Pharmacotherapeutic options in the treatment of nocturia: an update on the current oral drug therapies

ABSTRACT

Introduction

Nocturia is a common urinary complaint among patients presenting with lower urinary tract symptoms and in recent years, there is a greater emphasis to tailor the treatment for nocturia in a more holistic and multidisciplinary manner given the potential multifactorial causes for nocturia.

Areas covered

Current oral drug therapies can be classified into three main groups, namely, decreasing polyuria, targeting bladder capacity, and improving sleep-wake and circadian rhythm. The authors focus this article on these oral therapies and provide their expert opinion.

Expert opinion

Treatment strategies should always involve lifestyle changes and behavioral modifications, with the targeted treatment of underlying medical conditions that may cause nocturia. Desmopressin remains the only drug approved specifically for the treatment of nocturia. Medications targeting the bladder and prostate can have secondary benefits in minimizing nocturnal frequency and urgency especially if the drug is taken at nighttime. Treatment of an underlying sleep disorder or circadian disorder can often help to increase total sleep time and quality, and perhaps reducing the nocturnal diuresis and nocturia episodes. Future studies in nocturia should improve the identification and diagnosis of underlying mechanisms that lead to nocturia, so treatment can become more streamlined, while at the same time, explore the role of various pharmacotherapeutic agents and novel therapy to reduce or eliminate nocturia.

KEYWORDS:

• Nocturia
• nocturnal polyuria
• bladder capacity
• circadian rhythm
• overactive bladder

Article highlights

• Clinicians must be aware that nocturia is likely multifactorial in nature and the treatment strategy requires a multidisciplinary approach.

• The causative factors contributing to the development and/or progression of nocturia can be largely categorized into three main groups, namely global and/or nocturnal polyuria, reduced bladder capacity, and sleep and circadian rhythm disorders

• Treatment for nocturia should be offered to patients who are concerned by the frequency of nocturia and reported a decreased quality of sleep (≥2 or more nocturnal voids per night).

• Targeted treatment of underlying medical conditions that can cause nocturia are warranted, and simple behavioral and lifestyle modifications remain first-line therapy.

• To date, desmopressin remains the only drug approved and other drugs targeting prostate, bladder or sleep disorders are not designed specifically for the treatment of nocturia.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This manuscript has not been funded.