Previous changes

March 2023 — minor update. Added information about the option to prescribe Demovo® for the treatment of primary enuresis in children over the age of 5. 

March 2020 — reviewed. A literature search was conducted in February 2020 to identify evidence-based guidelines, UK policy, systematic reviews, and key randomized controlled trials published since the last revision of the topic. No major changes to clinical recommendations have been made, but the topic has been restructured.

January 2017 — minor update. To reflect name change of ERIC, The Children's Bowel & Bladder Charity.

September to October 2014 — reviewed. A literature search was conducted in September 2014 to identify evidence-based guidelines, UK policy, systematic reviews, and key randomized controlled trials published since the last revision of this topic. No major changes to the recommendations have been made. A prescribing information section on desmopressin has been added to this topic.

June 2011 — minor update. Removed the black triangle status from desmopressin prescriptions because desmopressin is no longer a black triangle drug. 

October to December 2010 — topic updated. The evidence base has been reviewed in detail, and recommendations are more clearly justified and transparently linked to the supporting evidence.

January 2010 — minor correction to contact details for ERIC. 

January to August 2009 — converted from CKS guidance to CKS topic structure. The evidence base has been reviewed in detail, and recommendations are more clearly justified and transparently linked to the supporting evidence.

July 2007 — updated to remove text and prescriptions for nasal desmopressin. The Medicines and Healthcare Products Regulatory Agency (MHRA) have removed the enuresis indication for desmopressin nasal preparations because of safety concerns.

November 2005 — minor technical update. 

March 2005 — reviewed. Validated in June 2005 and issued in July 2005.

September 2001 — reviewed. Validated in November 2001 and issued in April 2002.

February 1999 — written. Validated April 1999 and issued in May 1999.

New evidence

Evidence-based guidelines

No new evidence-based guidelines since 1 November 2024.

HTAs (Health Technology Assessments)

No new HTAs since 1 November 2024.

Economic appraisals

No new economic appraisals relevant to England since 1 November 2024.

Systematic reviews and meta-analyses

No new systematic reviews and meta-analyses since 1 November 2024.

Primary evidence

No new primary evidence which reaches the CKS threshold for inclusion published since 1 November 2024.

New policies

No new national policies or guidelines since 1 November 2024.

New safety alerts

No new safety alerts since 1 November 2024.

Changes in product availability

No changes in product availability since 1 November 2024.

How should I assess a child or young person with primary bedwetting without daytime symptoms?

• If a child or young person presents with primary bedwetting without daytime symptoms, assess:
  • The pattern of bedwetting, including:
    • How many nights a week, and how many times a night, bedwetting occurs — frequent bedwetting is less likely to resolve spontaneously than infrequent bedwetting.
    • The quantity of urine passed.
    • The times of night that bedwetting occurs.
    • Whether the child or young person wakes up after bedwetting.
  • The child or young person's sleep quality:
    • Determine if the parents/carers have noticed features suggestive of obstructive sleep apnoea, such as snoring and breathing pauses while sleeping. For more details, please see the CKS topic on Obstructive sleep apnoea syndrome.
  • The child or young person's fluid intake throughout the day.
    • Ask whether the parents/carers are restricting fluid intake owing to bedwetting. Inadequate fluid intake may mask an underlying bladder problem, such as overactive bladder disorder, and may impede the development of an adequate bladder capacity.
    • Nocturnal polyuria can result from a child obtaining most of their daily fluid intake after school instead of gradually throughout the day.
    • Consider asking the parents/carers to keep a 2-week diary of the child or young person's fluid intake, bedwetting, and toileting patterns. This may also involve weighing nappies or pull-ups to understand how much urine the child is passing at night, compared with during the day.
  • The home situation, including:
    • If there is easy access to the toilet at night.
    • Whether the child or young person shares a bedroom — this may affect the decision to use an enuresis alarm.
  • The reason for the consultation. For example:
    • Reassurance — bedwetting is considered to be normal in children younger than 5 years of age.
    • Short-term treatment (for a sleepover or school trip) or long-term treatment.
  • Whether the child or young person and the parents/carers are willing or able to take part in behavioural interventions, such as using an enuresis alarm.
  • How the parents/carers are coping with the practical impact of bedwetting, to determine if they need support.
• If the child is younger than 5 years of age, consider assessing for constipation.
  • Undiagnosed chronic constipation is a common cause of wetting and soiling in younger children.

