Amelioration of Polyuria by Amiloride in Patients Receiving Long-Term Lithium Therapy

Vasopressin-resistant diabetes insipidus is a common side effect of the treatment of affective disorders with lithium. We studied the effect of amiloride on lithium-induced polyuria in nine such patients receiving maintenance lithium therapy who had a vasopressin-resistant defect in urinary concentrating ability. After a mean (±S.E.) of 24±6 days of amiloride administration, the urine volume fell (from 4.7±0.6 to 3.1±0.3 liters per 24 hours; P<0.005), and the urine osmolality increased (from 228±35 to 331±34 mOsm per kilogram of H20; P<0.001). The decrease in urine output was sustained during six months of observation in the absence of any significant change in plasma levels of lithium, potassium, or bicarbonate; urinary excretion of sodium or lithium; or creatinine clearance. Amiloride administration was also associated with a significant increase in urine osmolality (from 575±54 to 699±48 mOsm per kilogram of H₂0; P<0.005) measured after fluid deprivation and the injection of exogenous vasopressin. We conclude that amiloride mitigates lithium-induced polyuria, at least partly, by blunting the inhibitory effect of lithium on water transport in the renal collecting tubule. Thus, amiloride may provide a specific therapy for polyuria in lithium-treated patients while obviating the need for potassium supplementation in the treatment of this kind of polyuria. (N Engl J Med 1985; 312:408–14.).