A review on hyponatremia associated with SSRIs, reboxetine and venlafaxine

Egger, Christoph; Muehlbacher, Moritz; Nickel, Marius; Geretsegger, Christian; Stuppaeck, C.

doi:10.1080/13651500500410216

Cited by 18 publications

(10 citation statements)

References 85 publications

(89 reference statements)

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“…Among internistic drugs, especially thiazide diuretics are reported to enhance the risk of HN. Taking into account the high co-morbidity of depression and arterial hypertension in the elderly and the higher prescribing rates of SSRIs in this group of patients, it seems obvious that these patients have a higher risk of developing HN (Egger et al 2006 ;Liu et al 1996 ;Smith, 2010).…”

Section: Discussionmentioning

confidence: 98%

Hyponatraemia during psychopharmacological treatment: results of a drug surveillance programme

Letmaier

Painold

Holl

et al. 2011

Int. J. Neuropsychopharm.

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Hyponatraemia (HN) can be a life-threatening medical condition which may lead to severe neurological and psychiatric symptoms. The AMSP (Arzneimittelsicherheit in der Psychiatrie) is a multicentre drug surveillance programme that assesses severe or new adverse drug reactions during psychopharmacological treatment in psychiatric inpatients. We report on a total of 263 864 psychiatric inpatients monitored from 1993 to 2007 in 80 psychiatric hospitals in Germany, Switzerland and Austria. During this period plasma sodium levels below 130 mmol/l (severe HN according to AMSP) were reported in 93 patients (relative frequency 0.04%). On average, the plasma sodium levels of all cases were 119.7 mmol/l (±5.8 s.d.); median 121 mmol/l (range 104-129 mmol/l). Patients who showed no clinical signs (n=65, 70%) had a mean sodium level of 121.3 mmol/l (±5.0 s.d.); median 122 mmol/l (range 114-129 mmol/l). By contrast, patients with clinical symptoms (n=28, 30%) had a mean sodium level of 116.0 mmol/l (±6.0 s.d.); median 117 mmol/l (range 104-125 mmol/l). HN was mainly observed during treatment with selective serotonin reuptake inhibitors (SSRIs) (0.06%), Serotonin noradrenaline reuptake inhibitors (SNRIs) (0.08%), carbamazepine (0.10%) and oxcarbazepine (1.29%); the highest rate was found for oxcarbazepine. Antipsychotics, mirtazapine and tricyclic antidepressants were only rarely involved in HN (0.003-0.005%). Combinations of several drugs known to induce HN significantly increased the risk of HN, e.g. more than 10-fold for SSRI+diuretics+ACE inhibitors (0.37%) vs. SSRI given alone (0.02%). This is clinically relevant because such combinations, e.g. SSRI+diuretics may occur especially in elderly patients, who are in general at higher risk of developing HN.

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Section: Discussionmentioning

confidence: 98%

Hyponatraemia during psychopharmacological treatment: results of a drug surveillance programme

Letmaier

Painold

Holl

et al. 2011

Int. J. Neuropsychopharm.

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“…Istnieje wiele danych na temat występowania hiponatremii po zastosowaniu selektywnych inhibitorów wychwytu zwrotnego serotoniny (SSRI) [27]. Wiele badań iż zarówno neuroleptyki klasyczne, jak i atypowe mogą wiązać się z pojawieniem polekowej hiponatremii [52].…”

Section: Leczenie Siadhunclassified

“…There are many reports on the occurrence of hyponatremia following the use of selective serotonin reuptake inhibitors (SSRIs) [27]. Many studies confirm that SSRIs are the most common iatrogenic cause of hyponatremia [28], and that one in every 200 SSRI patients develops hyponatremia [29].…”

Section: Siadh and Antidepressantsmentioning

confidence: 99%

Hiponatremia in the practice of a psychiatrist. Part 1: SIADH syndrome and drug-induced hyponatremia.