How should I assess a child or young person with bedwetting who has daytime symptoms?

• If a child or young person is bedwetting and has daytime symptoms, assess:
  • The pattern of bedwetting, including:
    • If daytime symptoms occur only in some situations.
    • If the child or young person avoids using the toilet at school or other settings.
    • If the child or young person goes to the toilet more or less frequently than his or her peers.
  • The child or young person's fluid intake throughout the day.
    • Ask whether the parents/carers are restricting fluid intake owing to bedwetting. Inadequate fluid intake may mask an underlying bladder problem, such as overactive bladder disorder, and may impede the development of an adequate bladder capacity.
    • Consider asking the parents/carers to keep a 2-week diary of the child or young person's fluid intake, bedwetting, and toileting patterns. This may also involve weighing nappies or pull-ups to understand how much urine the child is passing at night, compared with during the day.
  • For an underlying cause, such as:
    • Chronic constipation — undiagnosed chronic constipation is a common cause of wetting and soiling in younger children. See the CKS topic on Constipation in children for more information.
    • Urinary tract infection. See the CKS topic on Urinary tract infection - children for more information.
    • Congenital malformations — examine the child's back to look for signs of congenital spinal malformations, such as dimples or a hairy patch.
  • Whether the child or young person and the parents/carers are willing or able to take part in behavioural interventions, such as using an enuresis alarm.
  • How the parents/carers are coping with the practical impact of bedwetting, to determine if they need support.

How should I assess a child with secondary bedwetting?

• Assess for an underlying cause that may have triggered bedwetting, such as:
  
  • Constipation (and/or soiling). See the CKS topic on Constipation in children for more information.
  • Diabetes. See the CKS topics on Diabetes - type 1 and Diabetes - type 2 for more information.
  • Urinary tract infection (UTI). See the CKS topic on Urinary tract infection - children for more information.
  • Behavioural problems and emotional problems — these may be a cause or a consequence of bedwetting.
  • Family problems — a difficult or stressful environment may be a trigger for bedwetting.
  • Child maltreatment. See the CKS topic on Child maltreatment - recognition and management and the NSPCC guidance on Continence Issues for more information.
    • Be aware that female genital mutilation can be associated with urinary continence issues.
• Determine the pattern of bedwetting, including:
  • When bedwetting started — bedwetting that has started in the last few days or weeks may be a presentation of a systemic illness (for example UTI), or a change in the child's environment (for example bullying or abuse).
  • How many nights a week, and how many times a night, bedwetting occurs — frequent bedwetting is less likely to resolve spontaneously than infrequent bedwetting.
  • How many times a night bedwetting occurs.
  • The quantity of urine passed.
  • The times of night that bedwetting occurs.
  • Whether the child or young person wakes up after bedwetting.
• Consider asking the parents/carers to keep a 2-week diary of the child or young person's fluid intake, bedwetting, and toileting patterns. ​​​​​

Basis for recommendation

These recommendations are largely based on the National Institute for Health and Care Excellence (NICE) guideline Bedwetting in under 19s [NICE, 2010].

Assessment

• Expert opinion is that a careful clinical history is fundamental to the evaluation of enuresis [Nevéus, 2020; EAU, 2024].
• Recommendations on how to assess a child with bedwetting are largely based on the expert opinion of the NICE guideline development group (GDG) [NICE, 2010].
  • The GDG identified 34 studies that looked at different methods for assessing bedwetting. Most of these studies were small cohort studies or case series in children in secondary or tertiary referral centres. The GDG considered the evidence identified to be of poor quality and were unable to use it to guide decision-making.

