Late night eating

I often take care of kids on desmopressin (DDAVP). This is a medication that children take at night to decrease the amount of urine they produce.  I’m shocked that patients take it without any drinking restrictions, this can be a dangerous practice.  However, I’ve never asked them to change their eating practices.

Michelet et al. (2016) wanted to identify if pharmacokinetics differed between fed vs fasted children and different formulations, tablet vs melts.  Pharmacokinetics refers to the absorption, metabolism, and excretion of a drug.  I tell my patients that we dose desmopressin off of effectiveness, not off of their weight.  They found that the melts were absorbed better and children that had fasted also absorb the medication better.

My Opinion: We do not have desmopressin melts as an option in the United States, so I recommend the tablets.  (The nasal spray is no longer recommended to treat bedwetting because of the increased risk of headaches and nosebleeds.) I currently recommend to every patient that they start with the smallest dose possible. I have them start with one tablet of 0.2 mg and every week go up by one pill for a maximum of 3 pills.  If they are dry every night on one pill that’s where they stay.  I also educate them to stop drinking one hour before taking the medication and NOT to drink anything after taking the medication.  This is to decrease their risk of decreasing their sodium and having headaches or seizures.  It’s very rare but it’s important to know the risks.   This study is interesting because I’ve never recommended my patients stop eating prior to taking their desmopressin.  If a child has been very difficult to treat and isn’t responding to behavioral interventions we trial desmopressin.  If desmopressin isn’t working (100% dry nights), I will now encourage their family to have dinner earlier, so their child can have better absorption and increase the efficacy of the medication.

Michelet, R., Dossche, L., Bruyne, P. D., Colin, P., Boussery, K., Walle, J. V., . . . Vermeulen, A. (2016). Effects of Food and Pharmaceutical Formulation on Desmopressin Pharmacokinetics in Children. Clinical Pharmacokinetics,55(9), 1159-1170. doi:10.1007/s40262-016-0393-4

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