Diabetes insipidus medical therapy: Difference between revisions
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{{CMG}} | {{CMG}} | ||
==Overview== | ==Overview== | ||
The mainstay of treatment for diabetes insipidus is [[desmopressin]] ([[DDAVP]]). | The mainstay of treatment for central diabetes insipidus is [[desmopressin]] ([[DDAVP]]) while nephrogenic diabetes insipidus is treated according to the cause. | ||
==Medical Therapy== | ==Medical Therapy== | ||
===[[Central diabetes insipidus|Central Diabetes Insipidus]]=== | ===[[Central diabetes insipidus|Central Diabetes Insipidus]]=== | ||
The mainstay of therapy for [[central diabetes insipidus]] is [[desmopressin]]. [[Fluid]] restriction should be observed. Dosing should be individualized to response.<ref name="pmid8877030">{{cite journal |vauthors=Lam KS, Wat MS, Choi KL, Ip TP, Pang RW, Kumana CR |title=Pharmacokinetics, pharmacodynamics, long-term efficacy and safety of oral 1-deamino-8-D-arginine vasopressin in adult patients with central diabetes insipidus |journal=Br J Clin Pharmacol |volume=42 |issue=3 |pages=379–85 |year=1996 |pmid=8877030 |pmc=2042683 |doi= |url=}}</ref><ref name="pmid8241672">{{cite journal |vauthors=Fjellestad-Paulsen A, Laborde K, Kindermans C, Czernichow P |title=Water-balance hormones during long-term follow-up of oral dDAVP treatment in diabetes insipidus |journal=Acta Paediatr. |volume=82 |issue=9 |pages=752–7 |year=1993 |pmid=8241672 |doi= |url=}}</ref> | |||
**[[IV]], [[Subcutaneous| | *Preferred regimen (1): | ||
**[[Intramuscular injection|IM]], [[IV]], [[Subcutaneous| | **[[IV]], [[Subcutaneous|SQ]]: 2 to 4 mcg daily (0.5 to 1 mL) in 2 divided doses or one-tenth (1/10) of the maintenance [[Intranasal route|intranasal]] dose. | ||
**[[Intranasal route|Intranasal]] | **[[Intramuscular injection|IM]], [[IV]], [[Subcutaneous|SQ]]: Canadian labeling ([[DDAVP]] Injection only): 1 to 4 mcg (0.25 to 1 mL) once daily or one-tenth (1/10) of the maintenance [[Intranasal route|intranasal]] dose. | ||
**[[Oral]] | **[[Intranasal route|Intranasal]]: 100 mcg/mL nasal solution, Usual dose range: 10 to 40 mcg daily (0.1 to 0.4 mL) as a single dose or divided 2 to 3 times daily. | ||
**[[Oral]]: | |||
***US labeling: Initial: 0.05 mg twice daily; total daily dose should be increased or decreased as needed to obtain adequate [[Antidiuretic effect|antidiuresis]] (range: 0.1 to 1.2 mg divided 2 to 3 times daily). | ***US labeling: Initial: 0.05 mg twice daily; total daily dose should be increased or decreased as needed to obtain adequate [[Antidiuretic effect|antidiuresis]] (range: 0.1 to 1.2 mg divided 2 to 3 times daily). | ||
***Canadian labeling: Initial: 0.1 mg 3 times daily; total daily dose should be increased or decreased as needed to obtain adequate [[Antidiuretic effect|antidiuresis]] (maximum: 1.2 mg/day in 3 divided doses) | ***Canadian labeling: Initial: 0.1 mg 3 times daily; total daily dose should be increased or decreased as needed to obtain adequate [[Antidiuretic effect|antidiuresis]] (maximum: 1.2 mg/day in 3 divided doses) | ||
**[[Sublingual]] formulation (Canadian product): | **[[Sublingual]] formulation (Canadian product): | ||
***[[DDAVP]] Melt: Initial: 60 mcg 3 times daily | ***[[DDAVP]] Melt: Initial: 60 mcg 3 times daily | ||
Total daily dose should be increased or decreased as needed to obtain adequate [[Antidiuretic effect|antidiuresis]] effects. | |||
