatic hyperplasia . Long-term desmopressin therapy gradually decreases serum sodium and it might induce hyponatremia even in patients without initial hyponatremia . For long-term desmopressin administration serum sodium should be assessed carefully , at least at 1 week after treatment Objective To investigate the efficacy and safety of oral desmopressin in the treatment of nocturia in men OBJECTIVES To examine the safety and efficacy of desmopressin in three doses given to women with multiple sclerosis to treat nocturia with or without enuresis . PATIENTS AND METHODS Eight women with clinical ly confirmed multiple sclerosis and nocturia with or without enuresis were entered as in- patients into an open , nonr and omized , placebo-controlled study of incremental doses of 20 , 40 and 60 micrograms desmopressin .  Urinary and serum sodium , plasma arginine vasopressin and urine osmolality were monitored every 4 h for 24 h. A single dose of placebo or desmopressin was given during each of four 24-h periods . RESULTS There was a significant decrease in nocturnal urinary volumes and a significant increase in nocturnal urinary osmolalities in patients taking desmopressin when compared with those taking a placebo , but there was no difference among the desmopressin doses . There was no significant difference in serum sodium level between the desmopressin doses . However , at the end of the 24-h period with the 60 micrograms dose , serum sodium was decreased significantly . CONCLUSIONS Neither a significant decrease in nocturnal urinary volumes nor an increase in urinary osmolality was achieved by doses of desmopressin > 20 micrograms . A dose of 60 g was associated with a decreased serum sodium level at the end of the 24-h period but there was no biochemical hyponatraemia . Because there were no benefits and a possibility of clinical hyponatraemia with higher doses , doses of > 20 micrograms desmopressin can not be recommended OBJECTIVES To investigate efficacy , safety , and impact on quality of sleep of desmopressin in the treatment of nocturia . METHODS Adults aged > or = 18 yr with nocturia ( > or = 2 voids/night ) received desmopressin tablets ( 0.1 , 0.2 , or 0.4 mg ) during a 3-wk dose-titration period . Patients should show sufficient response during the dose-titration period ( > or = 20 % reduction in nocturnal diuresis ) and a return of nocturnal diuresis to > or = 80 % of baseline levels during washout . Eligible patients then entered a 3-wk double-blind treatment period and received either desmopressin or placebo . RESULTS 127 patients were r and omised to either desmopressin ( n=61 ) or placebo ( n=66 ) . Twenty ( 33 % ) desmopressin-treated patients compared with seven ( 11 % ) placebo-treated patients showed a clinical response , defined as a > or = 50 % reduction in the number of nocturnal voids compared with baseline ( p=0.0014 ) . Compared with placebo , desmopressin result ed in a significant reduction in the mean number of nocturnal voids ( 39 % reduction with desmopressin vs. 15 % with placebo ; absolute difference -0.84 , p<0.0001 ) and duration of the first sleep period ( prolonged by 108 min with desmopressin vs. 41 min with placebo ; p<0.0001 ) . Quality of sleep was also improved with desmopressin versus placebo ( statistically significant for one of the two parameters evaluated ) . Adverse events were mainly mild . CONCLUSIONS Oral desmopressin tablets provide an effective and well-tolerated treatment for nocturia . Compared with placebo , nocturnal voiding frequency is reduced , duration of the first sleep period is increased , and sleep quality may be improved BACKGROUND Neurogenic bladder affects up to 80 % of patients with multiple sclerosis ( MS ) and , in 50 % of these patients , it is a significant cause of disability . The current management of neurogenic bladder , based on fluid restriction , anticholinergic agents , intermittent self-catheterization , and , in some cases , surgical intervention , often fails to relieve all symptoms . Furthermore , anticholinergic drugs have significant adverse effects and may be medically contraindicated . Nocturia is a particularly disabling symptom of neurogenic bladder ; by disrupting sleep patterns , it aggravates the chronic fatigue of MS , imposes serious dem and s on caregivers , and can lead to institutionalization . To evaluate a novel approach to the symptomatic management of nocturia in patients with MS , we have conducted a trial of desmopressin acetate ( 1-desamino-8-D-arginine vasopressin ) , a synthetic analogue of antidiuretic hormone . OBJECTIVE To evaluate