Condition Drug Dose
Complete central DI dDAVP 10-20 (g intranasally q 12-24 h
Partial central DI Vasopressin tannate 2-5 U IM q 24-48 h
Aqueous vasopressin 5-10 U SC q 4-6 h
Chlorpropamide 250-500 mg/d
Clofibrate 500 mg tid-qid
Carbamazepine 400-600 mg/d
Treatment of central diabetes insipidus (DI). Central DI may be treated with hormone replacement or drugs. In acute settings when renal water losses are extensive, aqueous vasopressin (pitressin) is useful. It has a short duration of action that allows for careful monitoring and avoiding complications like water intoxication. This drug should be used with caution in patients with underlying coronary artery disease and peripheral vascular disease, as it can cause vascular spasm and prolonged vasoconstriction. For the patient with established central DI, desmopressin acetate (dDAVP) is the agent of choice. It has a long half-life and does not have significant vasoconstrictive effects like those of aqueous vasopressin. It can be conveniently administered intranasally every 12 to 24 hours. It is usually tolerated well. It is safe to use in pregnancy and resists degradation by circulating vasopressinase. In patients with partial DI, agents that potentiate release of antidiuretic hormone can be used. These include chlorpropamide, clofibrate, and carbamazepine. They work effectively only if combined with hormone therapy, decreased solute intake, or diuretic administration .
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