Desmopressin Nasal Spray for Treatment of Nocturia: Proceed with Caution
SOURCE: Fralick M, Kesselheim AS. JAMA 2017;317:2059-2060.
Nocturia is a symptom than can reflect a variety of underlying pathologies, including heart failure, diabetes, and benign prostatic hyperplasia. Although it might be tempting to go directly to pharmacologic treatment, with the recent approval of an agent designed to treat such symptoms, caution is in order. The indication for the recently approved desmopressin nasal spray (Noctiva) is specified for “treatment of nocturia due to nocturnal polyuria in adults who awaken at least two times per night to void.” Fralick and Kesselheim reinforced the FDA labeling, indicating that the use of desmopressin should be preceded by elimination of underlying serious pathology (e.g., bladder cancer, pituitary pathology) as well as confirmation of polyuria with a 24-hour urine collection.
Adverse effects of desmopressin include hyponatremia, which can be severe. Although clinical trial data demonstrated severe hyponatremia (≤ 125 mmol/L), only rare (0.7% of desmopressin recipients vs. 0.3% of placebo subjects), moderate hyponatremia (126-129 mmol/L) is substantially more common (2.2% of desmopressin subjects vs. no placebo subjects). Finally, the mean change in nocturia episodes decreased from about 3.3 episodes per night to about 1.9/night with desmopressin treatment, which many of us might consider only a modest symptomatic improvement.
Because desmopressin can result in serious adverse events, it is important that clinicians become fully familiar with FDA labeling of the new product and be confident that no underlying serious pathology is present before prescribing.
Because desmopressin can result in serious adverse events, it is important that clinicians become fully familiar with FDA labeling.
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