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Medical Therapy for BPH and OAB

BPH and OAB Medication

  • Standard medications to treat OAB include anticholinergics such as oxybutynin (Ditropan) and tolterodine (Detrol). These medications provide a modest 0.3 fewer times up to urinate at night.
  • BPH medication such as tamsulosin (Flomax) and alfuzosin (Uroxatral) have similar results

Topical vaginal estrogen

  • For postmenopausal women with continued nocturia despite other treatments, it is reasonable to add topical vaginal estrogen to other therapies.

Nocturia Specific Medication

Desmopressin or ddAVP

  • This medication works to decrease urine production at night.   The oral version is not FDA approved, however in 2018 a sublingual version  (Nocdurna™) was approved.
    • In clinical trials of oral  ddAVP (Nocdurna™), there was a reduction of 1.5 voids in women and 1.3 voids in men relative from mean baselines of 2.9 in women and 3.0 in men.
    • There have been studies in men with nocturia using oral ddAVP to treat nocturia.  These studies show that patients get up 0.7 fewer times to urinate using this version of the drug.


Do not use Nocdurna™ if you have the following:

  • Hyponatremia or history of hyponatremia
  • Polydypsia
  • Primary nocturnal enuresis
  • On loop diuretics or inhaled glucocorticoids
  • Poor Kidney Function- GFR < 50 ml/min/1.13m2     
  • SIADH – Syndrome of Inappropriate Anti- Diuretic Hormone Secretion
  • During illness that can cause electrolyte abnormality
  • CHF – Congestive Heart Failure – NYHA Class II-IV  
  • Uncontrolled HTN – Hypertension

Common Side effects:

  • Hyponatremia/ Blood Sodium Decreased (4% in men, 3% in women)
  • Dry Mouth (14% in men, 12% in women)
  • Head Ache (4% in men, 3% in women)
  • Dizziness (4% in men, 2% in women)

Hyponatremia occurs when the sodium concentration in blood is too low.  Sodium is an important electrolyte that helps regulate how urine is concentrated.  

Hyponatremia signs and symptoms may include:

  • Nausea and vomiting
  • Headache and Confusion
  • Loss of energy, drowsiness, and fatigue
  • Restlessness and irritability
  • Muscle weakness, spasms or cramps
  • Seizures

When to see a doctor

Seek emergency care for severe signs and symptoms of hyponatremia, such as nausea and vomiting, confusion, seizures, or lost consciousness.

Call your doctor if after starting Nocdurna™ you experience headache, nausea, cramping or weakness.


Please click here for more information on Nocdurna™ .

Procedures for BPH and OAB

Treatment for BPH and OAB may also help with nocturia.  This may include procedures or advanced therapies.  See the BPH and OAB pathways on this website for more information. (Insert links)

BPH procedures:

  • TURP
  • Other transurethral procedures

OAB procedures:

  • Posterior tibial nerve stimulation
  • Intravesical BOTOX
  • Sacral nerve stimulation

Combination Therapy

Making several changes in your overall health and daily routine offers the best chance at successfully improving your nocturia.   Maximizing treatment of other other medical conditions and continuing behavior/lifestyle modifications is essential.

These steps may include improvement in:

  • Diabetes and heart disease management
  • Treatment of depression
  • Exercise
  • Sleep hygiene (including obstructive sleep apnea)
  • Fluid management
  • Daytime compression stockings
  • Medication
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