Drug Therapy for Nocturnal Enuresis

Abstract

It is estimated that enuresis occurs in 5 to 7 million children in the United States. The treatment approach for enuresis is controversial, in large part due to a lack of consensus as to the exact cause of enuresis. Several factors either alone or together may contribute to this syndrome. In addition, there is strong evidence of a genetic component to enuresis. Pharmacotherapy continues to be the preferred treatment for both physicians and families. The most widely used drugs include antidepressants, anticholinergics, and desmopressin. The tricyclic antidepressant imipramine has been used extensively since the 1960s. The exact mechanism of action in enuresis is unknown although it appears to be related to the anticholinergic and antispasmodic effects of the drug. The most common adverse effects reported with imipramine include personality changes, insomnia, anorexia and anxiety. There has been renewed interest in antidiuretic treatment of enuresis. Researchers have found that enuretic children do not have the ability to reduce urine volume at night or concentrate the urine they produce during the night. Clinical trials with desmopressin administered by nasal inhalation report a marked reduction in enuretic episodes. Adverse effects were limited to nasal complaints, rhinitis, or epistaxis. Additional long term studies are needed to delineate desmopressin's role in therapy. Although the number of options for treatment of enuresis is expanding, criteria to predict patient response need to be defined.

Desmopressin Use in the Treatment of Aripiprazole-Induced Nocturnal Enuresis in a Child Diagnosed with Autistic Disorder

“…Although enuresis was observed as a very rare side effect during the premarketing evaluation of oral aripiprazole, to our knowledge, there is only one diurnal enuresis case in the literature (Bozkurt et al 2011). Desmopressin is a synthetic replacement for arginine vasopressin (AVP) that binds to V2 receptors at the renal tubule and collecting ducts, and increases water absorption, thus causing denser urine with less volume (Miller et al 1992). In the case reports of two adults at the beginning of the 1990s, desmopressin use has been found to be safe and effective in the treatment of clozapine-induced enuresis (Bennett et al 1994;Lurie and Hosmer 1997).…”

Combined pharmacotherapy for nocturnal enuresis

“…This may be due, in part, to the low dosage used in the present study compared with that in the literature: we used 30 mg/day imipramine compared with 25-75 mg/day in the literature [12], and 2-4 mg/day oxybutinin compared with 10-15 mg/day in the literature [12]. Our lack of side effects may also be due to the age of the children we enrolled, since fatal poisoning due to tricyclic antidepressants has been frequently observed in children under the age of 5 years [13].…”

“…Our lack of side effects may also be due to the age of the children we enrolled, since fatal poisoning due to tricyclic antidepressants has been frequently observed in children under the age of 5 years [13]. The current evidence indicates that tricyclic antidepressants should not be used in children below 6 years of age [4,12].…”

Therapie der kindlichen Harninkontinenz mit Trospiumchlorid

“…Neben Blasentraining und Verhaltenstherapie wurden zur Therapie des kindlichen Einnässens ± wobei in der Vergangenheit meist nicht zwischen kindlicher Harninkontinenz und Enuresis differenziert wurde ± ADH [6,22,24,26], trizyklische Antidepressiva [7,21] Bemerkenswert ist die auûeror-dentlich rasch einsetzende Besserung der Symptomatik unter der Medikation; 90 % der Patienten konnten einen Behandlungserfolg bereits nach einer Woche vermelden. Dieser sich auf die Compliance günstig auswirkende Effekt ist gerade bei einem hohen Leidensdruck von Eltern und Kindern als wichtig zu erachten.…”

“…Da Trospiumchlorid als quaternä-res Ammoniumsalz die Blut-HirnSchranke nicht überwinden kann, sind zentrale Nebenwirkungen auch bei der Behandlung von Kindern nicht zu erwarten [21]. Während die Gesamtzahl der unerwünschten Arzneimittelwirkungen in einer von Madersbacher vorgelegten vergleichenden Studie bei Erwachsenen mit Detrusorhyperreflexie bei Trospiumchlorid und Oxybutynin in etwa gleich hoch war, lieûen sich Vorteile für Trospiumchlorid bei den subjektiv als schwerwiegend empfundenen Nebenwirkungen erkennen [15].…”