Minirin® treatment

1. What is enuresis?
2. What is the treatment for enuresis?
3. What should you know about Minirin®?
4. What should be done if treatment with Minirin® administered nasally is currently underway?
5. What should you know about Minirin® administered orally?
6. What should you do if your child goes away on a trip?
7. What are the effects of Minirin®?
8. How to monitor treatment with Minirin®?
9. When and how to stop treatment?

1. What is enuresis?

Bedwetting (enuresis) is defined as the involuntary passage of urine during sleep at an age when the child is usually dry (at least 5 years old). It is a common symptom, affecting approximately 6 to 10% of 7-year-olds. Bedwetting improves over time: without treatment, the annual cure rate is 10 to 15% in children aged 5 to 10 years.

2. What is the treatment for enuresis?

Bedwetting is not an illness. It should not be treated before the age of 6. However, it has psychological, familial, and social repercussions which, in some cases, may require psychotherapeutic consultation to guide the child and their parents in their treatment. The management process must actively involve the child and is based primarily on educational and hygiene measures.

Educational and hygiene measures

It is recommended to create a dry (and wet) night diary with the child: the child notes each day whether or not they wet the bed. This exercise allows the child to participate in their own care, to set goals…

Other measures:

• Avoid drinking too much at the end of the day: avoid drinks before sleeping, soups with the evening meal, salty and sugary foods;
• Do not drink at night;
• Remove diapers if the child gets used to them too easily and if this represents a hindrance to the motivation to "do something";
• Establish a simple system for washing sheets, properly protecting the mattress, etc., to make laundry management easier and, if possible, manageable by the child themselves. If these measures prove insufficient, treatment may be added: alarm systems and/or medication.

Alarm systems

When the child needs to urinate, the alarm systems trigger a sound signal, which the child must silence themselves. These systems promote awareness of the urge to urinate. Their long-term effectiveness is significantly greater than that of medication.

The drugs

Minirin® temporarily retains water in the body, thus limiting the amount of urine produced, reducing the urge to urinate. Some antidepressants are indicated for the treatment of enuresis. In practice, they are rarely used in this situation and never as a first-line treatment.

3. What should you know about Minirin®?

Until June 2006, Minirin® was available in several forms for this indication:

• Minirin® tablets,
• Minirin® nasal spray,
• Minirin® nasal administration solution.

From June 2006, nasal forms should no longer be prescribed for enuresis due to the observation, though rare, of sometimes serious adverse effects with this route of administration. These adverse effects (vomiting, headaches, and even seizures) are linked to excessive water retention (water intoxication), which may be explained by the difficulty of handling the nasal forms. Nasal forms can nevertheless continue to be used for other indications of Minirin® where this route of administration is appropriate.

4. What should be done if treatment with Minirin® administered nasally is currently underway?

Given the observed side effects, if your child is currently being treated with Minirin® nasal spray, do not change anything: there is no need to stop treatment immediately. However, you should consult your doctor, without urgency, who will determine whether it is necessary to switch from the nasal spray to the tablet form.

5. What should you know about Minirin® administered orally?

The initial treatment consists of a single 0.2 mg dose of Minirin® at bedtime, either as one 0.2 mg tablet or two 0.1 mg tablets. Drinking fluids should be limited: at least one hour before and up to eight hours after taking Minirin®. When prescribing this medication, it is essential to clearly explain these recommendations to the child, the parents, and anyone responsible for the child's care. If the treatment is not sufficiently effective, your doctor may decide to gradually increase the dose of Minirin®. After the dose increase phase, the treatment is administered for three to four months at the minimum effective dose. Minirin® should never be taken on an ad hoc basis, i.e., occasionally or on demand, due to the significant risk of water retention and toxicity.

6. What should you do if your child goes away from home? (group stay, summer camp, etc.)

It is recommended to anticipate situations where the child might need to receive Minirin® outside the home. In this case, treatment should begin at least one month before the departure date in order to:

1. Determine the optimal dose the child should receive.
2. Ensure the effectiveness of the treatment;

7. What are the effects of Minirin®?

A decrease in the number of wet nights was observed in approximately 30% of children during treatment. However, the relapse rate is around 90% after treatment is stopped. The most frequent side effects of Minirin® are headaches, nausea, and abdominal pain. These may be the first signs of more serious complications. If they occur, you must contact your doctor immediately. It is recommended to carefully follow the precautions for use mentioned in the Minirin® leaflet.

8. How to monitor treatment with Minirin®?

It is necessary to closely monitor treatment with Minirin®, in particular:

• at the very beginning, in case of an increase in dose.

The warning signs that should raise suspicion of water poisoning are:

• significant weight gain over a short period of time
• unusual fatigue
• loss of appetite with nausea or even vomiting,
• Headaches sometimes accompanied by other signs: agitation, irritability, mental confusion, drowsiness, convulsions.

The appearance of these signs requires stopping treatment and necessitates specialist medical advice.

Treatment should also be discontinued if fever or infectious episodes occur (particularly gastroenteritis). If taking other medications, consult your doctor.

9. When and how to stop treatment?

1. In case of failure, treatment can be stopped at any time.
2. If there is a satisfactory response to treatment, it should be discontinued after 3 months at the minimum effective dose, in order to assess the child's natural ability to control themselves (normalization of the disorder without drug treatment):
3. If the child stops wetting the bed, the treatment will be permanently stopped;

In case of relapse, treatment can be prescribed again, respecting the same rules as when the treatment was initially initiated.