Lithium remains the gold standard of pharmacological treatment of bipolar disorder. Adverse effects include weight gain, tremor, diarrhoea, polyuria and diabetes insipidus, which can occur in up to 40% of those treated.
Drug induced diabetes insipidus is always of the nephrogenic type, thought to be due in part to the lack of response to antidiuretic hormone by aquaporins (water transport channels) in the collecting ducts of the nephrons, which are in turn responsible for the urinary concentrating mechanism.
Antidiuretic hormone is thought to open the aquaporins at the cell membrane level via a complex process and this action is inhibited by lithium. Those affected by nephrogenic diabetes insipidus can lose up to 4-6 litre of fluid each day, resulting in increased thirst, polydipsia and possible dehydration.
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A joint initiative of the Patient Services Section and the Drug and Therapeutics Information Service of the Pharmacy Department, Repatriation General Hospital, Daw Park, South Australia. The RGH Pharmacy E-Bulletin is distributed in electronic format on a weekly basis, and aims to present concise, factual information on issues of current interest in therapeutics, drug safety and cost-effective use of medications.
Editor: Assoc. Prof. Chris Alderman, University of South Australia – Director of Pharmacy, RGH © Pharmacy Department, Repatriation General Hospital, Daw Park, South Australia 5041.
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