1/17/2024 0 Comments Nocturia and nocturnal polyuriaThe proposed rationale for using diuretics in the treatment in nocturia has been to reduce salt and water load in the body prior to bedtime, and positive effects have been documented with, e.g., bumetanide and furosemide. Preliminary data showed that the antidiuretic effect of fedovapagon can be controlled by dose, giving the potential to improve the risk/benefit profile of V2 receptor agonists in the treatment of nocturia. įedovapagon (VA106483), a novel non-peptide drug, is a selective V2 receptor agonist, currently in phase II/III development. In patients with nocturia, treated with low-dose desmopressin combined with a sodium monitoring plan during the first month of treatment, mainly mild, non-clinically significant hyponatremia was observed.ĭesmopressin is the only therapeutic agent to be highly recommended for treating nocturnal polyuria by the International Consultation on Incontinence (ICI) committee. showed that the incidence of hyponatremia can be reduced by using minimum effective gender-specific dosing with the ODT formulation of desmopressin (25 μg in women, 50 μg in men). Patients received placebo or desmopressin orally disintegrating tablet (ODT). performed a meta-analysis of data from three clinical trials of desmopressin in nocturia. To explore risk factors for desmopressin-induced hyponatremia and evaluate the impact of a serum sodium monitoring plan, Juul et al. They concluded that patients with advanced age (≥ 65 years) and low hemoglobin are at risk of desmopressin-associated hyponatremia. Hyponatremia (< 135 mmol/l) was found in 24 patients (14%), and it was severe in 7 (< 126 mmol/l). retrospectively analyzed data from 172 patients who were prescribed desmopressin for nocturnal polyuria at a urology clinic from September 2010 through February 2013. Hyponatremia (defined as serum sodium 65 years), had lower body mass, higher urine output, lower basal serum sodium level, and lower creatinine clearance at baseline than those who did not develop hyponatremia. The lowest therapeutically beneficial dose of desmopressin (orally disintegrating tablet) has been determined as 50 μg for men and 25 μg for women. This has been attributed to the fact that the gene for the vasopressin V2 receptor is located on the X chromosome in a region with high probability of escape from inactivation this may lead to phenotypic sex differences, with females expressing higher levels of transcript than males. Women appear to be more sensitive to desmopressin than men. Based on their results, the authors recommended lower and gender-specific dosing to reduce the small but clinically significant risk of hyponatremia. Post hoc analyses by gender suggested a lower minimum effective dose for women. Increasing doses of desmopressin were associated with decreasing numbers of nocturnal voids and voided volume, greater proportions of subjects with > 33% reduction in nocturnal voids, and increased duration of first sleep period. The study included 757 patients reporting three or more nocturic episodes per night with 90% due to nocturnal polyuria. performed a 4-week, randomized, double-blind study comparing 10, 25, 50, or 100 μg desmopressin (oral dispersible desmopressin (Minirin R Melt) versus placebo in adults with defined nocturia. However, in 2017, FDA approved desmopressin nasal spray (Noctiva R, desmopressin acetate) for the “treatment of nocturia due to nocturnal polyuria in adults who awaken at least 2 times per night to void.” An oral desmopressin lyophilisate formulation (Nocdurna R) requiring no concomitant fluid intake is currently the most widely used DDAVP preparation.ĭDAVP has shown efficacy in nocturia due to nocturnal polyuria as evident from numerous reviews. Food and Drug Administration (FDA) and the European Medicines Agency (EMA) removed the indication for the treatment of primary nocturnal enuresis from all intranasal preparations of desmopressin in 2007. Because of symptomatic hyponatremia with water intoxication, which occurred after intranasal or intravenous administration of desmopressin, the U.S. DDAVP is available in formulations for oral, parenteral, and nasal administration. DDAVP is a synthetic analogue of antidiuretic hormone (ADH) and it binds to V2 receptors in the renal collecting duct and stimulates water reabsorption. Desmopressin (DDAVP) has for a long time been in clinical use for the treatment of nocturnal polyuria, and there are several recent reviews of the mechanism of action and clinical use of the drug.
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