Sleep apnoea

• There is strong evidence of a link between obstructive sleep apnoea and enuresis. Expert opinion in review articles by the International Children's Continence Society and the Canadian Paediatric Society state that treatment of obstructive sleep apnoea can resolve enuresis  [Nevéus, 2020; Harris, 2023].

Assessing for underlying causes of bedwetting with daytime symptoms, and secondary bedwetting

• Primary bedwetting with daytime symptoms is usually caused by disorders of the lower urinary tract, such as an overactive bladder, but may also be caused by congenital malformations or neurological disorders [Lauters, 2022]. It is occasionally caused by chronic constipation or urinary tract infection.
  • The recommendation to examine the child's back for signs of congenital spinal malformations, such as dimples or hairy patch, is based on expert opinion in a review article [Lauters, 2022].
• Secondary bedwetting may have an underlying cause, such as diabetes, urinary tract infection, constipation, psychological problems (for example behavioural or emotional problems), or family problems (vulnerable child or family). NICE states that although most children with bedwetting will not have an underlying systemic illness, it is important that these are considered, especially if bedwetting has started recently [NICE, 2010].

Keeping a diary

• NICE recommends considering keeping a diary of symptoms because in order to make a good assessment, healthcare professionals need to understand the symptoms experienced by the child, and the child's drinking and toileting behaviour [NICE, 2010]. It is thought that:
  • Parents or carers are often not aware of their child or young person’s drinking and toileting behaviour when the child or young person spends a lot of their time outside the home. A diary may help the child and family recognize the problem and monitor progress.
  • When the child is managed in pull ups or nappies, it can sometimes be useful to weigh these to inform an understanding of how much urine the child is passing at night, compared with how much they pass when urinating during the day.
• The recommendation to keep a diary for 2 weeks is based on expert consensus opinion from the NICE GDG [NICE, 2010].

When to consider child maltreatment

• This recommendation is based on the NICE guidelines Bedwetting in under 19s [NICE, 2010] and Child maltreatment: when to suspect maltreatment in under 18s [NICE, 2017].
  • The NSPCC has issued guidance on Continence Issues for professionals working with children and young people, including information on recognising and responding to suspected safeguarding concerns including abuse. This guidance also states that female genital mutilation can lead to incontinence and difficulties with urination [NSPCC, 2024].

Urinalysis

• These recommendations are based on the expert opinion of the NICE GDG [NICE, 2010].
  • The NICE GDG found no evidence to support the routine use of urinalysis in children with bedwetting.
  • Urinalysis was, however, recommended for bedwetting with daytime symptoms, and if symptoms only started in the past few days or weeks, in order to determine if UTI is a likely underlying cause.

Including the child or young person in the assessment

• This recommendation is based on the expert opinion of the NICE GDG [NICE, 2010].
  • The GDG states that it is important to consider the views of the child or young person (as well as the family) in order to understand the expectations of the child or young person and their family/carers.

How should I manage bedwetting without daytime symptoms in children younger than 5 years of age?

