What is the first-line pharmacotherapeutic treatment for enuresis?

The first-line pharmacotherapeutic treatment for enuresis, particularly nocturnal enuresis, is desmopressin. This synthetic analogue of vasopressin works by promoting water reabsorption in the kidneys, effectively reducing urine output at night. Desmopressin is beneficial for children who experience bedwetting, especially when there is a need to establish dry nights, such as for sleepovers or other social situations that may be sensitive for the child.

Desmopressin's use is supported by its safety profile and its effectiveness in a significant portion of the pediatric population dealing with enuresis. It can also be used in conjunction with behavioral interventions, making it a comprehensive approach to managing the condition. Children with diabetes insipidus and those who are not responding to lifestyle changes or alarm systems are prime candidates for this pharmacotherapy.

Keeping in mind the other options, while imipramine, amitriptyline, and desipramine are antidepressants that have been used in the past or considered for managing enuresis, they are not preferred as first-line treatments due to their side effect profiles and less favorable outcomes compared to desmopressin. Their use may be limited to cases where des