Carbamazepine can induce kidney water absorption by increasing aquaporin 2 expression.
BACKGROUND
Carbamazepine (Carba) is an anticonvulsant and psychotropic drug used widely for the treatment of intellectual disability and severe pains, but the incidence of hyponatremia is a common related occurrence. This hyponatremia is frequently attributed to a SIADH induced by this drug. It is also known that Carba is used to decrease the urinary volume in Diabetes Insipidus (DI) because it has an antidiuretic effect. Lithium (Li) is one of the most important drugs used to treat bipolar mood disorders. However Li has the undesirable capacity to induce DI. Nowadays, the association of these drugs is used in the treatment of patients with psychiatric and neurological problems.


METHODS
In vivo and in vitro (microperfusion) experiments were developed to investigate the effect of Carba in the rat Inner Medullary Collecting Duct (IMCD).


RESULTS
The results revealed that Carba was able to stimulate the V2 vasopressin receptor-Protein G complex increasing the (Pf) and water absorption. In vivo studies showed that in rats with lithium-induced DI, Carba decreased the urinary volume and increased the urinary osmolality. AQP2 expression was increased both in normal IMCD incubated with Carba and in IMCD from lithium-induced DI after Carba addition to the diet, when compared with the control.


CONCLUSIONS
These results showed that the hyponatremia observed in patients using this anticonvulsant drug, at least in part, is due to the Carba capacity to increase IMCD's Pf and that the Lithium-Carbamazepine association is beneficial to the patient.
de Bragança
Ana C
AC
Universidade de Sao Paulo, Hospital das Clínicas da Faculdade de Medicina da USP, Sao Paulo, Brazil.
Moyses
Zenaide P
ZP
Magaldi
Antonio J
AJ
D000042:Absorption / Q000187:drug effects; D000818:Animals; D000927:Anticonvulsants / Q000009:adverse effects / Q000494:pharmacology*; D051399:Aquaporin 2 / Q000378:metabolism*; D002220:Carbamazepine / Q000009:adverse effects / Q000494:pharmacology*; D003919:Diabetes Insipidus / Q000139:chemically induced / Q000378:metabolism; D004195:Disease Models, Animal; D007010:Hyponatremia / Q000139:chemically induced / Q000378:metabolism; D007685:Kidney Tubules, Collecting / Q000187:drug effects / Q000378:metabolism*; D018021:Lithium Chloride / Q000009:adverse effects / Q000494:pharmacology; D008297:Male; D051381:Rats; D017208:Rats, Wistar; D017483:Receptors, Vasopressin / Q000378:metabolism; D014867:Water / Q000378:metabolism*
D000927:Anticonvulsants; D051399:Aquaporin 2; D017483:Receptors, Vasopressin; D014867:Water; D002220:Carbamazepine; D018021:Lithium Chloride