This narrative review synthesizes current evidence on the medical management of nocturnal
polyuria, including antidiuretic replacement
therapy as well as other emerging modalities, with particular emphasis on areas of active investigation and future research directions. Relative to earlier formulations, the pharmacological profiles of novel
desmopressin acetate nasal spray and orally disintegrating
tablet formulations appear favorable in optimizing the balance between efficacy and safety. Additionally, several highly selective small-molecule
arginine vasopressin 2 receptor agonists are under active development, while appropriately timed short-acting
diuretics,
pharmacotherapy for
hypertension, nonsteroidal anti-inflammatory drugs, and
sex hormone replacement
therapy are also a focal point of extensive ongoing nocturnal
polyuria research. Emerging laboratory technologies now make feasible a sub-stratification of nocturnal
polyuria patients into substrate-based phenotypes for individualized treatment. An increasingly refined understanding of the pathogenesis of nocturnal
polyuria, and
arginine vasopressin dysregulation in particular, has also introduced new opportunities for point-of-care testing in patients with nocturnal
polyuria.