Medical conditions and medications my limit the use of desmopressin for nocturia

This study investigated if people with nocturia (waking up at night to urinate) can take desmopressin acetate (Noctiva) medication. Researchers suggested that desmopressin may increase the risk of side effects in older adults with other medical conditions taking many medications.

Nocturia means waking up at night to urinate more than once. Nocturia predicts poor sleep quality and affects the quality of life of the patients. It can result from sleep disorders, low bladder capacity, and/or increased urine volume. Physicians usually address nocturia by treating the underlying conditions.   

One type of nocturia is nocturnal polyuria which consists of an increase of urine that is excreted at night-time. This condition can be treated with behavioral therapy and/or medications. Desmopressin is the only FDA medication approved for the treatment of nocturia. It decreases the production of urine during night-time which allows postponing the urination. However, it is also associated with a decrease in blood levels of sodium, especially in older patients. Low sodium in the bloodstream might lead to life-threatening conditions such as seizures and coma.

The concerns around prescribing DSA might delay treatment initiation. Moreover, it involves a more frequent follow-up of blood levels. The occurrence of these prescribing concerns in a population of older adults with nocturia is still unknown.

This study included information about 4111 participants aged 50 years who reported nocturia. The main outcomes were the frequency of medical conditions and medications that might increase the risk of side effects for desmopressin use.

Desmopressin prescribing concerns were present in 80.5%. 41.6% received another drug that could increase the risk of low sodium in the blood.

50% of participants had at least 1 contraindication to desmopressin use. These included having uncontrolled high blood pressure, kidney disease, taking corticosteroids or loop diuretics (medication that increases urine elimination), or having congestive heart failure. Desmopressin contraindications were higher with old age and present in 73.2% of those with 80 years of age.

This study concluded that older adults with nocturia have a high occurrence of other medical conditions and abnormal blood levels that might limit the prescription of desmopressin for nocturia.