Related guidance:
Bedwetting in under 19s Clinical guideline (CG111 October 2010)
- The use of desmopressin may be considered specifically to reduce nocturia in women with urinary incontinence or overactive bladder who find it a troublesome symptom. Use particular caution in women with cystic fibrosis and avoid in those over 65 years with cardiovascular disease or hypertension.
- Consider offering oral desmopressin to men with nocturnal polyuria if other medical causes have been excluded and they have not benefited from other treatments. Measure serum sodium 3 days after the first dose. If serum sodium is reduced to below the normal range, stop desmopressin treatment.
- Medical conditions that can cause nocturnal polyuria symptoms include diabetes mellitus, diabetes insipidus, adrenal insufficiency, hypercalcaemia, liver failure, polyuric renal failure, chronic heart failure, obstructive apnoea, dependent oedema, pyelonephritis, chronic venous stasis, sickle cell anaemia. Medications that can cause nocturnal polyuria symptoms include calcium channel blockers, diuretics, and selective serotonin reuptake inhibitors (SSRIs).
| Therapeutic Area | Formulary Choices | Cost for 28 (unless otherwise stated) | Rationale for decision / comments |
|---|---|---|---|
| Pituitary and Hypothalamic hormones ans analogues, Vasopressin and analogues | Desmopressin acetate as Noqdirna® | 25mcg oral lyophilosate £15.16 (30) | NHS Somerset classify Desmopressin oral lyophilisate as an Amber drug as per Traffic light guidance. Noqdirna is indicated for symptomatic treatment of nocturia due to idiopathic nocturnal polyuria in adults. Elderly patients are at increased risk of developing hyponatraemia with desmopressin treatment and may also have impaired renal function. Caution should therefore be exercised in this age group and daily doses above 25mcg for females and 50 mcg for males should not be used. In elderly patients serum sodium must be within the normal range, before initiating treatment, in the first week (4-8 days after initiation) and again at one month. Noqdirna should be discontinued if the serum sodium level falls below the lower limit of normal range. Continued therapy must be carefully reconsidered in elderly patients who show no evidence of therapeutic benefit beyond 3 months. 25mcg daily (females) and 50mcg daily (males) 1 hour before bedtime. |
| 50mcg oral lyophilosate £15.16 (30) | |||
| Desmopressin acetate as DesmoMelt® | 120mcg oral lyophilosate £30.34 (30) | For primary nocturnal enuresis in children >5 years of age for upto 3 months treatments at a time. 120mcg once daily, increased if necessary to 240mcg once daily, dose to be taken at bedtime, limit fluid from 1 hour before to 8 hours after administration, dose to be increased only if lower dose not effective, reassess after 3 months by withdrawing treatment for at least a week. |
|
| 240mcg oral lyophilosate £60.68 (30) |