Open Journal of Urology, 2011, 1, 72-75
doi:10.4236/oju.2011.14015 Published Online November 2011 (
Copyright © 2011 SciRes. OJU
Oral Desmopressin in the Management of
Adults with Nocturia
Shahram Gooran1, Sevil Nasirmohtaram2, Mohammad Ghasem Mohseni1, Behzad Narouie3*
1Department o f Urology, Tehran University of Medical Sciences, Tehran, Ira n
2Departmen t o f ENT, Tehran University of Medical Sciences, Tehran, I ra n
3Department of Clinical Research Development Center, Zahedan University of Medical Sciences, Z ah edan, Iran
E-mail: *
Received July 20, 2011; revise August 26, 2011; accepted S ep tember 2, 2011
We investigated the efficacy of oral desmopressin in the treatment of adult nocturia. In an analytical study
between 2007-2009 in Zahedan-Iran, Thirty patients 55 years with verified nocturia (two voids/night)
were enrolled. Patients with a history of an obstructive cause of nocturia, those with diseases getting worse
by the anti-diuretic affect of desmopressin and those with well-defined curable causes (e.g. cystitis) were
excluded. Patients received 0.2 mg of oral desmopressin at bed time for a period of 3 weeks. p < 0.05 was
taken as the significant level. All 30 patients enrolled completed the trial. Fourteen (47 %) patients receiving
desmopressin had fewer than half the number of nocturnal voids relative to base line (p < 0.001). The mean
number of nocturnal voids decreased from 4.6 to 2.4 (p < 0.001). Fatigue (10%), headache (3%) and dizzi-
ness (3%) were reported. All adverse events were of mild intensity and there were no instances of hypona-
tremia. Oral desmopressin is an effective treatment in patients with nocturia and is well-tolerated.
Keywords: Nocturia, Desmopressin, Arginine Vasopressin
1. Introduction
Nocturia is defined as waking at night to void [1]. Al-
though by definition even a single episode of awakening
to urinate is nocturia, most clinicians consider nocturia to
have significance when a patient voids two or more times
nightly [2]. Nocturia is a very common and bothersome
symptom [3]. The prevalence of nocturia increases with
age and affects quality of life in both men and women [4].
Rising at night to void increases the risk of personal in-
jury, particularly in the elderly where the condition is
associated with a greater risk of falls [5]. Nocturia may
be due to either polyuria, nocturnal polyuria or low
bladder capacity [6]. As the diurnal variation in AVP
release is absent in many older subjects [7], nocturnal
polyuria, or the over-production of urine at night, is an
important cause of nocturia [8], that may be due to
age-related changes in the secretion and action of argin-
ine vasopressin (AVP) [9,10]. Treatments currently li-
censed to improve bladder function do not control noc-
turnal polyuria [11]. Desmopressin (1-deamino-8-D-argi-
nine vasopressin, ddAVP), a synthetic analogue of AVP
is used for treatment of adult nocturia [12], and when
administered at bed-time, decreases night-time urine pro-
duction [13]. Effectively treating nocturia with desmo-
pressin has been shown by some others [11,14,15]. The
primary aim of the present study was to investigate the
efficacy of oral desmopressin in a 3-week treatment pe-
riod, in reduction in the number of voids at night.
2. Materials and Methods
In a analytical study, included 30 patients aged 55
years between 2007-2009 in Zahedan-Iran, with com-
plaint of two or more episodes of nocturnal voids during
night (night is defined as the period between going to
bed for sleeping and waking for rising) and nocturnal
diuresis > 0.9 ml/min [5]. Screening included a precise
medical history (including other lower urinary tract
symptoms, past medical diseases, fluid intake and medi-
cations), physical examination (including measuring su-
pine and standing blood pressure), serum electrolytes,
renal function tests and urine analysis. The upper and
lower urinary tract ultrasonography with careful attention
to post-void residual urine volume was also done. Pa-
tients with a serum sodium level below the normal range,
epilepsy, clinically significant renal, hepatic or cardio-
vascular disease, uncontrolled hypertension, diabetes in-
sipidus, multiple sclerosis, primary polydipsia, genitouri-
nary tract infection, urge incontinence, and untreated BPH
(benign prostatic hyperplasia) were excluded. The number
of nocturnal voids and nocturnal urine volume were re-
corded in the questionnaire before commencing the treat-
ment. The patients received 0.2 mg of oral desmopressin
(Minirin®, Ferring pharmaceuticals, Sweden) at bed-time
for three weeks.
The patients were instructed to drink only to satisfy
their thirst until 8 hours after taking the tablets and to
stop the treatment and inform their doctor if side-affects
such as headaches not relieved by acetaminophen, vision
problems, faster heart rate, rapid weight gain, nausea and
vomiting, confusion or seizures occur. All patients were
visited at the end of the first week of treatment to check
their serum sodium levels and probable adverse affects.
