Hyponatremia in desmopressin treated patients What is evidence by mikeholy

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									Hyponatremia in desmopressin
treated patients - What is evidence
based?
Norgaard JP
Journal für Urologie und                                                                                         Homepage:
Urogynäkologie 2004; 11 (Sonderheft
5) (Ausgabe für Österreich), 7
                                                                                       www.kup.at/urologie
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Indexed in EMBASE/Excerpta Medica/Scopus                                                                                            www.kup.at/urologie



P. b . b .   G Z 0 2 Z 0 3 1 1 1 6 M ,   V e r l a g s p o s t a m t :   3 0 0 2   P u r k e r s d o r f ,   E r s c h e i n u n g s o r t :   3 0 0 3   G a b l i t z
J. P Nørgaard
   .                                                                                                                          HYPONATREMIA
                                                                                                                              IN
HYPONATREMIA IN DESMOPRESSIN                                                                                                  DESMOPRESSIN
                                                                                                                              TREATED
TREATED PATIENTS – WHAT IS EVIDENCE                                                                                           PATIENTS – WHAT
                                                                                                                              IS EVIDENCE
BASED?                                                                                                                        BASED?

Approximately 1.3 million patients are        recovered [1]. In a recent survey of the      However, we know from our data that
annually treated with Minirin®; of these      safety and efficacy of long-term treatment    the incidence of clinical relevant hypo-
900,000 children with PNE are treated         (> 6 months) comprising 1.083 patients,       natremia is 5 %. These 5 % are mainly
with tablets and approx. 400,000 with         seven patients (1 %) developed hypo-          derived from the population above 65. It
spray. It is estimated that more than 10      natremia with no clinical symptoms [2].       is consequently not recommended to
million patients have been treated                                                          treat this age group with desmopressin
worldwide. Desmopressin is registered         Due to the inherent limitations of the        without se-sodium monitoring.
for treating Central Diabetes Insipidus       post-marketing reporting system, a
(CDI), Primary Nocturnal Enuresis (PNE)       precise quantification of the risk is         The supposed mechanisms for hyponatre-
and recently also nocturia. A survey of       difficult. However, it is estimated that      mia will be discussed at the meeting –
the two latter conditions and reports of      more than 10 million patients have been       and practical recommendations for
hyponatremia is discussed.                    exposed to Minirin®. Based on this            desmopressin use will be discussed to
                                              estimation, the reporting frequency for       avoid this infrequently reported
                                              hyponatremia can be approximated to           condition.
                                              less than 1 per 20,000 patients exposed;
PRIMARY NOCTURNAL ENURESIS – PNE              thus it is considered a very rare event.
                                                                                            References:
                                                                                            1. Robson WLM, Nørgaard JP, Leung AKC. Hypo-
                                                                                            natraemia in patients with nocturnal enuresis treated
Hyponatremia is very rarely reported in                                                     with DDAVP. Eur J Pediatr 1996; 155: 959–62.
clinical studies of treatment with desmo-     NOCTURIA                                      2. Van Kerrebroeck P. Experience with the long-term
pressin for primary nocturnal enuresis. A                                                   use of desmopressin for nocturnal enuresis in
literature review covering the period                                                       children and adolescents. BJU Int 2002; 89: 420–5.
from 1966 to 1994, identified 14 studies      Increasing awareness of the troublesome
comprising 529 patients with nocturnal        condition nocturia in the adult and
enuresis treated with desmopressin. A         elderly population has initiated intensive
total of 11 case reports of hyponatremia      research into both the pathogenesis of        Corresponding adress:
in patients aged 5 to 15 years were           the condition and into treatment. Knowing     Jens Peter Nørgaard, MD DMSc
reported. Excessive water intake was          that approx. 80 % of patients complai-        Executive Director
identified as a contributing factor in 6 of   ning of nocturia show to have a polyuric      Ferring International Centre
the 11 cases. All of the patients who         background antidiuretic treatment has         Copenhagen, Denmark
developed neurological symptoms               proven efficient in this population.          E-mail: jenspeter.norgaard@ferring.com




                                                                                           J. UROL. UROGYNÄKOL. Sonderheft 5/2004                   7
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