Aripiprazole-Induced Syndrome of Inappropriate Antidiuretic Hormone Secretion (SIADH)

Abstract

Aripiprazole is a newer atypical antipsychotic agent used for effective treatment of schizophrenia. It significantly reduces unwanted side effects of older typical antipsychotics by targeting, with high affinity, dopamine D2/D3 and serotonin 5-HT1A/5-HT-2A receptors. Its documented mechanism of action makes it an unlikely agent to cause syndrome of inappropriate antidiuretic hormone secretion (SIADH). We present the first reported case of SIADH caused by aripiprazole in a patient with history of schizophrenia without other precipitating factors to explain hyponatremia or SIADH.

Syndrome of inappropriate antidiuretic hormone associated with aripiprazole

“…Four other cases of possible aripiprazole-related hyponatremia have been reported in the literature. 22,[27][28][29] In two of these cases, hyponatremia occurred within days of aripiprazole dosage titration to 20 mg per day; in two cases, the patient was reported to be receiving other psychotropic medications that have been associated with SIADH. Our patient was also prescribed bupropion hydrochloride 150 mg twice daily and a high but stable dose of sertraline (300 mg per day).…”

Antipsychotic-Induced Hyponatremia: Case Report and Literature Review

“…It is usually drug induced and is the most common form of hyponatremia in hospitalized patients. 4 A clinician should suspect SIADH in patients with concentrated urine (urine osmolality . 300), decreased serum osmolality (urine osmolality .…”

Recognition and treatment of hyponatremia in psychiatric practice: Analysis of the frequency and report of case series

“…Osobe sa psihijatrijskim poremećajima predstavljaju grupu pacijenata u riziku od nastanka hiponatremije, pre svega zbog osobina pojedinih psihofarmaka, a zatim i usled određenih psihopatoloških fenomena (primarna polidipsija). Psihofarmaci, najpre antidepresivi (triciklični antidepresivi (TCA) -amitriptilin; selektivni inhi-bitori preuzimanja serotonina (SSRI) -citalopram, escitalopram, paroksetin; antidepresivi iz grupe NaSSA -mirtazapin), zatim antikonvulzivi (karbamazepin, fenitoin, valproat, lamotrigin) i antipsihotici (fenotiazini, haloperidol, risperidon, kvetijapin, olanzapin, aripiprazol, klozapin) povezani su sa rizikom od nastanka hiponatremije posredstvom mehanizama koji dovode do sindroma neadekvatnog lučenja antidiuretskog hormona (SIADH) [1,2,4,[6][7][8][9][10][11][12] . Sa druge strane, sindrom preteranog uzimanja tečnosti, odnosno intoksikacija vodom, koja je relativno čest psihopatološki fenomen udružen sa psihotičnim poremećajima, može dovesti do intoksikacije vodom i dilucione hiponatremije [4,[13][14][15] .…”