*Usual maintenance: 120 to 720 mcg equally divided 2 or 3 times daily. | |||
*[[Chlorpropamide]] | *[[Chlorpropamide]] | ||
*[[Carbamazepine]] or [[clofibrate]] | *[[Carbamazepine]] or [[clofibrate]] | ||
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===[[Nephrogenic diabetes insipidus]]=== | ===[[Nephrogenic diabetes insipidus]]=== | ||
Early diagnosis is helpful in decreasing the long term [[side effects]] of [[nephrogenic diabetes insipidus]] such as [[mental retardation]] that results from repeated episodes of [[dehydration]] and [[hypernatremia]] | Early diagnosis is helpful in decreasing the long term [[side effects]] of [[nephrogenic diabetes insipidus]] such as [[mental retardation]] that results from repeated episodes of [[dehydration]] and [[hypernatremia]]: | ||
*Decreased dietary [[solute]]<ref name="pmid22427315">{{cite journal |vauthors=Wesche D, Deen PM, Knoers NV |title=Congenital nephrogenic diabetes insipidus: the current state of affairs |journal=Pediatr. Nephrol. |volume=27 |issue=12 |pages=2183–204 |year=2012 |pmid=22427315 |doi=10.1007/s00467-012-2118-8 |url=}}</ref> | *Decreased dietary [[solute]]<ref name="pmid22427315">{{cite journal |vauthors=Wesche D, Deen PM, Knoers NV |title=Congenital nephrogenic diabetes insipidus: the current state of affairs |journal=Pediatr. Nephrol. |volume=27 |issue=12 |pages=2183–204 |year=2012 |pmid=22427315 |doi=10.1007/s00467-012-2118-8 |url=}}</ref> | ||
*[[Diuretics]] | *[[Diuretics]] | ||
**[[Thiazide diuretics]] 25 mg once or twice daily<ref name="pmid16695887">{{cite journal |vauthors=Earley LE, Orloff J |title=THE MECHANISM OF ANTIDIURESIS ASSOCIATED WITH THE ADMINISTRATION OF HYDROCHLOROTHIAZIDE TO PATIENTS WITH VASOPRESSIN-RESISTANT DIABETES INSIPIDUS |journal=J. Clin. Invest. |volume=41 |issue=11 |pages=1988–97 |year=1962 |pmid=16695887 |pmc=291129 |doi=10.1172/JCI104657 |url=}}</ref><ref name="pmid3969096">{{cite journal |vauthors=Batlle DC, von Riotte AB, Gaviria M, Grupp M |title=Amelioration of polyuria by amiloride in patients receiving long-term lithium therapy |journal=N. Engl. J. Med. |volume=312 |issue=7 |pages=408–14 |year=1985 |pmid=3969096 |doi=10.1056/NEJM198502143120705 |url=}}</ref> | **Preferred regimen (1): [[Thiazide diuretics]] 25 mg once or twice daily<ref name="pmid16695887">{{cite journal |vauthors=Earley LE, Orloff J |title=THE MECHANISM OF ANTIDIURESIS ASSOCIATED WITH THE ADMINISTRATION OF HYDROCHLOROTHIAZIDE TO PATIENTS WITH VASOPRESSIN-RESISTANT DIABETES INSIPIDUS |journal=J. Clin. Invest. |volume=41 |issue=11 |pages=1988–97 |year=1962 |pmid=16695887 |pmc=291129 |doi=10.1172/JCI104657 |url=}}</ref><ref name="pmid3969096">{{cite journal |vauthors=Batlle DC, von Riotte AB, Gaviria