"Is there a medication to stop my child from wetting?" — the most common question in the paediatrician's office. The answer is yes, but the issue is not simple. In this article we examine the two best-known medications for enuresis and explain their place in international protocols.

Desmopressin (DDAVP)

Desmopressin is synthetic vasopressin (antidiuretic hormone). Mechanism of action: it signals the kidneys to produce less urine. Taken 1–2 hours before bedtime, it reduces nocturnal urine production by 30–50%.

When is it prescribed?

  • When the alarm is insufficient (second line)
  • In special situations — a trip, camp, sleepover — on a short-term basis
  • When providing support for alarm use is not possible in the family
  • When a rapid result is needed

Available forms:

  • Tablet — most common (Minirin, DDAVP)
  • Sublingual — when the child has difficulty swallowing a tablet
  • Nasal spray is no longer recommended — due to the risk of hyponatraemia

Dose: 0.2 mg one hour before bedtime. If no effect — 0.4 mg. Maximum 0.6 mg.

Duration: A typical course is 3 months. Every 3 months, evaluation with a 1-week break.

Advantages of Desmopressin

  • Rapid effect — can appear from the very first night
  • Bedding needs changing less often — daily life becomes easier
  • Particularly useful for trips and sleepovers
  • Well-studied safety profile

Disadvantages of Desmopressin

  • High relapse risk — enuresis returns in 60% of cases upon discontinuation
  • More "symptom management" than "treatment" — does not train the brain
  • Risk of hyponatraemia — drop in blood sodium (rare but serious)
  • Fluid restriction is mandatory — less fluid should be drunk before bed and during the night
  • Side effects — headache (5–10%), nausea, abdominal pain

Hyponatraemia warning: Unrestricted fluid intake can dangerously lower blood sodium levels. Symptoms: headache, nausea, seizures, coma. Therefore, a child taking desmopressin must not drink large amounts of fluid before bedtime.

Imipramine — Why It Is Not Recommended

Imipramine (Melipramyne, Tofranil) is an older-generation tricyclic antidepressant. It has been used for enuresis since the 1960s. However, current guidelines (NICE 2010, ICCS 2020) have excluded imipramine from first-line therapy.

Why?

  • Cardiovascular side effects — arrhythmia, tachycardia, hypotension
  • Anticholinergic effects — dry mouth, constipation, visual disturbances
  • CNS side effects — drowsiness, dizziness, behavioural changes
  • High doses are dangerous for a child — in some cases fatal
  • Average effectiveness — 40–60% (lower than the alarm)
  • High relapse risk — enuresis returns in 80% of cases upon discontinuation

In some countries, imipramine is still occasionally prescribed by paediatricians and neurologists — this is a practice that contradicts international protocols.

Anticholinergic Medications (Oxybutynin)

These medications reduce bladder spasms. They are used only for polysymptomatic enuresis (with daytime and nocturnal symptoms), but not for PMNE. Side effects: dry mouth, constipation, facial flushing.

Combined Approach — Most Effective

Clinical experience and research show: when the enuresis alarm and desmopressin are used together, the result is better than either one separately.

Typical plan:

  1. Weeks 1–4: alarm + desmopressin (rapid relief)
  2. Weeks 5–8: desmopressin reduced, alarm continues
  3. Weeks 9–12: alarm only
  4. After 14 dry nights: both treatments are concluded

This protocol reduces the relapse risk to 15%.

Why Medication Alone Is Not Enough

Medications manage the symptom but do not train the brain–bladder connection. Upon discontinuation — the original condition returns. The alarm, however, trains the brain — and the brain does not forget what it has learned.

This is precisely why international protocols always consider behavioural treatment (alarm + fluid schedule + psychological support) as primary. Medications are a tool, not a "solution."