Definition
Although known as diabetes, the "insipid" form has nothing to do with diabetes mellitus, a disease related to a deficit of insulin action; diabetes insipidus, on the other hand, expresses a rather rare metabolic deficit, characterized by intense thirst and a "excessive passing of urine.
Causes
Diabetes insipidus is the consequence of a metabolic alteration which consists in the reduction of the synthesis of vasopressin (antidiuretic hormone secreted by the pituitary), associated with a marked decrease in renal sensitivity to its action. The causes of origin can be various: infections, neurological surgery, chronic renal failure, hypercalcemia / hyperkalaemia, hypothalamic malformations, head trauma, intracranial tumor.
Symptoms
The symptoms that characterize diabetes insipidus materialize in thirst - permanent and insatiable - and in the excessive excretion of urine, which can sometimes reach 18 liters per day; it follows the tendency to dehydration, associated with weight loss and, in cases more serious, death Urine also has low specific gravity and osmolarity.
The information on Diabetes Insipidus - Medicines for the Treatment of Diabetes Insipidus is not intended to replace the direct relationship between health professional and patient. Always consult your doctor and / or specialist before taking Diabetes Insipidus - Drugs for the Treatment of Diabetes Insipidus.
Medicines
The main goal of treatment for diabetes insipidus is undoubtedly to decrease the amount of urine excreted, as well as to replace the fluids lost with urination. Since diabetes insipidus is closely related to a functional alteration of vasopressin, drug treatment consists of hormone replacement therapy. In other cases, diabetes insipidus may result from a lack of vasopressin activity in the kidney (nephrological diabetes insipidus), despite the fact that vasopressin production is preserved: in such situations, the disease cannot be corrected by exogenous administration of ADH, and the patient must take large quantities of water, take diuretics and limit sodium intake with the diet.
→ Diuretics, in fact, are able to sensitize the renal tubules to the action of vasopressin
→ a low sodium diet can help reduce the amount of water lost in the urine
When diabetes insipidus is linked to a brain tumor, the surgical removal of the neoplastic mass can reverse the metabolic alteration.
The following are the classes of drugs most used in the therapy against diabetes insipidus, and some examples of pharmacological specialties; it is up to the doctor to choose the most suitable active ingredient and dosage for the patient, based on the severity of the disease, the state of health of the patient and his response to treatment:
Antidiuretic hormone: the first-line therapy for pituitary diabetes insipidus is represented by the administration of antidiuretic hormone and its analogues; the dosage must be carefully established by the doctor after accurate diagnosis of the patient, in order to produce a slight diuresis during the arch of the day, thus avoiding a "water intoxication.
- Vasopressin (eg. Pitressin): the drug, also used for the treatment of esophageal varices, is not on the market in Italy due to its side effects (anaphylaxis, abdominal cramps, hypertension, peripheral ischemia, headache, nausea, pallor, tenesmus, fluid retention and, in severe cases, gangrene). Anyway, it is injected intramuscularly or subcutaneously (5-20 units every 4 hours).
- Desmopressin (eg. Minirin / Ddvap): it is an analogue of vasopressin, capable of carrying out the same therapeutic activities but with a longer duration of action and with fewer side effects; more precisely, desmopressin does not have vasoconstrictive effects, therefore it does not cause hypertension. The drug is available in the form of sublingual tablets (60-120 mcg), tablets to be taken with water (0.1-0.2 mg), solution for injection (4 mcg, indicated for patients without consciousness and by injection after surgery), oral drops (250mcg) and 0.125mcg nasal spray. For the exact dosage consult your doctor; in general, the indicative dose is 300 mcg for oral initiation therapy, and 300-600 mcg for oral maintenance therapy. When taking desmopressin, it is recommended that fluids be taken only when clearly needed.
Thiazide diuretics: these drugs exert a particular paradoxical beneficial effect in the treatment of neurogenic and partial pituitary diabetes insipidus. Medicines are useful for reducing the amount of urine excreted:
- Chlorthalidone (eg. Igroton): it is recommended to start therapy with a drug dose of 100 mg, to be taken twice a day. The maintenance dose is 50 mg per day.
- Hydrochlorothiazide (eg Esidrex, Ifirmacombi, CoAprovel): start therapy with 50 mg of active, to be taken orally once a day. The maintenance dose involves taking 100 mg of active per day. Consult your doctor before taking the drug.
Potassium-sparing diuretics: drugs are also indicated for the treatment of diabetes insipidus, since they help the kidneys to use vasopressin in a better way, decreasing the amount of urine excreted and ensuring the body a constant level of potassium.
Sulfonylureas: Sometimes some sulfonylureas can be used in the treatment of diabetes insipidus (partial pituitary type), although they are not the treatment of first choice. Probably, these drugs are able to sensitize the renal tubules to the hormonal activity of the remaining vasopressin. Blood glucose must be constantly monitored in patients who use them, since the drug can cause hypoglycemia.
- Chlorpropamide (eg Diabemide, Clorprop FN): indicatively, the dosage of the drug is 350 mg per day for adults and 200 mg per day for children with diabetes insipidus.
Antiepileptics: just like the previous drug, some antiepileptics are also used in therapy to alleviate the typical symptoms of diabetes insipidus; although not the first-line drug for the treatment of this pathology, carbamazepine seems to act by increasing the sensitivity of the renal tubules to the action of vasopressin.
- Carbamazepine (eg Tegretol, Carbamazepine EG): at a dosage of 200 mg, to be taken 1-2 times a day, carbamazepine can be used for the treatment of partial pituitary diabetes insipidus.
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