DDAVP

Follow these guidelines to obtain the best results from the medication.

Start by keeping track for two weeks, counting DRY nights without medication. Then begin the medication. Start with one spray in each nostril every night at bedtime. Keep track of DRY nights on a calendar.

Adjust medication dose as follows:

Child is dry all the time or has had one accident on two sprays.
You may try to decrease the medication to one squirt per night. (Make sure you record dry nights!) If your child stays dry on this dose, maintain one spray for three months, and then try to reduce the dose to every other night. If there are accidents, go back to the previous effective dose for an additional three months.

Two squirts per night (total), and your child is still wet after two weeks.
Increase the dose to three squirts (one squirt in one nostril; then two squirts in the other nostril). Continue this dose for two weeks. Make sure you record the progress and reward dry nights. Your child may still have an occasional wet night. If your child has good results at this dose, continue for the three to six month time period recommended.

Still frequent wet nights at three squirts.
Increase dose to two squirts in each nostril. This is the MAXIMUM DOSE allowed that is safe for your child. If your calendar reflects progress at this dose, continue for a three to six month time period.

Don't get discouraged! If your child was an every night wetter, and now has an occasional accident with the medicine, we consider this progress. If you see no difference on your calendar of dry nights, given at the maximum dose, call us. A different course of treatment may be needed.

Your follow-up appointment has been scheduled for three to six months from this visit. This appointment is to review your child's enuresis and discuss his or her further plan of care.

In preparing for this visit, you will need to try to wean the child off the medication. To do this, reverse the steps you used to get at the current dose. Reduce the dosage by one squirt every two weeks. If your child is taking four squirts, you will need to start this about six weeks before your appointment.

If your child has several wet nights during the two week period, keep your child on the lowest effective dose. Keep your calendar while you are adjusting the medication. Bring the calendar with you to your appointment so we may review it with you.

Some children can stay dry on as low a dose as one spray every other night. Of course, our goal is the same as yours -- no medication and to be dry every night -- but when medication must be used, we strive to keep it at the lowest effective dose.

Some children complain about the taste in the back of their throats. A very small sip of water after the medicine should reduce this. Other reported complaints include headache, nasal congestion and flushing. If your child has any of these symptoms, please call us.

The medication works by reducing the amount of urine the body makes; therefore, the bladder is able to hold this smaller amount. If your child drinks a lot of fluids in the evening, the medicine probably won't work. You need to limit your child's fluids after dinner, especially caffeine, carbonation and citrus. Make sure your child empties his or her bladder just prior to bedtime. If you have further questions or concerns, please give us a call.