Stelmach

Hołownia

Słotwiński

et al. 2017

Current Problems of Psychiatry

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Introduction. Hyponatremia is an important part of psychiatric practice. In order to analyze its causes and symptoms, the literature on hyponatremia in psychiatric patients has been reviewed. The work has been divided into two separate manuscripts. In the first one the authors discuss the syndrome of inappropriate antidiuretic hormone secretion (SIADH) and hyponatremia occurring with the use of psychotropic drugs (antidepressants, antipsychotics, normotimics), while the second paper discusses research on psychogenic polydipsia. The causes of hyponatremia in patients treated in psychiatric wards include: water intoxication associated with polydipsia, somatic comorbidities, side effect of internal medicine and psychiatric drugs. The most common mechanism leading in these cases to hyponatremia is the syndrome of inappropriate secretion of vasopressin (SIADH). The SIADH syndrome is a group of symptoms, first described in 1967 by Schwartz and Bartter in The American Journal of Medicine, which results from the hypersecretion of antidiuretic hormone, also called vasopressin, which causes patients to develop normovolemic hyponatremia. The phenomenon of drug-induced hyponatremia in psychiatric practice is generally observed with the use of antidepressants, antipsychotics and anti-epileptic drugs (used in psychiatry as normotimic drugs).Aim and method. The first manuscript includes a review of literature on the syndrome of inappropriate secretion of vasopressin (SIADH) and hyponatremia occurring after the use of psychotropic drugs, and is divided into two subsections: 1. The syndrome of inappropriate secretion of vasopressin (SIADH), 2. Hyponatremia and psychotropic drugs (antidepressants, antipsychotics, normotimics).Conclusion. In the view of the reviewed literature it is extremely important to control the natremia level during pharmacotherapy using the above mentioned drugs, especially in the initial period of therapy.

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“…It has therefore been suggested that serum sodium concentrations be corrected no faster than 0.5 mEq/L/h and 8-12 mEq/L in the first 24 hours, with complete correction over 48-96 hours. 2,26 Upon discontinuation of the SSRI, the time course of return to normal sodium concentrations has ranged from 48 hours to 6 weeks, with most cases resolving within 2 weeks. 2 There is a paucity of published data on rechallenge with the same drug.…”

Section: Treatment and Time Coursementioning

confidence: 99%

“…1 If untreated, hyponatremia can lead to seizure, coma, and respiratory arrest when serum sodium levels fall below 120 mmol/l. 2 Worldwide, the population is aging, with more prominent demographic shifts occurring in developed nations with the best access to health care. Aged persons are susceptible to depression at a rate that exceeds that of their younger peers.…”

Section: Introductionmentioning

confidence: 99%

Association between serum sodium levels and selective serotonin reuptake inhibitors in patients with depression

Rajiv

Nandimath

2017

Int J Basic Clin Pharmacol

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Background: Hyponatremia is known to occur in patients on antidepressants. It is prevalent in approximately 2.5% of general hospital inpatient population, but can approach 11% among elderly patients. Relying only on symptoms for detecting hyponatremia may lead to under-diagnosing of hyponatremia; therefore, routine and frequent testing for serum sodium level is recommended, especially for older patients. This study is done to analyse the association between serum sodium levels and SSRIs in patients with depression. Methods: A Prospective, Interventional study in the in-patient and out-patient department of Psychiatry Department was conducted for 3 months (August 2105 to October 2015). A total of 100 patients, aged over 18 years, diagnosed of depression, on SSRIs were analysed. Changes in serum sodium levels were observed at baseline and Week 4 of starting SSRI. Results: A total of 100 patients were analyzed. 8 patients had serum sodium ≤130mmol-1, out of which 5 were females (62.5%) and 3 were males (37.5%). Prevalence of hyponatremia was more pronounced in patients aged >60 years (100%), on Fluoxetine or Sertraline. Patients between15 to 45 years of age did not experience any clinically significant hyponatremia at the fourth week after the therapy. Conclusions: Our study indicates that users of SSRIs in elderly age group have a higher risk of developing hyponatremia. Clinicians evaluating elderly patients taking SSRIs are encouraged to monitor serum sodium if the patient presents with vague, nonspecific symptoms commonly associated with older age or depression to rule-out SIADH.

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A review on hyponatremia associated with SSRIs, reboxetine and venlafaxine

Cited by 18 publications

References 85 publications

Hyponatraemia during psychopharmacological treatment: results of a drug surveillance programme

Hyponatraemia during psychopharmacological treatment: results of a drug surveillance programme

Hiponatremia in the practice of a psychiatrist. Part 1: SIADH syndrome and drug-induced hyponatremia.

Association between serum sodium levels and selective serotonin reuptake inhibitors in patients with depression

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