In a nutshell
This study examined the risk of hyponatremia (low blood sodium levels) with desmopressin treatment for nocturia. Patients at high risk of hyponatremia were identified and a monitoring scheme is proposed to prevent this potentially dangerous side effect.
Some background
Desmopressin has been under the focus of investigation as a novel way to treat nocturia. While desmopressin has been shown to reduce nightly trips to the toilet and sleep interruptions, it may also cause a potentially dangerous side effect; hyponatremia (low blood sodium levels).
Methods & findings
This study further examined the risk and prevention of hyponatremia with desmopressin treatment.
The study analyzed data from three different clinical trials on desmopressin, including a total of 1443 patients with nocturia. Overall, 6.7% of patients receiving desmopressin experienced significant hyponatremia. However, severe hyponatremia was only noted in 2% of patients. Most hyponatremia events occurred within 2-3 weeks from starting treatment.
The higher the dose of desmopressin, the greater the risk of hyponatremia. Significant hyponatremia was noted in 14% of patients taking high desmopressin doses (75-100 mcg), compared to only 5% of those receiving the minimal effective dose (25-50 mcg).
Other risk factors for hyponatremia included low sodium levels before treatment, age over 65, poor kidney function, and use of other medications which may cause low sodium (such as thiazides, epilepsy drugs and antidepressants).
Based on these results, the following recommendations were made:
1. Check baseline sodium levels before starting treatment. Desmopressin should not be started if the sodium level is less than 135 mmol/L.
2. Patients above the age of 65, or those receiving other medications which may cause hyponatremia, are at high risk. Blood sodium levels should be checked 1 week and 1 month after starting treatment in high risk patients.
3. Stop treatment if at any time sodium levels are lower than 135 mmol/L.
The bottom line
This study concluded that desmopressin is a safe treatment for nocturia when given at minimal effective dose, with proper risk prevention and sodium monitoring.
The fine print
It should be noted that this analysis was performed using older forms of desmopressin which have higher associated rates of hyponatremia.
What’s next?
Consult with a doctor regarding the risks and benefits of desmopressin treatment for nocturia.
Published By :
BJU international
Date :
May 01, 2017