• Explain that bedwetting is not the child's fault. 
  • It occurs because the volume of urine produced at night exceeds the capacity of the bladder to hold it, and the sensation of a full bladder does not wake the child.
• Reassure the parents or carers that many children younger than 5 years of age wet the bed, and this usually resolves without treatment. 
  • Bedwetting usually resolves as children get older because they develop an increased bladder capacity, and/or produce less urine at night, and/or learn to wake to the sensation of a full bladder.
• If the child has features suggestive of sleep apnoea, manage as appropriate. For further information, see the CKS topic on Obstructive sleep apnoea syndrome.
• Give advice on:
  • Diet and fluid intake. Advise that the child should:
    • Eat a healthy diet; they should not restrict their diet as a form of treatment for bedwetting.
    • Have adequate daily fluid intake.
    • Avoid drinking caffeine-based drinks (such as colas, coffee, and tea) before sleep.
    • Avoid drinking large volumes of fluid before bedtime.
  • Toileting patterns. Advise that:
    • The child should be encouraged to empty their bladder regularly during the day and before sleep (between 4–7 times in total).
    • A waterproof mattress and duvet cover, absorbent quilted sheets, and bed pads can be used.
    • There should be easy access to a toilet and/or potty at night.
    • If the child has been toilet trained by day for longer than 6 months, they should consider a trial of at least 2 nights in a row without nappies or pull-ups (appropriate waterproof mattress protection will be required).
  • Lifting and waking. Advise that:
    • Lifting or waking the child during the night (at regular times or randomly) does not promote long-term dryness. However, if the child wakes at night, they should be taken to the toilet.
    • Waking of children should be used only as a practical measure in the short-term management of bedwetting.
  • Positive reward systems. Advise that:
    • Positive reward systems may be offered to children who have some dry nights. They should be adapted to the age of the child.
    • Rewards may also be given for drinking recommended levels of fluid during the day and for using the toilet before going to bed.
    • Reward systems that penalise the child or remove previously gained rewards are not recommended.
    • The child should not be punished for bedwetting as this has the potential to humiliate the child and reduce their self esteem. 
• Provide additional sources of information and support.

How should I manage bedwetting without daytime symptoms in children aged 5 years and older?

• Explain that bedwetting is not the child or young person's fault. 
  • It occurs because the volume of urine produced at night exceeds the capacity of the bladder to hold it, and the sensation of a full bladder does not wake the child or young person.
• Reassure the parents or carers that bedwetting resolves as children get older because they develop an increased bladder capacity, and/or produce less urine at night, and/or learn to wake to the sensation of a full bladder.
• Give advice on:
  • Diet and fluid intake. Advise that the child or young person should:
    • Eat a healthy diet; they should not restrict their diet as a form of treatment for bedwetting.
    • Have adequate daily fluid intake. Recommended adequate daily fluid intake from drinks are:
      • At 5–8 years of age — 1000–1400 mL (girls); 1000–1400 mL (boys).
      • At 9–13 years of age — 1200–2100 mL (girls); 1400–2300 mL (boys).
      • At 14–18 years of age — 1400–2500 mL (girls); 2100–3200 mL (boys).
    • Avoid drinking caffeine-based drinks (such as colas, coffee, and tea) before sleep.
    • Avoid drinking large volumes of fluid before bedtime — some experts recommend that 80% of the child or young person's fluid intake should occur before 4 pm.
  • Toileting patterns. Advise that:
    • The child or young person should be encouraged to empty their bladder regularly during the day and before sleep (between 4–7 times in total).
    • A waterproof mattress and duvet cover, absorbent quilted sheets, and bed pads can be used.
    • There should be easy access to a toilet at night.
    • If the child or young person has been toilet trained by day for longer than 6 months, they should consider a trial of at least 2 nights in a row without nappies or pull-ups (appropriate waterproof mattress protection will be required). A longer trial can be considered in older children, children who achieve a reduction in wetness, and those whose family circumstances allow the trial to continue.
  • Lifting and waking. Advise that:
    • Lifting or waking the child or young person during the night (at regular times or randomly) does not promote long-term dryness. However, if they wake at night, they should be taken to the toilet.
    • Waking of children and young people should be used only as a practical measure in the short-term management of bedwetting.
    • Young people with bedwetting who have not responded to treatment may find self-instigated waking (for example using a mobile phone alarm or alarm clock) a useful management strategy.
  • Positive reward systems. Advise that:
    • Positive reward systems may be offered to children who have some dry nights. They should be adapted to the age of the child or young person. 
    • Rewards may be given for drinking recommended levels of fluid during the day, using the toilet before going to bed, engaging in management (for example taking medication or helping to change sheets).
    • Reward systems that penalise the child or young person, or remove previously gained rewards are not recommended.
    • The child or young person should not be punished as this has the potential to humiliate them and reduce their self esteem. 
• If the child or young person has features suggestive of sleep apnoea, manage as appropriate. For further information, see the CKS topic on Obstructive sleep apnoea syndrome.
• Offer treatment to children and young people whose bedwetting has not responded to advice on fluids, toileting, or an appropriate reward system.
  • If rapid or short-term control of bedwetting is required (for example for sleepovers or school trips), offer treatment with desmopressin.
  • If long-term treatment is required, offer treatment with an enuresis alarm (first-line treatment). 
    • A positive, age-appropriate reward system should be used with enuresis alarms to reward desired behaviour.
    • Desmopressin is less preferred but may be considered if an alarm is considered undesirable or innapropriate.
  • If bedwetting is infrequent (less than twice a week), reassure the parents or carers that bedwetting may resolve without treatment and offer the option of a wait-and-see approach.
• Provide additional sources of information and support.
• If bedwetting has not responded to at least two complete courses of treatment with either an alarm or desmopressin (this may be one course of each treatment, or two of the same), refer the child or young person to secondary care, an enuresis clinic, or a community paediatrician, depending on local protocols and availability.
  • Further assessment is required for factors that may be associated with a poor response, such as an overactive bladder, an underlying disease, or social and emotional factors.
  • Tricyclic antidepressants (such as imipramine) or antimuscarinics (such as oxybutynin) may be initiated in secondary or primary care following an assessment by a healthcare professional with expertise in managing bedwetting.

