Pantoprazole-related Symptomatic Hyponatremia

Ferreira, Filipa; Mateus, Sofia; Santos, Ana Rita; Moreira, Hugo; Ferreira, Natália Cristina

doi:10.12890/2015_000341

Cited by 11 publications

(10 citation statements)

References 6 publications

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“…Hyponatremia is a reported risk in human populations administered PPI with cases suggesting that age may play a role (12). In our study, hyponatremia was only observed in one animal Difference described post-administration levels minus pre-administration baseline.…”

Section: Discussionmentioning

confidence: 45%

“…When used in humans for therapy, multiple adverse events have been reported from patients administered PPIs, mainly skin reactions, nephritis, pancytopenia, anaphylaxis, edema, hepatotoxicity, as well as biochemical changes such as hyponatremia and hypomagnesemia (8)(9)(10)(11)(12)(13)(14). Pantoprazole specifically has been associated with thrombocytopenia, hepatotoxicity, and pancreatitis (9,11,(15)(16)(17).…”

Section: Introductionmentioning

confidence: 99%

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A Retrospective Clinical Investigation of the Safety and Adverse Effects of Pantoprazole in Hospitalized Ruminants

2020

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Clinical safety data for the use of gastroprotectants in hospitalized ruminants is lacking. In human patients, multiple adverse effects are possible from the use of pantoprazole including hematologic and electrolyte abnormalities as well as anaphylaxis and edema. The medical records of all hospitalized cattle, goats, and sheep administered pantoprazole over an ∼5-year period were retrospectively analyzed for adverse effects. Seventy-nine eligible patients were observed. Hypomagnesemia was observed after pantoprazole administration in 10 cattle; however, no significant changes were noted when compared to baseline before pantoprazole administration. Significant changes were noted in serum indicators of hepatic and renal function; however, these represented downward trends that were most likely clinically insignificant. Anaphylaxis after pantoprazole administration was not observed; however, seven cattle displayed edema after pantoprazole administration. Veterinary clinicians should be aware of the potential for hypomagnesemia in hospitalized ruminants being administered pantoprazole and monitor patients accordingly. While these preliminary retrospective results indicate that pantoprazole may be a safe adjunctive therapy in hospitalized ruminants, additional studies are necessary to further determine the safety and toxicity of pantoprazole in ruminants.

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Section: Discussionmentioning

confidence: 45%

Section: Introductionmentioning

confidence: 99%

A Retrospective Clinical Investigation of the Safety and Adverse Effects of Pantoprazole in Hospitalized Ruminants

2020

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“…However, with long-term use several adverse effects are reported, such as a changed gut microbiome, fundic mucosal hypertrophy, Clostridium difficile infection, vitamin B12 deficiency, hypomagnesemia, and acute interstitial nephritis [11]. There are only a few reports on PPI-induced hyponatremia with either omeprazole or pantoprazole [12][13][14][15]. Durst et al reported the reoccurrence of hyponatremia after reintroducing omeprazole [12].…”

Section: Discussionmentioning

confidence: 99%

Omeprazole-induced and pantoprazole-induced asymptomatic hyponatremia: a case report

