EURURO Vol. 72 No. 5

760 860

reduced nocturnal diuresis of 0.59 ml/min and fewer
micturitions at night than for placebo (1.1 vs 1.7,
p < 0.001; mean difference 0.59) . Twenty-four-hour
diuresis was unaffected. Another RCT looked at 60 men
receiving 0.1-mg desmopressin or placebo for 8 wk (LoE 2b)
Mean number of nocturia episodes reduced from 2.6 to
1.6 (vs placebo 2.5 to 2.3).
Antidiuretic therapy adverse effects are summarized in
The key adverse event of hyponatremia (<
125 mmols/l), while rare, means that baseline sodium level
(< 130 mmols/l) was a selection criterion in research
studies, and accordingly review of sodium levels is essential
during treatment. An RCT of 115 men older than 65 yr with
nocturia and nocturnal polyuria compared placebo with
nontitrated 0.1 mg desmopressin (LoE 1b) , showing
decreased nocturnal urine output and number of nocturia
episodes (p < 0.01). The authors stated that long-term
desmopressin might induce hyponatremia gradually, but
specific data provided was limited.
Options for formulation and reduced dose level have
been further investigated. A 4-wk placebo-controlled
exploratory study described outcomes with low doses
(10–100 m g) of desmopressin in 757 people (55% men; LoE
Table 3 – Adverse effects (AEs) during desmopressin treatment, in
studies where dose titration was undertaken
Study Fu
et al
Mattiasson
et al
Van Kerrebroek
et al
Patients exposed ( n) 122 224 184
Total AE, n (%) 62 (50) 107 (48) 93 (51)
Serious AE 3 (3) 1 (<1) 3 (2)
Deaths 0 1 (<1 NR
AE related to
study medication
37 (39) 60 (27) 52 (28)
Headache 10 (8) 26 (12) 17 (9)
Nausea 5 (4) 10 (4) NR
Hyponatremia 3 (3) 8 (4) 6 (3)
Abdominal pain NR NR 8 (4)
Dry mouth NR NR 5 (3)
Micturition frequency 0 NR NR
Dizziness 6 (5) NR 1 (1)
Fatigue NR NR NR
Peripheral edema NR NR NR
Hypertension 4 (3) NR 3 (2)
Diarrhea NR 9 (4) NR
Insomnia NR NR 3 (2)
Diplopia NR NR 1 (<1)
Depression NR NR 1 (<1)
NR = not reported.
a Unlikely to be study related (exacerbation of chronic lung disease).
Table 1 – Effect of desmopressin (with dose titrated against response) on nocturnal voiding frequency
Desmopressin Placebo Mean difference
Study or subgroup Mean SD Total Mean SD Total Weight (%) IV, fixed, 95% CI
Asplung 1999 –0.8 0.99 17 –0.2 1.1 17 15.4 –0.60 (-1.30, 0.1)]
Fu 2011 –1.5 1.28 39 –0.3 1.41 41 21.9 –1.20 (-1.79, –0.61)
Mattiasson 2002 –1.3 1.25 81 –0.5 1.75 62 28.8 –0.80 (-1.31, –0.29)
Rezakhanina 201 –1 0 30 –0.2 0 30 Not estimable
Van Kerrebroeck2007 –1.25 1.35 59 –0.4 1.29 61 34.4 –0.85 (1.32, –0.38)
Wang 201 –1.5 0 57 –0.8 0 58 Not estimable
Total (95% CI) 283 269 100 –0.87 (–1.15, –0.60)
Heterogeneity: x2 = 1.85, df = 3 (p = 0.60); I2 = 0%
Test for overall effect: Z = 6.21 (p < 0.00001)
CI = confidence interval; df = difference; SD = standard deviation.
a No standard deviation values.
b No standard deviation values.
Table 2 – Effect of desmopressin (with dose titrated against response) on hours of undisturbed sleep
Desmopressin Placebo Mean difference
Study or subgroup Mean SD Total Mean SD Total Weight (%) IV, fixed, 95% CI
Asplung 199 102 0 17 18 0 17 Not estimable
Fu 2011 69.6 52.798 39 23.7 50.434 41 50.9 45.90 (23.25, 68.55)
Mattiasson 2002 110.4 102.71 81 24 84.483 62 27.7 86.40 (55.70, 117.10)
Rezakhanina 201 120 0 30 30 0 30 Not estimable
Van Kerrebroeck2007 108 106.523659 40 87.055 61 21.5 68.00 (33.13, 102.87)
Wang 201 23 0 57 3 0 58 Not estimable
Total (95% CI) 283 269 100 61.85 (45.70, 78.00)
Heterogeneity: x2 = 4.48, df = 2 (p = 0.11); I2 = 55%
Test for overall effect: Z = 7.51 (p < 0.00001)
CI = confidence interval; df = difference; SD = standard deviation.
a No standard deviation values.
b No standard deviation values.
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