From the Guidelines
Medications such as lithium, demeclocycline, amphotericin B, foscarnet, cidofovir, cisplatin, and phenothiazines can contribute to the development of diabetes insipidus, a condition characterized by excessive urination and thirst due to problems with antidiuretic hormone (ADH). The most recent and highest quality study 1 provides evidence that certain medications can increase the risk for diabetes, although it does not specifically address diabetes insipidus. However, based on the available evidence, it is clear that medications such as lithium, demeclocycline, and amphotericin B can cause nephrogenic diabetes insipidus by reducing kidney sensitivity to ADH or damaging kidney tubules. Other medications that may contribute to diabetes insipidus include:
- Foscarnet (antiviral)
- Cidofovir (antiviral)
- Certain chemotherapy drugs like cisplatin
- Some psychiatric medications such as phenothiazines Excessive alcohol consumption can also temporarily inhibit ADH release from the pituitary gland. If symptoms like extreme thirst and frequent urination occur while taking these medications, it is essential to consult a healthcare provider immediately, as dosage adjustments or alternative treatments may be necessary. Never stop prescribed medications without medical guidance.
From the Research
Medications that Contribute to Diabetes Insipidus
- Lithium salts, commonly used to treat affective disorders, can cause nephrogenic diabetes insipidus, with an incidence of about 10% in patients treated long-term 2
- Foscarnet and clozapine have also been reported to cause nephrogenic diabetes insipidus, although less frequently than lithium 2
- Other medications, such as antimicrobials and cytostatics, can also contribute to the development of nephrogenic diabetes insipidus, particularly in critically ill patients 2
Mechanisms of Medication-Induced Diabetes Insipidus
- Lithium can cause nephrogenic diabetes insipidus by dysregulating the aquaporin system in principal cells of the collecting duct, leading to impaired urine concentration 3
- Lithium can also promote polyuria by counteracting intracellular vasopressin signaling and altering the expression of certain proteins and hormones 3, 4
Treatment of Medication-Induced Diabetes Insipidus
- Discontinuation of the offending medication is often the first step in treating medication-induced nephrogenic diabetes insipidus 2, 5
- Thiazide diuretics and nonsteroidal anti-inflammatory drugs (NSAIDs) may be used to reduce urine output in patients with nephrogenic diabetes insipidus 2, 6
- Desmopressin, a synthetic antidiuretic hormone, may also be effective in treating lithium-induced nephrogenic diabetes insipidus, particularly when used in combination with thiazide diuretics and NSAIDs 6