2020

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Background: Hyponatremia is the most common electrolyte disorder. Thiazides, antidepressants, antipsychotic drugs, and antiepileptic drugs are well-known causes of hyponatremia. Proton pump inhibitor use is a rare cause of hyponatremia and, when reported, it is due to one specific proton pump inhibitor, mostly omeprazole. Case presentation: A 67-year-old Caucasian male was referred to our outpatient clinic because of hyponatremia (127 mmol/L) found at routine laboratory examination. He had consulted his general practitioner because of abdominal pains. No other symptoms were present. At physical examination, he appeared euvolemic and had no abdominal tenderness. Besides omeprazole for reflux esophagitis he used no medication. Additional laboratory results included: serum osmolarity 274 mOsmol/kg, urinary osmolarity 570 mOsmol/kg, and urinary sodium 35 mmol/L. Other causes of hyponatremia were excluded and we diagnosed hyponatremia due to the syndrome of inappropriate antidiuretic hormone secretion secondary to use of omeprazole. Omeprazole was replaced by ranitidine after which his serum sodium levels normalized to 135 mmol/L. During follow-up, because of persistent reflux complaints despite ranitidine use, ranitidine was switched to another proton pump inhibitor: pantoprazole. After this intervention, his serum sodium level declined again to 133 mmol/L. We concluded that both omeprazole and pantoprazole induced syndrome of inappropriate antidiuretic hormone secretion in this patient. Conclusion: Hyponatremia is worrisome and awareness of medication-induced hyponatremia, especially due to proton pump inhibitors, is needed. In our case, sequential hyponatremia occurred with two different proton pump inhibitors, suggesting a class effect. Therefore, when syndrome of inappropriate antidiuretic hormone secretion due to a proton pump inhibitor is diagnosed, preferably no other medication from the same class is prescribed. When after consideration another proton pump inhibitor is prescribed, serum sodium concentrations should be monitored.

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“…PPIs are often considered devoid of ADRs (Nachnani et al 2015 ) and are liberally prescribed (Falhammar et al 2019b ). Most published case reports of PPI-induced HN were related to the use of omeprazole and esomeprazole (Ferreira et al 2016 ; van der Zalm et al 2020 ) which are also viewed as the PPIs with the highest risk for this overall rare PPI-induced ADR (Falhammar et al 2019b ). Lansoprazole was first reported to be involved in HN in 2000 (Fort et al 2000 ), while indications of pantoprazole-induced HN arose in 2014 (Naharcý et al 2014 ).…”

Section: Discussionmentioning

confidence: 99%

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

Seifert

Letmaier

Greiner³

et al. 2021

J Neural Transm

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Hyponatremia (HN) is the most common electrolyte imbalance (defined as a serum sodium concentration Na(S) of < 130 mmol/l) and often induced by drugs including psychotropic drugs. AMSP (Arzneimittelsicherheit in der Psychiatrie) is a multicenter drug surveillance program that assesses severe or unusual adverse drug reactions (ADRs) occurring during treatment with psychotropic drugs. This study presents data from 462,661 psychiatric inpatients treated in participating hospitals between 1993 and 2016 and serves as an update of a previous contribution by Letmaier et al. (JAMA 15(6):739–748, 2012). A total of 210 cases of HN were observed affecting 0.05% of patients. 57.1% of cases presented symptomatically; 19.0% presented with severe symptoms (e.g., seizures, vomiting). HN occurred after a median of 7 days following the first dose or dose increase. Incidence of HN was highest among the two antiepileptic drugs oxcarbazepine (1.661% of patients treated) and carbamazepine (0.169%), followed by selective serotonin-norepinephrine reuptake inhibitors (SSNRIs, 0.088%) and selective serotonin reuptake inhibitors (0.071%). Antipsychotic drugs, tricyclic antidepressants, and mirtazapine exhibited a significantly lower incidence of HN. The risk of HN was 16–42 times higher among patients concomitantly treated with other potentially HN-inducing drugs such as diuretic drugs, angiotensin-converting-enzyme inhibitors, angiotensin II receptor blockers, and proton pump inhibitors. Female SSNRI-users aged ≥ 65 years concomitantly using other HN-inducing drugs were the population subgroup with the highest risk of developing HN. The identification of high-risk drug combinations and vulnerable patient subgroups represents a significant step in the improvement of drug safety and facilitates the implementation of precautionary measures.

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Pantoprazole-related Symptomatic Hyponatremia

Cited by 11 publications

References 6 publications

A Retrospective Clinical Investigation of the Safety and Adverse Effects of Pantoprazole in Hospitalized Ruminants

A Retrospective Clinical Investigation of the Safety and Adverse Effects of Pantoprazole in Hospitalized Ruminants

Omeprazole-induced and pantoprazole-induced asymptomatic hyponatremia: a case report

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

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