Desmopressin: A new Principle for Symptomatic Treatment of Urgency and Incontinence in Patients with Multiple Sclerosis

Abstract

Thirteen patients with advanced multiple sclerosis and urge urinary incontinence were treated with desmopressin--a synthetic analogue of antidiuretic hormone--in a double-blind cross-over study. The micturition frequency decreased significantly (p less than 0.05). Less leakage was considered valuable for daily life. Peroral medication was favourable in these patients with muscular dysfunction. Side-effects were few.

Desmopressin, as a “designer‐drug,” in the treatment of overactive bladder syndrome

“…The results are similar to the ones we have demonstrated with decreased daytime micturition frequency and UUI episodes in the first 6-hr following tablet 9 or intranasal desmopressin. 19 Robinson et al 20 administered 40 mg intra-nasal desmopressin to 64 women, with urinary incontinence, over 10 days (7 days active drug; 3 days placebo).…”

“…However this decision was made after long discussions between the investigators and it was felt that measuring output during the trial period would reduce compliance and certainly it would not be possible for all the patients to measure output at all times because most of those recruited would be working people and it would have been inconvenient for them to measure urine output at work. Also there is plenty of evidence from desmopressin in nocturia studies [15][16][17] and during daytime studies in neurogenic patients 9,19 that urine output is reduced by administering desmopressin. Therefore we would only have duplicated the previous work unnecessarily and would have compromised patient compliance.…”

Antidiuresis therapy: Mechanism of action and clinical implications

“…67 It may also be effective in the treatment of nocturia not associated with nocturnal polyuria; for example, in patients with benign prostatic enlargement, 68 neurogenic bladder due to multiple sclerosis [69][70][71][72] and detrusor overactivity refractory to evening fluid restriction and antispasmodic therapy. 73 It has been given a level 1, grade A recommendation by the International Consultation on Incontinence for the treatment of nocturia.…”

Pharmacological Management of Detrusor Instability

“…Desmopressin is safe for long-term use, but should be used with care in the elderly. Nocturnal frequency and urinary incontinence can be reduced by the use of DDAVP: Kinn and Larsson [76] reported a significant decrease from 3.2 to 2.5 episodes in the 6 hours after treatment in patients with multiple sclerosis and urge incontinence. Oral desmopressin has been used as treatment for nocturia: it significantly reduces nocturia but does not produce an increase in daytime frequency [77].…”