To diurese or to anti-diurese—that is the question.

So begins a pair of articles about increasing or decreasing the amount of urine output. This first one will discuss anti-diuresis, or the inhibition of urinary output. This is done with drugs called antidiuretics, and to understand them, it is helpful to discuss nature’s way of doing the same thing with a hormone upon which the synthetic drugs are based.

What is Anti-diuretic hormone (ADH, or vasopressin)?

The posterior pituitary gland in your brain stores and releases anti-diuretic hormone (ADH, or vasopressin), which is made in the hypothalamus. This hormone decreases the amount of urine that is produced by your kidneys. At first, this sounds like the opposite of what is desirable, because urinating several times a day is a good indicator that all is well—your heart is pumping blood with enough healthy force to reach your kidneys and a good blood pressure there is obviously in effect. So directly it gives you an assessment of your kidneys, but indirectly it is a check on your heart and blood pressure.

ADH and Dehydration

The human body isn’t a clump of clay, although you may feel differently about some certain people in your life. No, it is a dynamic interplay of actions involving, for one thing, fluid dynamics. Your body’s ADH comes into play if you are dehydrated. You are always losing fluids, whether you know it or not. You breathe out humidity, you sweat, and you urinate. Even your bowel movements and bile have moisture, not to mention your saliva and tears. If you put out more fluid than you take in (drinking and eating), ADH will decrease your fluid loss by limiting urination to keep things balanced. In fact, it is the principle regulator of making sure of this fluid dynamics balance.

Where is ADH produced in our body?

ADH is produced in your hypothalamus when pressure sensors there sense if there is too little pressure, meaning too little fluid in the hoses, so to speak. ADH production will also be stimulated by volume receptors in your left heart and pulmonary veins when they indicate your total blood volume is down. It is no different from the reason EMS workers start an IV in trauma patients—to correct the low blood volume from a victim’s blood loss by pumping in fluids. Your body accomplishes the same thing by preventing your losing fluids through the urine.

What affects the production of ADH?

Genetics and acquired causes

Your body is a genius at achieving that Goldilocks level of function—not too much of anything and not too little of anything. But…just right. But what if something interferes with this? Damage to your pituitary or hypothalamus from head trauma or meningitis, kidney disease that makes your kidneys unresponsive to ADH, pregnancy complications that destroy the mother’s ability to make it, and excessive water-drinking (which can make your kidneys insensitive to ADH) are all causes of things going wrong. This results in something called diabetes insipidus, which is the main reason one would take one of a class of drugs called the antidiuretics. If ADH is Goldilocks, diabetes insipidus is when the bears come home.

Diabetes insipidus

Diabetes insipidus has nothing to do with diabetes mellitus (the “sugar” diabetes from insulin production failure or insulin resistance). The same name came about when the excessive urination with ADH hypofunction was confused with the excessive urination of diabetes mellitus (which has nothing to do with ADH but with insulin—or the lack thereof). Homonyms only, not synonyms. Remember those?

Is Alcohol a diuretic?

So you have your ADH out of whack and you suffer with excessive urination and thirst. Sound familiar? Remember that morning-after when you swore you’d never drink again? You began urinating excessively by the second beer, which can ruin any road trip for sure. Your thirst will be your payback for all of this fluid loss. This demonstrates beautifully what it’s like without adequate ADH, because alcohol turns off your ADH. (Now you know.)

Diuretics and Antidiuretics

But if you’re not drinking but instead have a genetic cause or an acquired cause (see above) of inadequate ADH functioning, this is corrected with medications called antidiuretics. If diuretics refer to medicines that make you urinate, then antidiuretics are the opposite, of course.

 

FAQs About Antidiuretics

What are antidiuretic drugs?

These are drugs that are ADH or ADH-analogs (synthetics). They include ADH (vasopressin), as well as the other antidiuretic class:

  • vasopressin—synthetic pituitary ADH hormone
  • desmopressin—synthetic version of the ADH hormone found in the kidney
  • argipressin—a version of vasopressin that emphasizes the presence of arginine

The most common Antidiuretic medications include: Generic and brand drugs cointaining desmopressin such as the generic APO-desmopressin and brand brands like Ddavp or Minirin; in the form of tablets or sprays. See a list here.  

What are antidiuretics used for?

Besides the main indication of diabetes insipidus, it can also be useful in bedwetting (enuresis), dehydration, and conditions increasing dehydration.

Who should not use antidiuretics?

People with asthma, kidney disease, congestive heart failure, migraine headaches, and circulation problems.

How is it taken?

Several ways: orally, subcutaneous injection, and even via a nasal spray.

What are some side effects?

Decreased urination, although I wouldn’t call this a side effect, but THE effect; also, drowsiness, headache, shortness of breath/wheezing, allergic rash, rapid weight gain via fluid retention, and nausea.

Are there alternatives?

Not really. Theoretically, you could increase the concentration of your blood by consuming high-sugar or high-salt items, but if you really have an underachieving ADH, you’re just going to urinate out the fluid retention that comes from such tricks.

What is an interesting fact about ADH?

It has a secondary effect similar to the secondary effect of its sister pituitary hormone, oxytocin, in that it enhances bonding and facilitates social behavior. This makes ADH both human and humanistic.

 

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Resources:

http://www.pharmainfo.net/msandhyasravya/blog/diuretics-and-anti-diur.html

https://meshb.nlm.nih.gov/record/ui?name=Antidiuretic%20Agents

http://www.pharmainfo.net/msandhyasravya/blog/diuretics-and-anti-diuretics

https://www.uptodate.com/contents/hypothalamic-pituitary-axis



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