the efficacy and short-term safety of desmopressin therapy in the symptomatic treatment of nocturia in patients with MS . METHODS Seventeen patients were enrolled in a double-blind , crossover trial of desmopressin administered at bedtime . Patients with both relapsing-remitting and chronic-progressive forms of MS were admitted . Night time voiding diaries were maintained for the 6 weeks of the trial ; similarly , serum electrolyte levels and plasma osmolality were measured twice weekly and urinalyses and urine cultures were performed weekly during the trial . RESULTS Desmopressin reduced the percentage of nights with nocturia in patients from 97 % to 66 % . The average number of episodes of nocturia per night in patients decreased from 2.35 to 1.09 and the maximum hours of sleep uninterrupted by nocturia increased from 3.74 to 5.77 . These results were highly significant . Four of the 17 patients discontinued participation in the study after developing asymptomatic or minimally symptomatic hyponatremia . CONCLUSIONS Desmopressin was found effective ; no tolerance and only minimal adverse effects have been observed . Our results suggest that desmopressin , either alone or in combination with other therapeutic modalities , is effective in the symptomatic management of nocturia in patients with MS . The only adverse effect attributed to desmopressin was hyponatremia , which occurred in 4 of 17 patients and appeared to be dose related OBJECTIVES To identify whether oral desmopressin ( ddAVP ) reduced nocturnal urine volume ( NUV ) in older men with nocturia without obvious bladder outlet obstruction and to determine whether deficiencies in arginine vasopressin ( AVP ) release and action demonstrated using water deprivation testing predicted responsiveness to ddAVP . DESIGN Participants had a 2-day Clinical Research Center ( CRC ) evaluation followed by a double-blinded , placebo-controlled , crossover trial of individually titrated oral ddAVP . SETTING Participants were from a single Department of Veterans Affairs Medical Center . MEASUREMENTS Maximum urine osmolality and percentage increase in osmolality were measured after subjects received aqueous vasopressin as part of the overnight water deprivation study ; these data were used to categorize participants as normal , having partial central AVP deficiency , or having impaired renal responsiveness to AVP . Response to ddAVP was assessed using data from frequency-volume records . RESULTS Fourteen participants completed the CRC stay and ddAVP trial . Subjects given ddAVP reduced NUV significantly from baseline ( P=.02 ) and had significantly lower NUV than when on placebo ( P=.01 ) . The mean net reduction in NUV from ddAVP compared to placebo was 14+/-18 % . Using water deprivation testing to categorize participants , 10 were normal , two had partial central AVP deficiency , and two had impaired renal responsiveness . The mean net reduction in NUV for those with abnormal water deprivation tests was 11+/-25 % , versus 15+/-16 % for those with normal water deprivation testing ( P=.70 ) . CONCLUSION In this small r and omized , controlled trial in older men with nocturia , ddAVP reduced NUV . Counter to expectations , participants deemed normal according to water deprivation tests had approximately equivalent responsiveness to ddAVP . Although this study can not offer definitive conclusions on the lack of prediction of water deprivation testing for ddAVP benefit , these data offer additional information that may help clarify the pathophysiology and optimal treatment of nocturia in older men AIMS The purpose of this study was to investigate efficacy , safety , and impact on quality of sleep of staggered furosemide and desmopressin in the treatment of nocturia in the elderly . METHODS Patients aged > 60 years with nocturia at least two voids per night were screened for enrollment into the study . A 3-week dose-titration phase established the optimum desmopressin dose ( 0.1 , 0.2 , or 0.4 mg ) . After a 1-week " washout " period , patients who showed sufficient response during the dose-titration period were r and omized to receive staggered furosemide and the optimal dose of desmopressin or placebo in a double-blind design for 3 weeks . Voiding diaries were assessed before and after the treatment . RESULTS In all , 82 patients were r and omized to either staggered furosemide and desmopressin ( n=41 ) or placebo ( n=41 ) . In the study group , most patients reported a good response with both reduced nocturnal voids ( 3.5 vs. 2.0 , P<0.01 ) and urine volume ( 919.6 ml vs. 584.2 ml , P<0.01 ) . The mean duration of the first sleep period was improved by 70 min ( 133.6 vs. 203.2 , P<0.01 ) . Compared to placebo , staggered furosemide and desmopressin result ed in a significant reduction in the mean number of nocturnal voids ( 43 % vs. 9 % ; P<0.01 ) , nocturnal urine volume ( 37 % vs. 5 % ; P<0.01 ) , and increase in the mean duration of the first sleep period ( 52 % vs. 19 % , P<0.01 ) . Adverse events were mild . CONCLUSIONS Staggered furosemide and desmopressin provide an effective and well-tolerated treatment for nocturia in the elderly Twenty two patients with multiple sclerosis , complaining of frequency of day time micturition  , completed a double blind crossover trial of desmopressin ( DDAVP nasal spray ) versus placebo . There was a significant decrease in micturition frequency in the 6 hour post-treatment period from 3.1 voids after placebo to 2.4 voids and a significant reduction in urinary volume after desmopressin . Eighty per cent of patients preferred the active treatment phase . Mean 24 hour urinary volume did not differ between active and placebo treatments and patients did not complain of increased night time frequency . Transient symptoms of hyponatraemia occurred in one patient but these resolved within 48 hours of stopping desmopressin . There were otherwise no side effects and mean serum sodium concentrations of the group remained unchanged throughout the study . The clinical indications for prescribing daytime desmopressin are discussed and the importance of patient compliance stressed BACKGROUND Female urinary incontinence ( UI ) , overactive bladder ( OAB ) , and other lower urinary tract symptoms ( LUTS ) are highly prevalent conditions with a profound influence on well-being and quality of life . There are a few studies describing progression as well as remission , in the short term , of UI in the general population as well as in selected groups ; at present , there are very few population -based studies describing the natural course of other LUTS in the same women , and there are no long-term longitudinal studies . OBJECTIVE To describe the prevalence of UI , OAB , and other LUTS in the same women studied prospect ively over time and , thus , to assess possible progression or regression . DESIGN , SETTING , AND PARTICIPANTS A longitudinal population -based study was performed in one primary health care district in the city of Gothenburg , Sweden . The participants were a sample of women aged > or = 20 yr who were r and omly selected from the Swedish National Population Register , assessed in 1991 ( n=2911 ) , and available for re assessment in 2007 ( n=1408 ) . METHODS A self-administered postal question naire regarding UI , OAB , and other LUTS was returned by 77 % of the contacted women in 1991 . The same women who responded in 1991 and who were still alive and available in the Swedish National Population Register 16 yr later were reassessed using a similar self-administered postal question naire . RESULTS AND LIMITATIONS In 2007 , 1081 of the available 1408 women responded to the question naire ( 77 % ) . The overall prevalence of UI , OAB , nocturia , and daytime micturition frequency of eight or more times per day increased by 13 % , 9 % , 20 % ( p<0.001 ) , and 3 % ( p<0.05 ) , respectively , from 1991 to 2007 . The incidence of UI and OAB were 21 % and 20 % , respectively , and the corresponding remission rates were 34 % and 43 % , respectively . Women with OAB symptoms were classified as OAB dry or OAB wet , depending on the presence or absence of concomitant UI . The prevalence of OAB dry did not differ between the two assessment occasions ( 11 % and 10 % , respectively ) , but the prevalence of OAB wet increased from 6 % to 16 % ( p<0.001 ) . CONCLUSIONS UI and other LUTS constitute dynamic conditions . In this study , there was a marked overall increase in the prevalence of UI , OAB , and nocturia in the same women from 1991 to 2007 . Both incidence and remission of most symptoms were considerable
target: The analysis revealed that desmopressin might significantly decrease the frequency of nocturnal voids , nocturnal urine volume and nocturnal diuresis , potentially result ing in an extended duration of the first sleep period and improved sleep quality .
  The adverse effects of desmopressin were similar to those observed in the placebo group .
  Conclusions Administered desmopressin was an effective and well-tolerated treatment for nocturia
background: Purpose The purpose of this analysis was to evaluate the efficacy and safety of desmopressin for the treatment of nocturia .