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Experience Of Medical Treatment With Desmopressin And Imipramine In Children With Severe Primary Nocturnal Enuresis
Thomson T Tai1,2, Brent T Tai2,3, Yu-Jun Chang2
1Loyola University Chicago, Stritch School of Medicine, Maywood, IL, USA.
Insights
This study found desmopressin and imipramine have similar efficacy for treating severe primary nocturnal enuresis (NE). Imipramine showed fewer side effects than previously thought, making it a cost-effective option for NE management.
Area of Science:
- Pediatric Nephrology
- Pharmacology
- Clinical Medicine
Background:
- Severe primary nocturnal enuresis (NE) is a common condition in children.
- Current treatment guidelines often favor desmopressin over imipramine due to safety concerns.
- Imipramine, a tricyclic antidepressant, has been used off-label for NE treatment.
Purpose of the Study:
- To compare the efficacy and safety of desmopressin versus imipramine in treating severe primary nocturnal enuresis (NE) in a Taiwanese pediatric population.
- To evaluate response rates, relapse rates, and adverse events associated with both medications.
- To assess the influence of patient demographics and NE severity on treatment outcomes.
Main Methods:
- Retrospective chart review of children diagnosed with primary nocturnal enuresis (monosymptomatic or non-monosymptomatic).
- Patients were treated with either desmopressin (n=125) or imipramine (n=71) for at least 3 months.
- Outcomes measured included response rates, relapse rates during a 3-month follow-up, and reported side effects.
Main Results:
- Response rates were similar: 77.6% for desmopressin and 81.7% for imipramine.
- Relapse rates were 48.8% for desmopressin and 36.6% for imipramine; differences were not statistically significant.
- Significantly fewer side effects were reported with desmopressin (0%) compared to imipramine (5.6%), although concerns about imipramine toxicity may be overstated.
Conclusions:
- Desmopressin and imipramine demonstrate comparable efficacy in treating severe primary nocturnal enuresis.
- Imipramine is a viable and potentially more cost-effective treatment option for NE, especially in resource-limited settings.
- Further consideration of imipramine is warranted, with attention to potential side effects, as its toxicity concerns may be exaggerated.
Purpose:
The aim of this study was to compare the efficacy and safety of desmopressin and imipramine in the treatment of severe primary nocturnal enuresis (NE) in Taiwan.
Patients And Methods:
This study was a retrospective chart review study conducted on children with primary monosymptomatic nocturnal enuresis (PMNE) or non-monosymptomatic nocturnal enuresis (PNMNE), referred to and treated by senior physicians in a Changhua medical center in Taiwan. After being screened, these children were treated with either desmopressin (n = 125) or imipramine (n = 71). All participants were treated for at least 3 months and followed afterward for at least 3 more months. The response and relapse rates were measured. Side effects were monitored. Age, gender, and severity of NE were recorded.
Results:
After 3 months of treatment, 97 children treated with desmopressin were responsive (77.6%) while 58 children treated with imipramine were responsive (81.7%). Sixty-one children treated with desmopressin (48.8%) and 26 treated with imipramine (36.6%) relapsed during the 3-month post-treatment monitoring. The differences in responsive and relapse rates were not statistically significant. Four children treated with imipramine (5.6%) reported side effects while none was reported for children treated with desmopressin (P < 0.05). Age, gender, and the presence or absence of daytime enuresis did not influence the response rate to either drug (P < 0.05).
Conclusion:
Currently, desmopressin is preferred over imipramine for treating NE due to the latter's side effects. Our results demonstrated similar response rates for both drugs, with imipramine demonstrating minimal side effects. While health practitioners should pay attention to its side effects, concerns regarding imipramine toxicity in NE treatment are often overblown. Since imipramine is much cheaper than desmopressin, using imipramine to manage NE can allow health practitioners, especially in Taiwan, to treat the greatest number of children with NE.
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