M, Grupp M |title=Amelioration of polyuria by amiloride in patients receiving long-term lithium therapy |journal=N. Engl. J. Med. |volume=312 |issue=7 |pages=408–14 |year=1985 |pmid=3969096 |doi=10.1056/NEJM198502143120705 |url=}}</ref> | ||
**[[Amiloride]]<ref name="pmid18596116">{{cite journal |vauthors=Bedford JJ, Weggery S, Ellis G, McDonald FJ, Joyce PR, Leader JP, Walker RJ |title=Lithium-induced nephrogenic diabetes insipidus: renal effects of amiloride |journal=Clin J Am Soc Nephrol |volume=3 |issue=5 |pages=1324–31 |year=2008 |pmid=18596116 |pmc=2518801 |doi=10.2215/CJN.01640408 |url=}}</ref> | **Preferred regimen (2): [[Amiloride]] 5 mg daily or twice a day<ref name="pmid18596116">{{cite journal |vauthors=Bedford JJ, Weggery S, Ellis G, McDonald FJ, Joyce PR, Leader JP, Walker RJ |title=Lithium-induced nephrogenic diabetes insipidus: renal effects of amiloride |journal=Clin J Am Soc Nephrol |volume=3 |issue=5 |pages=1324–31 |year=2008 |pmid=18596116 |pmc=2518801 |doi=10.2215/CJN.01640408 |url=}}</ref> | ||
*[[Nonsteroidal anti-inflammatory drugs]]<ref name="pmid7018256">{{cite journal |vauthors=Stokes JB |title=Integrated actions of renal medullary prostaglandins in the control of water excretion |journal=Am. J. Physiol. |volume=240 |issue=6 |pages=F471–80 |year=1981 |pmid=7018256 |doi= |url=}}</ref> | *Alternative regimen (1): [[Nonsteroidal anti-inflammatory drugs]]<ref name="pmid7018256">{{cite journal |vauthors=Stokes JB |title=Integrated actions of renal medullary prostaglandins in the control of water excretion |journal=Am. J. Physiol. |volume=240 |issue=6 |pages=F471–80 |year=1981 |pmid=7018256 |doi= |url=}}</ref> | ||
*Exogenous [[ADH]]<ref name="pmid18596116">{{cite journal |vauthors=Bedford JJ, Weggery S, Ellis G, McDonald FJ, Joyce PR, Leader JP, Walker RJ |title=Lithium-induced nephrogenic diabetes insipidus: renal effects of amiloride |journal=Clin J Am Soc Nephrol |volume=3 |issue=5 |pages=1324–31 |year=2008 |pmid=18596116 |pmc=2518801 |doi=10.2215/CJN.01640408 |url=}}</ref> | *Alternative regimen (2): Exogenous [[ADH]]<ref name="pmid18596116">{{cite journal |vauthors=Bedford JJ, Weggery S, Ellis G, McDonald FJ, Joyce PR, Leader JP, Walker RJ |title=Lithium-induced nephrogenic diabetes insipidus: renal effects of amiloride |journal=Clin J Am Soc Nephrol |volume=3 |issue=5 |pages=1324–31 |year=2008 |pmid=18596116 |pmc=2518801 |doi=10.2215/CJN.01640408 |url=}}</ref> | ||
==References== | ==References== | ||
Latest revision as of 21:52, 27 October 2017
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview
The mainstay of treatment for central diabetes insipidus is desmopressin (DDAVP) while nephrogenic diabetes insipidus is treated according to the cause.
Medical Therapy
Central Diabetes Insipidus
The mainstay of therapy for central diabetes insipidus is desmopressin. Fluid restriction should be observed. Dosing should be individualized to response.[1][2]
- Preferred regimen (1):
- IV, SQ: 2 to 4 mcg daily (0.5 to 1 mL) in 2 divided doses or one-tenth (1/10) of the maintenance intranasal dose.
