An open, in‐patient incremental safety and efficacy study of desmopressin in women with multiple sclerosis and nocturia

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Abstract
Objectives To examine the safety and efficacy of desmopressin in three doses given to women with multiple sclerosis to treat nocturia with or without enuresis. Patients and methods Eight women with clinically confirmed multiple sclerosis and nocturia with or without enuresis were entered as in‐patients into an open, non‐randomized, placebo‐controlled study of incremental doses of 20, 40 and 60 μg desmopressin. Urinary and serum sodium, plasma arginine vasopressin and urine osmolality were monitored every 4 h for 24 h. A single dose of placebo or desmopressin was given during each of four 24‐h periods. Results There was a significant decrease in nocturnal urinary volumes and a significant increase in nocturnal urinary osmolalities in patients taking desmopressin when compared with those taking a placebo, but there was no difference among the desmopressin doses. There was no significant difference in serum sodium level between the desmopressin doses. However, at the end of the 24‐h period with the 60 μg dose, serum sodium was decreased significantly. Conclusions Neither a significant decrease in nocturnal urinary volumes nor an increase in urinary osmolality was achieved by doses of desmopressin > 20 μg. A dose of 60 g was associated with a decreased serum sodium level at the end of the 24‐h period but there was no biochemical hyponatraemia. Because there were no benefits and a possibility of clinical hyponatraemia with higher doses, doses of > 20 μg desmopressin cannot be recommended.