The primary efficacy endpoint was the proportion of
patients who had a reduction by more than half in the
mean number of nocturnal voids after treatment com-
pared with baseline. Changes in nocturnal urine volume
and number of nocturnal voids, serum sodium levels,
incidence of adverse events and patient's satisfaction of
desmopressin treatment were also assessed. Statistical
analysis was performed by SPSS software (version 15)
and results were presented using P values based on the
paired T-test. p < 0.05 was taken as the significant level.
3. Results
Of the patients who reported two or more voids per night,
32 were screened and enrolled. Two patients withdrew
consent. The study population comprised 26 men (87%)
and 4 women (13%), with a median age of 63.5 (55 - 78)
years. A clinical response defined as fewer than half the
mean number of nocturnal voids after treatment com-
pared with baseline, was achieved by 14 (47%) patients
(p < 0.001). If a threshold of 40% reduction in noctur-
nal voids was supposed as a response instead of 50 %,
22 (73%) patients obtained a response to desmopres-
sion.The mean number (SD) of voids per night reduced
from 4.6 (0.9) at the baseline to 2.4 (0.7) at the end of
treatment period (p < 0.001) (Figure 1).And the mean
nocturnal urine volume decreased from 640 107.6 ml
to 395.3 98.8 ml (p < 0.001) (Figure 2). There was a
reduction of 20% in nocturnal urine volume in 27
(90%) patients. In all, 3 (10%) fatigue, 1 (3%) dizziness
and 1 (3%) headache were reported. All of adverse events
were of mild intensity. No instances of serious side-ef-
fects were detected. The mean serum sodium level de-
creased from 138 to 136 mmol/L during the first week of
treatment (p = 0.317) (Figure 3). Serum sodium level <
Figure 1. Mean numbe r of nocturnal voids before and after
Figure 2. Mean nocturnal urine volume at baseline and
after treatmen t.
Figure 3. Mean serum sodium values at baseline and 1 week.
Copyright © 2011 SciRes. OJU
130 mmol/L did not occur. Two patients had a decrease
of 5 units in serum sodium level during the first week
of treatment, but both remained asymptomatic during the
treatment period and hyponatremia was not reported at
all.Twenty-four (80%) patients were completely satisfied
with the treatment, opposed to 5 (17%) relatively satis-
fied and 1 (3%) not satisfied.
4. Discussion
Adults, particularly the elderly with frequent voiding
episodes at night, often suffer from poor sleep and con-
sequently they are often tired during the day, resulting in
a poor quality of life [16]. In older patients with nocturia,
the day: night urinary output ratio is reduced, and in such
patients there is an increased frequency of nocturnal
micturition. Plasma vasopressin is at undetectable levels
in many such patients [10], therefore desmopressin [a
synthetic analogue of arginine vasopressin) seems to be a
suitable therapeutic choice for patients with nocturia. As
found in previous studies, [13,15,17] desmopressin
treatment is associated with a decrease in nocturnal urine
output.The main aim of the present study was to investi-
gate the efficacy of oral desmopressin in reduction in
episodes of nocturnal voids, which is the main complaint
of subjects with nocturia.
The threshold chosen for clinical response was a
50% reduction in nocturnal void based on previous stud-
ies [11,18]. The mean number of nocturnal voids reduced
by 48% in patients on desmopressin compared with base-
line. In accordance with previous studies, [14,15,19] the
decrease in nocturnal diuresis with desmopressin treat-
ment was associated with reduction in nightly voids.
A slight decrease in serum sodium levels during
treatment was seen, which was not statistically signifi-
cant (p = 0.317).The study showed that adverse-effects
associated with desmopressin treatment were of mild
intensity and infrequent, similar to what was previously
reported [11]. Caution is warranted in interpreting the
results as there was no placebo arm. However, the results
accord with those in other trials of desmopressin for this
indication. A potential source of efficacy bias may be the
safety instructions given to patients, to drink only when
thirsty during the night, which could affect fluid intake
and thus urine volume, and the number of nocturnal
voids. In summary, oral desmopressin given at bed time
in patients with nocturia, reduces nocturnal diuresis and
nocturnal voids compared with the baseline. As desmo-
pressin is a potential therapeutic choice for subjects with
nocturia, patients not responding to general advice and
conventional treatments, and those who consider this
suffer as a normal consequence of aging, must be in-
formed that it is unnecessary to bear this problem any
more.The present study showed desmopressin to have
beneficial effects on nocturia and is well-tolerated; how-
ever, serum sodium testing is suggested in all patients
before and after a few days on treatment.
5. Acknowledgements
We would like to acknowledge the Clinical Research
Development Center of Ali-ebne-abitaleb Hospital, Za-
hedan University of Medical Sciences, Zahedan, Iran and
Department of Urology, Tehran University of Medical
Sciences, School of Medicine, Sina hospital, Tehran, Iran
for their help in preparing this manuscript.
6. References
[1] P. van Kerrebroeck, P. Abrams, D. Chaikin, et al., “Stan-
dardisation Sub-Committee of the International Continence
Society. The Standardisation of Terminology in Nocturia:
Report from the Standardisation Sub-Committee of the In-
ternational Continence Society,” Neurourology and Uro-
dynamics, Vol. 21, No. 2, 2002, pp. 179-183.
