Bed Wetting Medication

My son is 8 and wets every night. My doctor mentioned that he can prescribe a medication to help. I'm a little nervous about giving my son medicine for this. Can you tell me more?

The most frequently prescribed medication for bedwetting is DDAVP (desmopressin). This synthetic form of the natural hormone vasopressin decreases the quantity of urine produced for the next eight to 12 hours. It begins to work quickly, usually within one hour of taking it. This medication is designed to curb bedwetting by making the urine more concentrated and decreasing the total amount of urine produced that night. Medication often has immediate results, but when you stop it, the relapse rate is high-about 80 percent.

DDAVP allows about half the children who use it to sleep dry that night, which makes it particularly useful for sleepovers and camps. DDAVP is available in two forms: a nasal spray and tablet. The tablet is now preferred because it delivers a more consistent and convenient dose. The nasal spray has a Black Box Warning because of some reported cases of seizures and death because of water intoxication.

Also, children with allergic congestion can get erratic results with the nasal spray. Dosage of DDAVP must be individualized, with one to three tablets (0.2 mg.) each night before bed as the recommended dose. The greatest number of dry nights is achieved by 0.4 to 0.6 mg. nightly. If your child is taking the medication for a situation outside of his home, such as sleepover camp, start it ahead of time to establish the appropriate dose. Your child's doctor or nurse practitioner is responsible for determining your child's dosage, but the general recommendation is as follows:

• If your child wets when taking one tablet, increase it to two
• If wetting occurs with two tablets, his dosage should be three tablets
• Three tablets is the maximum amount recommended for any age group

DDAVP is generally safe with few side effects. Reported side effects include headache, stomach ache 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 with a one week break. If wetting persists, it can be used for another interval.

DDAVP is expensive, as much as $3-4 per tablet. The cost should be taken into account when considering long-term use. DDAVP does not stop wetting in every child. Increasing the length of time taken will not make it work. The expected results should be seen in a week or two. Parents should realize that this medication does not provide long-lasting effects, but it does provide short-term dryness for many children. For long lasting results, getting to dryness by using a bedwetting alarm has a more permanent response.