Severe Hyponatremia Associated With the Use of Pantoprazole

Nachnani, Jagdish; Bulchandani, Deepti; Bulchandani, Sheetal

doi:10.14309/00000434-201510001-00597

Cited by 2 publications

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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 ).…”

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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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