Hyponatraemia during psychopharmacological treatment: results of a drug surveillance programme
Open accessAbstract
Hyponatraemia (HN) can be a life-threatening medical condition which may lead to severe neurological and psychiatric symptoms. The AMSP (Arzneimittelsicherheit in der Psychiatrie) is a multicentre drug surveillance programme that assesses severe or new adverse drug reactions during psychopharmacological treatment in psychiatric inpatients. We report on a total of 263 864 psychiatric inpatients monitored from 1993 to 2007 in 80 psychiatric hospitals in Germany, Switzerland and Austria. During this period plasma sodium levels below 130 mmol/l (severe HN according to AMSP) were reported in 93 patients (relative frequency 0.04%). On average, the plasma sodium levels of all cases were 119.7 mmol/l (±5.8 s.d.); median 121 mmol/l (range 104-129 mmol/l). Patients who showed no clinical signs (n=65, 70%) had a mean sodium level of 121.3 mmol/l (±5.0 s.d.); median 122 mmol/l (range 114-129 mmol/l). By contrast, patients with clinical symptoms (n=28, 30%) had a mean sodium level of 116.0 mmol/l (±6.0 s.d.); median 117 mmol/l (range 104-125 mmol/l). HN was mainly observed during treatment with selective serotonin reuptake inhibitors (SSRIs) (0.06%), Serotonin noradrenaline reuptake inhibitors (SNRIs) (0.08%), carbamazepine (0.10%) and oxcarbazepine (1.29%); the highest rate was found for oxcarbazepine. Antipsychotics, mirtazapine and tricyclic antidepressants were only rarely involved in HN (0.003-0.005%). Combinations of several drugs known to induce HN significantly increased the risk of HN, e.g. more than 10-fold for SSRI+diuretics+ACE inhibitors (0.37%) vs. SSRI given alone (0.02%). This is clinically relevant because such combinations, e.g. SSRI+diuretics may occur especially in elderly patients, who are in general at higher risk of developing HN.
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Within SSRIs, citalopram and escitalopram were constantly noted for higher incidences of hyponatremia than other SSRIs.
“Within SSRIs, citalopram and escitalopram were constantly noted for higher incidences than other SSRIs.7475”
From Addressing the Side Effects of Contemporary Antidepressant Drugs: A Comprehensive Review (2018) · cites this paper as [75]
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- Authors
- Letmaier, M., Painold, A., Holl, A. K., Vergin, H., Engel, R., Konstantinidis, A., Kasper, S., & Grohmann, R.
- Affiliations
- Medical University of Graz (AT)
- Friedrich-Alexander-Universität Erlangen-Nürnberg (DE)
- Ludwig-Maximilians-Universität München (DE)
- Medical University of Vienna (AT)
- Corresponding author
- Letmaier, Martin
- Venue
- The International Journal of Neuropsychopharmacology
- Publisher
- Oxford University Press (OUP)
- Published
- 2011-07-22
- Volume
- 15
- Issue
- 06
- Pages
- 739-748
- ISSN
- 1461-1457 (ISSN-L)
- 1469-5111
- OpenAlex
- W2119148119
- Cited by
- 87
- References
- 26
- Citations by year
- 2026: 3 · 2025: 6 · 2024: 2 · 2022: 6 · 2021: 9 · 2019: 14 · 2018: 4 · 2017: 8 · 2016: 10 · 2015: 5 · 2014: 8 · 2013: 7 · 2012: 5
- FWCI
- 5.44
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- The International Journal of Neuropsychopharmacology (publishedVersion)
- PubMed (publishedVersion)
- OPUS FAU (Kooperativer Bibliotheksverbund Berlin-Brandenburg (KOBV), on behalf of the Universitätsbibliothek Erlangen-Nürnberg) (submittedVersion)
- Topics
- Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Electrolyte and hormonal disorders
- Life Sciences › Pharmacology, Toxicology and Pharmaceutics › Toxicology › Pharmacovigilance and Adverse Drug Reactions
- Health Sciences › Medicine › Psychiatry and Mental health › Schizophrenia research and treatment
- Keywords
- hyponatremia, adverse drug reactions, psychopharmacological treatment, psychiatric inpatients, pharmacovigilance, selective serotonin reuptake inhibitors, serotonin-norepinephrine reuptake inhibitors, oxcarbazepine, carbamazepine, diuretics, ACE inhibitors, elderly patients, plasma sodium, antipsychotic drugs, mirtazapine, tricyclic antidepressants
- MeSH terms
- Aged, Mental Disorders, Dose-Response Relationship, Drug, Female, Humans, Hyponatremia, International Cooperation, Male, Middle Aged, Product Surveillance, Postmarketing, Retrospective Studies, Risk Factors, Sodium, Antipsychotic Agents, Incidence, Adverse Drug Reaction Reporting Systems
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