Enuresis alarms

• Enuresis alarms are generally considered a first-line treatment for bedwetting unless:
  • The child or young person or their parents/carers do not want to use one.
  • The child or young person wets the bed (infrequently) less than once or twice a week.
  • Parents/carers have emotional difficulty coping with the burden of bedwetting.
  • Parents/carers express anger, negativity, or blame towards the child.
  • The child or young person is younger than 7 years of age and is not able to use an alarm.
    • The decision to use an alarm in a child younger than 7 years of age is based on the child's maturity, understanding of the alarm, and motivation.
• Provide detailed information on enuresis alarms to the child or young person and their parents/carers.
  • This should include information on the aims of alarm treatment, how the enuresis alarm works, and how to obtain an enuresis alarm (enuresis alarms cannot be prescribed on the NHS).
  • Advise that enuresis alarms have a high long-term success rate, but they may not suit all families. Using an alarm involves a significant commitment from the child or young person and the parents/carers. 
  • Advise that a positive, age-appropriate reward system should be used with enuresis alarms to reward desired behaviour.
  • See the section on Information on enuresis alarms for further information.
• Assess response after 4 weeks:
  • If there are no signs of a response (such as smaller wet patches, fewer wetting episodes per night, or fewer wet nights), stop the treatment.
  • If there are signs of a response, continue alarm treatment until a minimum of 2 weeks uninterrupted dry nights has been achieved.
  • If complete dryness is not achieved after 3 months, assess whether it is appropriate to continue with alarm treatment. Only continue with alarm treatment if the bedwetting is still improving and the child or young person and parents/carers are motivated to continue.
• If bedwetting does not respond to initial alarm treatment, consider offering:
  • Combination treatment with an alarm and desmopressin, or
  • Desmopressin alone if the child or young person and/or the parents/carers do not want to continue using an enuresis alarm.
• If there is a partial response to combination treatment of an alarm and desmopressin, consider offering desmopressin alone.

