Hyponatraemia and the Syndrome of Inappropriate Antidiuretic Hormone Secretion (SIADH) Induced by Psychotropic Drugs

Spigset, Olav; Hedenmalm, Karin

doi:10.2165/00002018-199512030-00006

Cited by 107 publications

(73 citation statements)

References 98 publications

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“…And other research fi ndings [17] suggested a considerable association between TCA and the occurrence of hyponatremia. Th e results of some recent studies [18] showed a lower incidence of hyponatremia in the application of TCAs (0.01% -0.33%) in comparison with previous studies (16.7%) [19,20], that can be explained by diff erent methodological approaches (active monitoring, higher hyponatremia threshold).…”

Section: Discussionmentioning

confidence: 78%

A case report of hyponatremia associated with maprotiline treatment

Stanković¹,

Pavlović²,

Jovičić³

et al. 2015

Hosp Pharm Int Multi J

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SUMMARYBackground: Maprotiline is a tricyclic antidepressant (sometimes classifi ed as a tetracyclic antidepressant), which is predominantly a norepinephrine/noradrenaline reuptake inhibitor, commonly prescribed for depression. Aim: To present a female patient with depressive episode and occurrence of hyponatremia during the maprotiline treatment. Case Report: A 62-year-old female was diagnosed with depressive episode four years ago. She was treated ambulatory with maprotiline 50mg/day and bromazepam 6mg/ day, from local psychiatrist. The patients also used enalapril 2x10 mg/day, metoprolol 2x50 mg/day, nifedipine 5 mg/day and simvastatin 20 mg/day for treating hypertension and dyslipidemia. After about 12 months of maprotiline use she was hospitalized at the Endocrinology unit of a local hospital due to appearance of confusion, unstable walking, cramps, as well as an increase in blood pressure. Then diagnosed hyponatremia (serum sodium level-112 mmol/L), corrected (137 mmol/L) by using parenteral therapy. The patient continued to use maprotiline without consultation with her psychiatrist. After one year, the patient was hospitalized at the Endocrinology unit of tertiary level due to detailed re-examination because of recurrent hyponatramia (117 mmol/L), corrected (136 mmol/L) by ambulatory use of parenteral therapy at a local hospital. Water test load was used and the Syndrome of inappropriate antidiuretic hormone secretion was diagnosed. Insulin Tolerance Test showed preserved the integrity of the hypothalamic-pituitary-adrenal axis. Antidepressant mirtazapine (15 mg/ day) was introduced due to recurrence of depression. Gradual reduction of depressive symptoms was observed to mirtazapine. Antihypertensive therapy, restriction of fl uid intake and dietary regimen were still applied. Serum sodium concentrations were in the normal ranges over the past 18 months. Conclusion: Serum sodium level should be measured before and during the therapy with any class of antidepressants, especially in those patients with increased risk of the hyponatremia occurrence.

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Section: Discussionmentioning

confidence: 78%

A case report of hyponatremia associated with maprotiline treatment

Stanković¹,

Pavlović²,

Jovičić³

et al. 2015

Hosp Pharm Int Multi J

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“…In our patient, the hyponatraemia was probably associated with the sertraline use. Its occurrence at 9 days after the antidepressant treatment was initiated (other authors have reported that hyponatraemia occurred after a median of 13 days of SSRI use, 5 together with the return of normal sodium plasma levels after the SSRI had been discontinued, reinforces the causality hypotheses. In addition, the advanced age of the patient might have favoured the antidepressant-induced SIADH by increasing antidiuretic hormone secretion and the response to osmolar stimuli.…”

mentioning

confidence: 62%

Sertraline-induced hyponatraemia

Papelbaum

Aguiar

2006

Rev. Bras. Psiquiatr.

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“…SIaDH is a well-recognized complication of many psychotropic drugs [7]. also, there are a few reports of benzodiazepine like lorazepam induced hyponatremia in literature [8].…”

Section: Discussionmentioning

confidence: 99%

Zolpidem Induced Hyponatremia: a Case Report

Priya

2014

JCDR

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CASE REPORTa 62-year-old male patient, doctor by profession, was admitted with gradual onset of drowsiness, nausea and vomiting of short duration. He was a known case of hypertension, diabetes mellitus and intervertebral disc prolapse of L3 -L4, L4-L5 joints for which midline decompression and laminectomy was done three years back. Despite the surgery, he continued to have low back ache and was later diagnosed with failed back syndrome for which he is on regular orthopaedic follow up.The patient also had a long history of insomnia for which he was receiving benzodiazepine alprazolam at bedtime for more than 10 y. He was initially taking nightly dose of 0.25 mg which he had gradually increased to 0.5 mg and then to 1 mg. He claims to have started taking the drug for sleeping difficulty but later continued it mainly due to pain related insomnia. about three years back, the patient had changed his medication to non-benzodiazepine hypnotic, zolpidem. He had started off with a dose of 5 mg, after which, he had progressively increased the dose to 10 mg and continued it for a period of upto four months before the date of admission for his present complaints. In the last 4 months, he had taken a high dose of 20 mg bed time daily. He was also receiving the combination of gliclazide 40 mg with metformin 250 mg twice daily, metoprolol 25 mg and the fixed drug combination of aspirin 75 mg and atorvastatin 10 mg once daily for the past five years.at admission, clinically the patient was found to be drowsy, arousable and moving all four limbs. He was euvolemic. His blood pressure was 120/80 mmHg. Complete blood counts showed leucocytosis, with a normal urine routine on investigation. biochemically, he had severe hyponatremia, low serum osmolarity, elevated urine spot sodium with normal urine osmolarity [Table/ Fig-1]. Renal, liver and thyroid function tests were normal. Serum cortisol was elevated [Table/ Fig-1] and lipid profile was within normal limits. Random and fasting blood glucose levels were normal. Serum calcium and lactate levels were also normal. blood and urine culture were sterile and ultrasound of the abdomen done showed fatty liver with cholelithiasis and grade I prostatomegaly.He was treated with fluid restriction, 3% saline infusion and vasopressin receptor antagonist, tolvaptan 15 mg once daily for a period of about 10 d for adequate correction of serum sodium in addition to withdrawal of the offending drug. Serial investigations done on the ensuing days showed normalization of sodium levels [ ABSTRACTZolpidem is a non-benzodiazepine hypnotic that acts by binding to (Gabaa) receptor. This is a case report of a patient with chronic insomnia for which he had initially been receiving benzodiazepine hypnotic alprazolam and for the past three years, he had switched himself to non-benzodiazepine hypnotic, zolpidem and had progressively increased the dose to 20 mg. The patient presented with history of drowsiness, nausea and vomiting of short duration. Investigations revealed that the patient had hyponatremia. Dec...

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Hyponatraemia and the Syndrome of Inappropriate Antidiuretic Hormone Secretion (SIADH) Induced by Psychotropic Drugs

Cited by 107 publications

References 98 publications

A case report of hyponatremia associated with maprotiline treatment

A case report of hyponatremia associated with maprotiline treatment

Sertraline-induced hyponatraemia

Zolpidem Induced Hyponatremia: a Case Report

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