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Amiloride has been proposed as an alternative for those patients who develop lithium-induced nephrogenic diabetes insipidus in whom drug suspension is not the best option. Whereas both modalities of treatment resulted in reduction in voiding frequency and urine volume, decrease in daily fluid intake

There is evidence that suggests lithium normalises cell membrane levels of sodium and calcium in mental health patients through various modulatory actions on arachidonic acid, N‐methyl‐D‐aspartate receptors, dopamine and serotonin neurotransmitter pathways.The kidneys play a key role in regulating water homeostasis. However, a subset of the mental health population is resistant to other forms of therapy, leaving lithium as their only option to successfully manage their mood disorder. The patient had recently suffered from a chest infection which had been treated with a short course of antibiotics. Once the patient was symptomatically stable, lithium was reintroduced at initiating dosage levels concomitantly with amiloride with aims of reversing the concentrating defect and preventing this side effect from occurring again.


Intravenous fluid replacements were provided until the patient's renal function and sodium levels returned to normal. For patients who suffer from mental health disorders, the literature has found that amiloride can be an effective means to restore a patient's impaired urine concentrating ability.Lithium is highly effective in treating several psychiatric disorders; however, despite its clinical utility in these settings its risk of inducing nephrogenic diabetes insipidus (NDI) is a major concern.Lithium's key mechanism of action has been difficult to ascertain.
While on this medication the patient suffered from acute kidney impairment, hypernatraemia, reduced urine osmolality, increased plasma osmolality, polyuria, polydipsia and severe dehydration. 1 As a consequence, the kidney produces … By continuing to browse this site, you agree to its use of cookies as described in our I have read and accept the Wiley Online Library Terms and Conditions of UseAustralian Prescriber: Safe and effective use of lithium5‐HT1B receptors: a novel target for lithium possible involvement in mood disordersNMDA receptor antagonists augment antidepressant‐like effects of lithium in the mouse forced swimming testLong‐term regulation of four renal aquaporins in ratsAmiloride restores renal medullary osmolytes in lithium‐induced nephrogenic diabetes insipidusQuantitative phosphoproteomics of vasopressin‐sensitive renal cells: regulation of aquaporin‐2 phosphorylation at two sitesA method for estimating the probability of adverse drug reactionsLithium‐induced nephrogenic diabetes insipidus: renal effects of amilorideDiabetes Insipidus Workup: Approach Considerations, Water Deprivation Testing, Pituitary StudiesThe effects of lithium on renal function in older adults‐a systematic reviewAmiloride blocks lithium entry through the sodium channel thereby attenuating the resultant nephrogenic diabetes insipidusLithium‐induced diabetes insipidus: prevention and management A supervised water deprivation test was carried out which showed the patient had a reduced urine osmolality of 175 mOsm/kg and increased serum osmolality of 365 mOsm/kg. This suggested partial‐to‐moderate NDI. Lithium‐induced NDI is considered to be dose‐dependent.Monitoring is another key factor due to lithium's narrow therapeutic range; for this reason therapeutic drug monitoring should be undertaken regularly.It is important for pharmacists and clinicians to recognise that lithium commonly induces NDI.
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