- IM, IV, SQ: Canadian labeling (DDAVP Injection only): 1 to 4 mcg (0.25 to 1 mL) once daily or one-tenth (1/10) of the maintenance intranasal dose.
- Intranasal: 100 mcg/mL nasal solution, Usual dose range: 10 to 40 mcg daily (0.1 to 0.4 mL) as a single dose or divided 2 to 3 times daily.
- Oral:
- US labeling: Initial: 0.05 mg twice daily; total daily dose should be increased or decreased as needed to obtain adequate antidiuresis (range: 0.1 to 1.2 mg divided 2 to 3 times daily).
- Canadian labeling: Initial: 0.1 mg 3 times daily; total daily dose should be increased or decreased as needed to obtain adequate antidiuresis (maximum: 1.2 mg/day in 3 divided doses)
- Sublingual formulation (Canadian product):
- DDAVP Melt: Initial: 60 mcg 3 times daily
Total daily dose should be increased or decreased as needed to obtain adequate antidiuresis effects.
- Usual maintenance: 120 to 720 mcg equally divided 2 or 3 times daily.
Nephrogenic diabetes insipidus
Early diagnosis is helpful in decreasing the long term side effects of nephrogenic diabetes insipidus such as mental retardation that results from repeated episodes of dehydration and hypernatremia:
- Decreased dietary solute[3]
- Diuretics
- Preferred regimen (1): Thiazide diuretics 25 mg once or twice daily[4][5]
- Preferred regimen (2): Amiloride 5 mg daily or twice a day[6]
- Alternative regimen (1): Nonsteroidal anti-inflammatory drugs[7]
- Alternative regimen (2): Exogenous ADH[6]
References
- ↑ Lam KS, Wat MS, Choi KL, Ip TP, Pang RW, Kumana CR (1996). "Pharmacokinetics, pharmacodynamics, long-term efficacy and safety of oral 1-deamino-8-D-arginine vasopressin in adult patients with central diabetes insipidus". Br J Clin Pharmacol. 42 (3): 379–85. PMC 2042683. PMID 8877030.
- ↑ Fjellestad-Paulsen A, Laborde K, Kindermans C, Czernichow P (1993). "Water-balance hormones during long-term follow-up of oral dDAVP treatment in diabetes insipidus". Acta Paediatr. 82 (9): 752–7. PMID 8241672.
- ↑ Wesche D, Deen PM, Knoers NV (2012). "Congenital nephrogenic diabetes insipidus: the current state of affairs". Pediatr. Nephrol. 27 (12): 2183–204. doi:10.1007/s00467-012-2118-8. PMID 22427315.
- ↑ Earley LE, Orloff J (1962). "THE MECHANISM OF ANTIDIURESIS ASSOCIATED WITH THE ADMINISTRATION OF HYDROCHLOROTHIAZIDE TO PATIENTS WITH VASOPRESSIN-RESISTANT DIABETES INSIPIDUS". J. Clin. Invest. 41 (11): 1988–97. doi:10.1172/JCI104657. PMC 291129. PMID 16695887.
- ↑ Batlle DC, von Riotte AB, Gaviria M, Grupp M (1985). "Amelioration of polyuria by amiloride in patients receiving long-term lithium therapy". N. Engl. J. Med. 312 (7): 408–14. doi:10.1056/NEJM198502143120705. PMID 3969096.
- ↑ 6.0 6.1 Bedford JJ, Weggery S, Ellis G, McDonald FJ, Joyce PR, Leader JP, Walker RJ (2008). "Lithium-induced nephrogenic diabetes insipidus: renal effects of amiloride". Clin J Am Soc Nephrol. 3 (5): 1324–31. doi:10.2215/CJN.01640408. PMC 2518801. PMID 18596116.
- ↑ Stokes JB (1981). "Integrated actions of renal medullary prostaglandins in the control of water excretion". Am. J. Physiol. 240 (6): F471–80. PMID 7018256.