[2] F. Y. Chen, Y. T. Dai, C. K. Liu, et al., “Perception of
Nocturia and Medical Consulting Behavior among com-
munity-Dwelling Women,” International Urogynecology
Journal and Pelvic Floor Dysfunction, Vol. 18, No. 4,
2007, pp. 431-436. doi:10.1007/s00192-006-0167-x
[3] R. Lundgren, “Nocturia: A New Perspective on an Old
Symptom,” Scandinavian Journal of Urology and Ne-
phrology, Vol. 38, No. 2, 2004, pp. 112-116.
[4] Y. Homma, “Classification of Nocturia in the Adult and
Elderly Patient: A Review of Clinical Criteria and Selected
Literature,” BJU International, Vol. 96, Supplement 1,
2005, pp. 8-14. doi:10.1111/j.1464-410X.2005.05655.x
[5] R. B. Stewart, M. More, F. E. May, et al., “Nocturia a
Risk Factor for Falls in the Elderly,” Journal of the
American Geriatrics Society, Vol. 40, No. 12, 1992, pp.
[6] S. P. Marinkovic, L. M. Gillen and S. L. Stanton, “Man-
aging nocturia,” British Medical Journal, Vol. 328, No.
7447, 2004, pp. 1063-1066.
[7] R. Asplund and H. Aberg, “Diurnal Variation in the Lev-
els of Antidiuretic Hormone in the Elderly,” Journal of
Internal Medicine, 1991, Vol. 229, No. 2, pp. 131-134.
[8] R. Asplund, “The Nocturnal Polyuria Syndrome (NPS),”
General Pharmacology, Vol. 26, No. 6, 1995, pp. 1203-
1209. doi:10.1016/0306-3623(94)00310-J
[9] M. Miller, “Nocturnal Polyuria in Older People: Patho-
physiology and Clinical Implications,” Journal of the
American Geriatrics Society, Vol. 48, No. 10, 2000, pp.
[10] J. L. Kirkland, M. Lye, D. W. Levy and A. K. Banerjee,
Copyright © 2011 SciRes. OJU
Copyright © 2011 SciRes. OJU
“Patterns of Urine Flow and Electrolyte Excretion in
Healthy Elderly People,” British Medical Journal (Clinical
Research Ed.), Vol. 287, No. 6406, 1983, pp. 1665-1667.
[11] A. Mattiasson, P. Abrams, P. Van Kerrebroeck, et al.,
“Efficacy of Desmopressin in the Treatment of Nocturia:
A Double-Blind Placebo-Controlled Study in Men,” BJU
International, Vol. 89, No. 9, 2002, pp. 855-862.
[12] S. Hunskaar, “Epidemiology of Nocturia,” BJU Interna-
tional, Vol. 96, Supplement 1, 2005, pp. 4-7.
[13] H. Vilhardt, “Basic Pharmacology of Desmopressin: A
Review,” Drug Investigation, Vol. 2, Supplement 5, 1990,
pp. 2-8.
[14] R. Asplund and H. Aberg, “Desmopressin in Elderly Sub-
jects with Increased Nocturnal Diuresis. A Two-Month
Treatment Study,” Scandinavian Journal of Urology and
Nephrology, Vol. 27, No. 1, 1993, pp. 77-82.
[15] R. Asplund, B. Sundberg and P. Bengtsson, “Oral Des-
mopressin for Nocturnal Polyuria in Elderly Subjects: A
Double-Blind, Placebo-Controlled Randomized Explora-
tory Study,” BJU International, Vol. 83, No. 6, 1999, pp.
591-595. doi:10.1046/j.1464-410x.1999.00012.x
[16] R. Asplund and H. Aberg, “Health of the elderly with
regard to sleep and nocturnal micturition,” Scandinavian
Journal of Primary Health Care, Vol. 10, No. 2, 1992, pp.
98-104. doi:10.3109/02813439209014044
[17] S. B. Dimson, “Desmopressin as a Treatment for Enure-
sis,” The Lancet, Vol. 1, No. 8024, 1977, p. 1260.
[18] G. Lose, O. Lalos, R. M. Freeman and P. van Kerre-
broeck, “Nocturia Study Group. Efficacy of Desmopres-
sin (Minirin) in the Treatment of Nocturia: A Double-
Blind Placebo-Controlled Study in Women,” American
Journal of Obstetrics & Gynecology, Vol. 189, No. 4, 2003,
pp. 1106-1113. doi:10.1067/S0002-9378(03)00593-3
[19] S. Salvatore, M. Soligo, F. Proietti, S. Citterio, W. Arti-
bani and R. Milani, “Overactive Bladder Syndrome: Con-
siderations in Pharmacotherapy and New Perspectives,”
European Journal of Obstetrics & Gynecology and Re-
productive Biology, Vol. 120, No. 2, 2005, pp. 129-133.