Desmopressin

• Consider prescribing desmopressin if:
  • A rapid onset in improvement or a short-term improvement is required (for example for sleepovers or school trips).
    • Consider starting a trial of desmopressin at least 1 week before the school trip or sleepover to determine the effectiveness of treatment.
  • The child or young person and their parents/carers are currently using an enuresis alarm and want to stop.
  • The child or young person and their parents/carers are unable or unwilling to use an enuresis alarm as a first-line treatment.
    • This includes children 5–7 years of age, who may not be considered mature enough to use an enuresis alarm.
• Give advice on how desmopressin works, and explain that there is usually a rapid response to treatment.
• Prescribe a low dose of oral desmopressin (Desmotabs^® 200 micrograms, sublingual DesmoMelt^® 120 micrograms, or Demovo^®180 micrograms) initially, at bedtime.
  • If there is a response to desmopressin, continue the treatment.
  • If complete dryness has not been achieved after 1–2 weeks of treatment with low-dose desmopressin, consider advising the parents to increase the dose of desmopressin (to Desmotabs^® 400 micrograms, DesmoMelt^® 240 micrograms or Demovo^®360 micrograms).
• Assess the response 4 weeks after starting treatment.
  • If there are signs of a response (smaller wet patches, fewer wetting episodes per night, or fewer wet nights), continue treatment for 3 months.
    • Stop desmopressin after 3 months for 1 week to check whether dryness has been achieved (repeated courses may be used).
  • If there is a partial response to desmopressin, consider:
    • Advising the parents/carers to increase the dose of desmopressin (to Desmotabs^® 400 micrograms, DesmoMelt^® 240 micrograms, or Demovo^®360 micrograms).
    • Advising the child to take desmopressin 1–2 hours before bedtime.
    • Continuing treatment for another 6 months — bedwetting may improve for up to 6 months after starting treatment (note: Demovo^® is recommended for treatment periods of three months). 
  • If there are no signs of a response, consider:
    • Stopping treatment with desmopressin, or
    • Continuing desmopressin treatment and recommending that it is taken 1–2 hours before bedtime (ensure the child can comply with a fluid restriction for 1 hour before desmopressin is taken).
• Review the child or young person regularly if desmopressin is being used long term.
  • Do not routinely measure weight, serum electrolytes, blood pressure, and urine osmolality.
• Seek specialist advice if desmopressin is being considered for children or young people with:
  • Sickle cell disease — the concentrating ability of the kidneys may be lost in children with sickle cell disease, resulting in high urine output.
  • Cystic fibrosis — case reports recommend caution because of altered handling of electrolytes.
  • Behavioural, attentional, and emotional disorders — the child may not be able to comply with fluid restrictions.

How should I manage children and young people who have been successfully treated and start to wet the bed again?

• For children and young people who have been treated successfully with an enuresis alarm and start wetting the bed again:
  • Restart alarm treatment, or
  • If there is more than one recurrence of bedwetting, offer combination treatment with an alarm and desmopressin.
• For children and young people who have responded well to desmopressin but experience recurrence when treatment is withdrawn, consider:
  • Prescribing another course of desmopressin (repeated courses may be used).
    • Withdraw desmopressin treatment at regular intervals (for 1 week every 3 months) to check whether dryness has been achieved.
  • Gradually withdrawing desmopressin rather than stopping it suddenly.
    • A suitable withdrawal regimen used in clinical trials was an increase of 'no-medication days' over an 8-week period.
  • Using an enuresis alarm instead of restarting desmopressin, if an alarm is now considered appropriate and the child or young person and/or their parents/carers want to try one.

What are the available sources of information and support?

• Information and support on bedwetting is available from:
  • ERIC, The Children's Bowel and Bladder Charity (www.eric.org.uk).
    • The ERIC's Guide to Night Time Wetting is a leaflet about night time wetting problems for children and their parents/carers. 
    • The ERIC online shop has a range of other leaflets, books, and continence products, including enuresis alarms.
  • The Bladder and Bowel Community (www.bladderandbowel.org).
  • The NHS website (www.nhs.uk).

How should I manage primary bedwetting with daytime symptoms?

Note: consider investigating and treating daytime symptoms before bedwetting, if daytime symptoms predominate.

