Desmopressin acetate the first sublingual tablet to treat nocturia due to nocturnal polyuria

ABSTRACT

Introduction: Desmopressin was widely used to treat nocturnal polyuria in adults under the age of 65 due to the well-established risk of hyponatremia. Since the prevalence of nocturia increases with age, and with an aging population, those most affected were excluded from treatment. Recently, a new lower dose sublingual tablet formulation that optimizes the balance between efficacy and tolerability has been licensed for symptomatic treatment of nocturia due to idiopathic nocturnal polyuria in adults of any age, with the caveat of regular serum monitoring for those over 65. This newer formulation aims to achieve the same clinical outcomes as previous formulations while reducing the risk of hyponatremia.

Areas covered: This review will look at the pharmacology of the newly formulated desmopressin and examine the results of the clinical trials that would support its treatment of adult nocturia with idiopathic nocturnal polyuria.

Expert opinion: When reporting on the clinical efficacy of desmopressin on nocturia, it is important for clinical trials to publish their complete data on nocturnal and 24-hour urine voided volumes. Further research examining the physiological reasoning behind this gender-specific dosing for desmopressin and the optimal recommended treatment duration of desmopressin for those over 65 is needed.

KEYWORDS:

• Nocturia
• Enuresis
• Nocturnal
• Polyuria
• Desmopressin

Article highlights

• A new lower dose of desmopressin sublingual tablet has been licensed for the treatment of nocturia due to idiopathic nocturnal polyuria.

• Unlike previously available higher dosages, the new 25 μg and 50 μg dose may be used to treat patients over 65.

• The reviewed studies support the use of 25 μg and 50 μg of sublingual desmopressin for the treatment of nocturia.

• The sublingual formulation is hypothesized to be pharmacologically superior to the tablet.

• Caution is recommended when initiating desmopressin in patients over 65 years.

Serum sodium monitoring has been implemented in at-risk patients.

Declaration of interest

H. Hashim has declared receiving personal fees from Ferring outside the submitted work for advisory board meetings and lectures. The authors have no other 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 apart from those disclosed.

Reviewer disclosures

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

Ferring provided a scientific accuracy review at the request of the journal editor.

Additional information

Funding

This paper was not funded.