NICE guidance states (1):
- anticholinergic treatment alone should not be used alone for the management of bedwetting in children and young people without daytime symptoms
- an anticholinergic combined with desmopressin should be considered for bedwetting in children and young people who also have daytime symptoms and have been assessed by a healthcare professional with expertise in prescribing the combination of an anticholinergic and desmopressin
- consider an anticholinergic combined with desmopressin for children and young people who have been assessed by a healthcare professional with expertise in the management of bedwetting that has not responded to an alarm and/or desmopressin and have any of the following:
- bedwetting that has partially responded to desmopressin alone
- bedwetting that has not responded to desmopressin alone
- bedwetting that has not responded to a combination of alarm and desmopressin
Continuation of treatment for children and young people with bedwetting should considered if the bedwetting has partially responded to desmopressin combined with an anticholinergic, as bedwetting may continue to improve for up to 6 months after starting treatment
Consider using repeated courses of desmopressin combined with an anticholinergic in children and young people who have responded to this combination but experience repeated recurrences of bedwetting following previous response to treatment
The adverse reactions of this group of medications include dry mouth and eyes, constipation, flushing, sedation, and cognitive effects (2)
Notes:
- not all anticholinergics have a UK marketing authorisation for treating bedwetting in children and young people. If a drug without a marketing authorisation for this indication is prescribed, informed consent should be obtained and documented
- do not offer an anticholinergic combined with imipramine for the treatment of bedwetting in children and young people
Reference: