Diabetes Insipidus Medication
- Author: Michael Cooperman, MD; Chief Editor: George T Griffing, MD more...
Medication Summary
Treat diabetes insipidus (DI) with desmopressin, nonhormonal drugs, or both. In central DI, the primary problem is a hormone deficiency; therefore, physiologic replacement with desmopressin is usually effective. Use a nonhormonal drug if response is incomplete or desmopressin is too expensive. Nonhormonal drugs usually are more effective in treating nephrogenic DI.
Hormones
Class Summary
Hormones prevent complications of DI and reduce morbidity.
Desmopressin (DDAVP)
Desmopressin is a synthetic analogue of antidiuretic hormone (ADH)—also known as arginine vasopressin (AVP)—with potent antidiuretic activity but no vasopressor activity.
Vasopressin (Pitressin)
Vasopressin has vasopressor and ADH activity. It increases water resorption at collecting ducts (ADH effect) and promotes smooth muscle contraction throughout the vascular bed of renal tubular epithelium (vasopressor effects). However, vasoconstriction is also increased in splanchnic, portal, coronary, cerebral, peripheral, pulmonary, and intrahepatic vessels.
Vasopressin decreases portal pressure in portal hypertension. A notable undesirable effect is coronary artery constriction, which may dispose patients with coronary artery disease to cardiac ischemia. This can be prevented with concurrent use of nitrates.
Sulfonylurea Compounds
Class Summary
Hypoglycemic agents help relieve diuresis.
Chlorpropamide
Chlorpropamide promotes renal response to ADH.
Anticonvulsants
Class Summary
Certain antiepileptic drugs, such as carbamazepine, have proven helpful in DI.
Carbamazepine (Tegretol, Carbatrol, Equetro)
Carbamazepine ameliorates DI by releasing ADH. It is not useful in total DI and generally is not a first-line drug.
Diuretics
Class Summary
Diuretics may reduce flow to the ADH-sensitive distal nephron.
Hydrochlorothiazide (Microzide)
Hydrochlorothiazide is a thiazide diuretic that decreases urinary volume in the absence of ADH. It may induce mild volume depletion and cause proximal salt and water retention, thereby reducing flow to the ADH-sensitive distal nephron. Its effects are additive to those of other agents.
Amiloride (Midamor)
Amiloride is a potassium-sparing diuretic. It has a potassium-sparing effect, so the risk of hypokalemia is decreased in combination with hydrochlorothiazide. In addition, the 2 agents are synergistic with respect to antidiuresis.
Nonsteroidal Anti-inflammatory Agents (NSAIDs)
Class Summary
The mechanism of action of nonsteroidal anti-inflammatory drugs (NSAIDs) is not known, but these agents may act by inhibiting prostaglandin synthesis.
Ibuprofen (Caldolor, Advil, Motrin)
Inhibition of prostaglandin synthesis reduces the delivery of solute to distal tubules, reducing urine volume and increasing urine osmolality. Ibuprofen is usually used in nephrogenic DI.
Indomethacin (Indocin)
Inhibition of prostaglandin synthesis reduces the delivery of solute to distal tubules, reducing urine volume and increasing urine osmolality. Indomethacin is usually used in nephrogenic DI.
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