เคยอยู่ ร.พ. เห็นหมอเด็กจ่ายเป็นตัว Imipramine อะครับ มีข้อบ่งใช้ด้วย Nocturnal enuresis Child: As hydrochloride: 6-7 yr (20-25 kg): 25 mg; 8-11 yr (25-35 kg): 25-50 mg; >11 yr (35-54 kg): 50-75 mg. Dose to be taken once daily before bedtime for up to 3 mth.
Treatment of nocturnal enuresis includes both behavioral and medical options. behavioral modifications - limiting nighttime fluid intake 2 hours before bedtime - limiting dairy products 4 hours before bedtime (to decrease urine output from osmotic diuresis) - voiding prior to going to sleep
Acupuncture and hypnosis are other treatments, but few data support their use.
Medications often are used in the treatment of nocturnal enuresis to help treat, rather than cure, the problem while awaiting natural resolution. The first-line choice is desmopressin acetate.
Imipramine is a tricyclic antidepressant developed in the 1960s that continues to be used in the treatment of enuresis. Its action is unknown, but it appears to have both a weak anticholinergic effect as well as an antispasmodic effect on the detrusor muscle. Recently, imipramine has been found to increase concentrations of ADH release. It has been postulated that imipramine affects the arousal center of the brain by increasing arousal and suppressing rapid eye movement sleep. Wide variation in cure rates have been reported (64% to 80%), but when imipramine therapy is discontinued, especially abruptly, only 25% of patients remain dry long-term. Adverse effects are uncommon but include gastrointestinal disturbance, sleep disturbances, anxiety, and dry mouth. Most serious adverse effects are associated with overdose and include fatal cardiac arrhythmias, seizure, hypotension, and coma. Parents should be notified of these risks, which can be a threat to younger siblings as well as to patients.
