MedicationWhat you should know
By: Renee Mercer, MSN, CPNP
A few medications are typically prescribed to children with bedwetting. These medications are designed to curb bedwetting either by decreasing the amount of urine produced at night or by allowing the bladder to hold more urine. Medication often has immediate results, but the relapse rate is extremely high – about 80 percent. After a 12 week course of medication, most children resume wetting. The most frequently prescribed medication for enuresis is called desmopressin (DDAVP). This is a synthetic form of the natural hormone vasopressin, and one dose of it can decrease the quantity of urine produced for up to 12 hours. It works quickly, usually within an hour of treatment.
Desmopressin allows many children to sleep dry for a night, which makes it particularly useful for sleepovers and camps. Desmopressin is available in two forms: a tablet and a nasal spray. The tablet form is recommended because it delivers a more consistent and convenient dose, with fewer side effects. Dosage of desmopressin must be individualized, though one to three tablets each night is the typical recommended dose. The greatest number of dry nights is achieved with 0.4-0.6 mg nightly. If your child is taking the medication for a situation outside of the home, such as sleepover camp, start treatment ahead of time to establish the appropriate dose. Your child's doctor or nurse practitioner is responsible for determining dosage, but the general recommendation is as follows:
- If your child wets when taking only one tablet, increase dosage to two.
- If wetting occurs with two tablets, increase dosage to three tablets.
- Three tablets is the maximum amount recommended for any age group.
Desmopressin does not stop wetting in every child. If results are not seen within the first two weeks, further treatment will be ineffective. Parents should realize that this medication is not a long-term solution. It does buy time while a more permanent solution is sought.
DDAVP provides only short-term dryness for many children.
Desmopressin is a safe medication with very few side effects. Reported side effects may include headache or water intoxication, if a large amount of water is ingested after taking it. The manufacturer provides fluid guidelines, recommending no more than four ounces of water before bedtime. This medication can be safely used for three to six month intervals separated by a one week break. If wetting persists, treatment can be repeated. Desmopressin is expensive, as much as $4 per tablet. The cost should be taken into account when considering long-term use.
Oxybutynin(Ditropan) is another medication that can be useful in treating enuresis in some children. If your child has shown signs of small functional bladder capacity, such as frequency or urgency during the day, this medication may assist with nighttime dryness. Oxybutynin works by relaxing the bladder's smooth muscle, increasing bladder capacity, and delaying the initial impulse to void. Your child's health-care provider can help you decide if this medication would be a helpful adjunct, and should be consulted about the dosage. This medication is inexpensive and safe. Possible side effects include dry mouth, constipation, and decreased ability to sweat. It is extremely important for those on taking oxybutynin to drink plenty of fluids and take breaks to cool down in hot weather.