Oral desmopressin for nocturnal polyuria in elderly subjects: a double-blind, placebo-controlled randomized exploratory study

Objective To evaluate the decrease in nocturnal diuresis, nocturnal polyuri a and the safety of oral desmopressin in elderly subjects with nocturia. Subjects and methods After being identified using a population-based questi onnaire, subjects were included in the study if they; (i) were healthy and free from medication with possible influence on the diuresis or voiding pat tern; (ii) had an increased nocturnal frequency (greater than or equal to 2 nocturnal voids/night, as reported before screening); (iii) had a nocturna l urinary output of greater than or equal to 0.9 mL/min; (iv) completed and responded to an initial dose-titration study. Twelve men and five women (m ean age 67.7 years, so 4.6 years) met these criteria and were treated with oral desmopressin or placebo at bedtime for 2 weeks on each medication in a randomized, double-blind, crossover design. Results Subjects treated with desmopressin had a significantly reduced noct urnal diuresis of 0.59 mL/min compared with those on placebo (95% confidenc e interval, CI, 0.33-0.85). The 24-h diuresis was unaffected by desmopressi n treatment. Patients treated with desmopressin had fewer micturitions at n ight than had those on placebo (1.1 and 1.7, respectively; P < 0.001; mean difference = 0.59; 95% CI, 0.32-0.85). The reduction in nocturnal diuresis was dependent on the baseline level of night-time diuresis (r = 0.886; r(2) = 0.785; P < 0.0001) and the nocturnal part of the baseline 24 h-diuresis (r = 0.708; r(2) = 0.502; P < 0.001). After desmopressin treatment was with drawn, diuresis returned to the levels before treatment. The time from fall ing asleep to first awakening was improved by 1.4 h in patients treated wit h desmopressin, There was no change in body weight or ankle circumference d uring desmopressin treatment. Overall, the treatment was well tolerated and no serious adverse events were observed. Conclusion Desmopressin was effective in reducing nocturnal diuresis and no cturnal voids in polyuric elderly subjects, with no significant adverse eve nts or inconvenience to the patient. The length of uninterrupted sleep was also improved.