Hyponatraemia: An Audit of Aged Psychiatry Patients Taking SSRIs and SNRIs

Giorlando, Francesco; Teister, Julia; Dodd, Seetal; Udina, Marc; Berk, Michael

doi:10.2174/15748863113089990036

Cited by 16 publications

(27 citation statements)

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“…86 cases of sertraline showed hyponatremia [5]. An audit of aged psychiatric patients using SSRI and SNRI showed that risk of hyponatremia is more with increasing age, female gender and more commonly associated with escitalopram and sertraline [10]. A very recent study has shown a higher prevalence of hyponatremia in patients with depression who are being prescribed SSRI and SNRI [11].…”

Section: Discussionmentioning

confidence: 99%

Sertraline induced hyponatremia

Bhat

Thanusubramanian

Balaji

2017

Asian J Pharm Clin Res

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A 53-year-old female patient with a history of carcinoma of the breast in remission and dilated cardiomyopathy on treatment was newly diagnosed with depression. She was started on sertraline 50 mg once a day. 2 days later she developed severe hyponatremia (serum sodium 114 mEq/l). Her condition further deteriorated and on the 6 th day her medication was stopped and replaced with mirtazapine. Osmolality studies she was diagnosed with syndrome of inappropriate antidiuretic hormone secretion. She was treated with IV sodium chloride for her hyponatremia. At discharge serum sodium levels improved (127 mEq/l) and subsequent follow-up 4 weeks later showed normal sodium values (138 mEq/L).

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Section: Discussionmentioning

confidence: 99%

Sertraline induced hyponatremia

Bhat

Thanusubramanian

Balaji

2017

Asian J Pharm Clin Res

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“…Os sintomas raramente surgem antes do Na + sérico descer para valores inferiores a 130 mEq/L e dependem da gravidade da hiponatremia (Tabela 2). A hiponatremia normalmente ocorre nas primeiras 10 semanas de tratamento e 79% dos casos nas primeiras três semanas 9 . Entre os fatores de risco de hiponatremia, encontram-se idade, sexo feminino, utilização de medicação concomitante que provoque hiponatremia (antidiabéticos, anti-inflamatórios não esteroides, anticonvulsivantes e, principalmente, os diuréticos tiazídicos e inibidores da enzima conversora de angiotensina -IECA), história de pneumonia recente e perturbação do humor, estando os três primeiros associados também a hiponatremia mais severa 1,6,10 .…”

Section: Métodosunclassified

“…A dieta com restrição de sódio concomitante também pode potenciar o desenvolvimento de hiponatremia 12 . Pensa-se que os ADs podem provocar a estimulação direta ou indireta da libertação de ADH, possivelmente mediante a estimulação da serotonina com atividade aumentada, ou que modulam a ação da ADH no rim causando retenção de água e hiponatremia 7,9,11,13 . Os critérios de diagnóstico de SIADH podem ser encontrados na Tabela 3.…”

Section: Mecanismo Da Hiponatremiaunclassified

Hiponatremia associada a antidepressivos: uma revisão

Costa¹,

Marins²

2018

J. bras. psiquiatr.

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RESUMOObjetivo: Rever a literatura mais recente sobre a associação entre a hiponatremia e o uso de antidepressivos. Métodos: Pesquisa bibliográfica nas bases de dados PubMed e SciELO, com os descritores "antidepressive agents" e "hyponatremia", incluindo artigos de janeiro de 2006 a maio de 2016. Resultados: Foram incluídos 45 artigos. A idade, o sexo feminino e a polimedicação são os fatores de risco mais relevantes, e os sintomas dependem da gravidade da hiponatremia. A hiponatremia pode ter várias causas, sendo a mais comum a síndrome da secreção inapropriada do hormônio antidiurético. Entre os inibidores seletivos da recaptação de serotonina, o citalopram e o escitalopram apresentam risco superior, à semelhança da venlafaxina. O risco de hiponatremia parece ser inferior com as classes restantes, à exceção dos inibidores da monoaminoxidase. Recomenda-se um ionograma prévio ao tratamento em doentes com mais de 60 anos e, sempre, um ionograma um mês após o seu início. O primeiro passo do tratamento é a suspensão do fármaco, revertendo a maioria dos casos leves. No entanto, o tratamento deve ser individualizado, considerando os riscos da hiponatremia e da correção. Conclusões: A hiponatremia é um efeito colateral a considerar nos doentes que tomam antidepressivos. Quando a manutenção do tratamento é necessária, deve ser evitado o mesmo antidepressivo ou outro da mesma classe, sendo opções a trazodona, abupropiona, a agomelatina, a mirtazapina e a reboxetina, porque existem poucos relatos de hiponatremia com esses fármacos. ABSTRACTObjective: Review the most recent literature about the association between hyponatremia and antidepressives' intake. Methods: Bibliographic search in PubMed and SciELO databases, with the MeSH terms "antidepressive agents" and "hyponatremia", including articles between January 2006 and May 2016. Results: A total of 45 articles have been included. Age, female sex and polymedication are the main risk factors and symptoms depend on hyponatremia severity. Hyponatremia may have several causes, being the most common the syndrome of inappropriate antidiuretic hormone secretion. Between the selective serotonin reuptake inhibitors, citalopram and escitalopram presented a bigger risk, similarly to venlafaxine. Risk of hyponatremia seems smaller with the other antidepressives' classes, with exception to

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“…Giorlando et al, in a retrospective study from 2013, found that risk factors for hyponatremia following SSRI and SNRI were age > 65 years, female sex and sertraline or escitalopram use [37]. Other risk factors for hyponatremia include past events of hyponatremia in the patient, body weight <60 kg, psychotic symptoms [31], female sex [25] and antidepressant combination with diuretics, angiotensin converting enzyme inhibitors (ACEI) or inhibitors of protonic pump (IPP) [34].…”

Section: Siadh and Antidepressantsmentioning

confidence: 99%

“…Retrospektywne badanie z 2013 roku przeprowadzone przez Giorlando i wsp. wykazało, że do czynników ryzyka wystąpienia hiponatremii po zastosowaniu leków z grupy SSRI i SNRI należą wiek > 65 roku życia, płeć żeńska oraz zastosowanie sertraliny lub escitalopramu [37]. Wśród innych czynników ryzyka rozwoju hiponatremii można występowanie hiponatremii u pacjenta w przeszłości, masę ciała < 60kg, obecność objawów psychotycznych [31], płeć żeńską [25] oraz stosowanie leków przeciwdepresyjnych w skojarzeniu z diuretykami, inhibitorami konwertazy angiotensyny (ACEI) lub inhibitorami pompy protonowej (IPP) [34].…”

Section: Przyczynyunclassified

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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Hyponatraemia: An Audit of Aged Psychiatry Patients Taking SSRIs and SNRIs

Cited by 16 publications

References 0 publications

Sertraline induced hyponatremia

Sertraline induced hyponatremia

Hiponatremia associada a antidepressivos: uma revisão

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

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