Hyponatraemia Associated with Psychotropic Medications

Abstract

Psychotropic medication-induced hyponatraemia is an uncommon but important clinical problem with potential serious consequences if not recognised and treated early. Several risk factors have been associated with the development of hyponatraemia. This article reviews reported cases of hyponatraemia associated with the use of psychotropic medications and evaluates possible risk factors and causes. The data were sourced by a search of Medline for reports of hyponatraemia associated with the use of psychotropic medication between January 1966 and December 2000 and a search of US Food and Drug Administration (FDA) spontaneous reporting system database between January 1966 and December 1999. All the reports were included in this review. In the case reports the following data were assessed: age, gender, daily dosage, days to onset, days to recovery, medical condition, concurrent medications. Several risk factors were identified: advanced age, female gender, use of other medications, medical comorbidity. The risk of hyponatraemia was found to be higher during the first 2 weeks of treatment. Administration of the dosage of the drug was not found to be related to the development of hyponatraemia. Hyponatraemia can cause confusion, agitation and lethargy. Any change in the course of illness should alert the physician to the possibility of hyponatraemia.

Psychotropic drug-induced hyponatremia: results from a drug surveillance program–an update

“…As found in the present study, risk of drug-induced HN appears to be the highest during the first 2–3 weeks of treatment (Liu et al 1996 ; Wilkinson et al 1999 ; Kirby and Ames 2001 ; Madhusoodanan et al 2002 ; Fabian et al 2004 ; Mazhar et al 2020 ). About 75% of patients who suffer from SSRI-induced HN develop HN within the first 30 days of treatment.…”

“…The occurrence of SSRI-induced HN appears to be unrelated to dose (Madhusoodanan et al 2002 ; Egger et al 2006 ) or plasma levels (Stedman et al 2002 ; Fabian et al 2004 ). Dose-dependent effects of HN were found only for oxcarbazepine in this study.…”

Bupropion Induced Hyponatremia in an Elderly Patient: A Case Report and Review of the Literature

“…Antidepressants, including the selective serotonin reuptake inhibitor (SSRI), serotonin norepinephrine reuptake inhibitor (SNRI), and tricyclic antidepressants (TCA), can cause hyponatremia [ 1 , 2 ]. It is hypothesized that serotonin induces an increase in ADH which is mediated by the hypothalamic serotonin receptors and that the greater the potency of the drug to inhibit the reuptake of serotonin, the greater the chance of hyponatremia [ 3 ].…”

Hyponatremia Associated with Bupropion

“…However, hyponatremia is not rare condition following a treatment with SSRI and antipsychotic drugs1-5). Case reports of hyponatremia associated with SSRI began appearing in 1989.…”

“…Antidepressants, including the selective serotonin reuptake inhibitor (SSRI) and the tricyclic antidepressants (TCA) often cause hyponatremia1-5). Bupropion is an atypical antidepressant and smoking cessation aid.…”