• Manage any identified underlying cause (such as constipation or a urinary tract infection) in primary care as appropriate. For further details, see the CKS topics on Constipation in children and Urinary tract infection - children.
• Arrange same-day referral to a multidisciplinary paediatric diabetes team for all children and young people with suspected type 1 diabetes.
• Consider referring children with primary bedwetting and daytime symptoms to secondary care or an enuresis clinic (if appropriate and available) for further investigations and assessment if:
  • Daytime symptoms are severe.
  • There is a history of recurrent urinary tract infection.
  • There are known or suspected physical or neurological problems.
  • The child or young person has developmental, attention or learning difficulties.
  • The child or young person has behavioural or emotional problems — consider involving a professional with psychological expertise.
  • There is no identified underlying cause.
• Be aware that while bedwetting is considered normal in children aged under five years, children over 2 years of age who are showing awareness of appropriate toileting behaviour, but are struggling to not wet themselves during the day as well as at night, may require further assessment and investigation to exclude a specific medical problem.

How should I manage a person with secondary bedwetting (previously been dry at night for 6 months)?

• Manage any identified underlying cause (such as constipation or a urinary tract infection) in primary care as appropriate. For further details, see the CKS topics on Constipation in children and Urinary tract infection - children.
• Arrange same-day referral to a multidisciplinary paediatric diabetes team for all children and young people with suspected type 1 diabetes.
• Consider referring children with secondary bedwetting to secondary care or an enuresis clinic (if appropriate and available) for further investigations and assessment if:
  
  • There is a history of recurrent urinary tract infection.
  • There are known or suspected physical or neurological problems.
  • The child or young person has developmental, attention or learning difficulties.
  • The child or young person has behavioural or emotional problems — consider involving a professional with psychological expertise.
  • There is no identified underlying cause.
• If child maltreatment is suspected, children's social care should be contacted to discuss the need for a referral. For further information, see the CKS topic on Child maltreatment - recognition and management.

Contraindications and cautions

• Do not prescribe desmopressin to children with:
  • Cardiac insufficiency.
  • Conditions treated with diuretics.
  • A history of hyponatraemia.
  • Polydipsia in alcohol dependence.
  • Psychogenic polydipsia.
  • Syndrome of inappropriate antidiuretic hormone secretion.
  • von Willebrand's Disease Type IIB (may result in pseudothrombocytopenia).
• Prescribe desmopressin with caution to children with:
  • Asthma.
  • Cardiovascular disease (not indicated for nocturnal enuresis or nocturia).
  • Conditions that might be aggravated by water retention.
  • Cystic fibrosis.
  • Epilepsy.
  • Heart failure.
  • Hypertension (not indicated for nocturnal enuresis or nocturia).
  • Migraine.
  • Nocturia — limit fluid intake to minimum from 1 hour before dose until 8 hours afterwards.
  • Nocturnal enuresis — limit fluid intake to minimum from 1 hour before dose until 8 hours afterwards.
  • Renal impairment — antidiuretic effect may be reduced.

[BNF, 2024; EMC, 2024]

Adverse effects

• Hyponatraemia and nausea are the most common adverse effects.
• Other adverse effects include (frequency unknown) abdominal pain, aggression, allergic dermatitis, emotional disorder, fluid retention, headache and dizziness, vomiting, and weight gain.
• Hyponatraemic seizure has also been reported.
  • Advise children and young people being treated for primary nocturnal enuresis to avoid fluid overload (including during swimming) and to stop taking desmopressin during an episode of vomiting or diarrhoea (until fluid balance normal).

[BNF, 2024; EMC, 2024]

Drug interactions

• Avoid concurrent use of desmporessin and other drugs that can cause fluid overload and/or hyponatraemia, such as:
  • Nonsteroidal anti-inflammatory drugs.
  • Antidepressants (tricyclic antidepressants and selective serotonin reuptake inhibitors).
  • Antiepileptics (lamotrigine, and carbamazepine).
  • Chlorpromazine.
  • Loperamide.
  • Furosemide.

[BNF, 2024; EMC, 2024]