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Lower urinary tract symptoms in men, age-related (including symptoms of benign prostatic hyperplasia/hypertrophy) - Management
How do I manage nocturnal polyuria as the predominant symptom?

  • Exclude or manage treatable causes of nocturnal polyuria, such as diabetes, renal disease, chronic heart failure, and drugs. However, it is often not possible to identify a specific cause.
  • Advise the man to limit his fluid intake in the late afternoon and evening, and offer information on self-help resources.
  • If limiting fluid intake in the late afternoon and evening is ineffective, consider offering a loop diuretic to be taken in the late afternoon. For example, furosemide 40 mg (this use is off-label).
  • If nocturnal polyuria remains bothersome, refer the man or seek specialist advice about switching to oral desmopressin to be taken at bedtime — this use is off-label.
    • Start treatment with the lowest dose — 200 micrograms of oral desmopressin.
    • To prevent fluid overload and hyponatraemia, advise the man to drink only enough to satisfy his thirst, to avoid fluids in the last 1–2 hours before bed, and to avoid fluids for 8 hours after taking desmopressin.
    • Monitor for dilutional hyponatraemia by measuring serum sodium 3 days after the first dose. If serum sodium decreases below the normal range, stop the desmopressin.
    • For detailed prescribing information, see Desmopressin for nocturnal polyuria.

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