Desmopressin and Indomethacin Therapy for Nephrogenic Diabetes Insipidus in Patients Receiving Lithium Carbonate
| Title: | Desmopressin and Indomethacin Therapy for Nephrogenic Diabetes Insipidus in Patients Receiving Lithium Carbonate |
|---|---|
| Authors: | Weinstock, Ruth S.; Moses, Arnold M. |
| Publisher: | Southern Medical Journal |
| Date Published: | December 01, 1990 |
| Reference Number: | 333 |
Individuals receiving lithium carbonate commonly have nephrogenic diabetes insipidus. There is no effective and practical treatment for this condition. We have found that large doses of desmopressin (DDAVP) may provide effective therapy without adverse effects. A recent report showed that indomethacin improved nephrogenic diabetes insipidus that had persisted after the lithium therapy was discontinued. We have provided additional evidence that indomethacin may be effective, even when treatment with lithium is continued. We also have shown that indomethacin together with desmopressin can markedly decrease polyuria, though indomethacin must be used with care because it may impair renal function.
This translation by the NDI Foundation is to assist the lay reader. To provide a clear, accessible interpretation of the original article, we eliminated or simplified some technical detail and complicated scientific language. We concentrated our translation on those aspects of the article dealing directly with NDI. The NDI Foundation thanks the researchers for their work toward understanding and more effectively treating this disorder.
© Copyright NDI Foundation 2007 (JC)
These reports prompted Weinstock, et al., to see if indomethacin and high doses of desmopressin would reduce LINDI symptoms in two female patients under their care. The results were positive. The patients' urine volumes decreased by 47% and 63% respectively. Their urine osmolalities (the relative concentration of particles to liquid in the urine) increased by 200% and 227%.
Treatment with indomethacin alone was partially effective, but most effective was a combination of desmopressin and indomethacin.
The authors' report is the first to document that some patients with LINDI can have a partial response to large doses of desmopressin. However, when the authors treated other LINDI patients similarly, it proved ineffective.
The authors note:
- The influence of desmopressin on long-term effects of lithium in the kidneys is unknown.
- Indomethacin must be used with caution as its effects on lithium levels are unclear and it can cause kidney damage.
- Lithium therapy can also rarely cause central diabetes insipidus (CDI) and primary polydipsia (PP). CDI should be treated with normal doses of desmopressin. PP should not be treated with desmopressin.