Dr. Bob's Psychopharmacology Tips

SIADH related to SSRIs

Date: Wed, 4 Jun 1997 08:51:56 +0500
From: Niraj Ahuja <niraj@giasdl01.vsnl.net.in>
Subject: SIADH related to fluoxetine

At 04:34 PM 6/3/97 EDT, Robert White wrote:

After fainting twice last week, a patient was admitted to the cardiology service with marked hyponatremia. Her cardiologists told her that the problem was probably related to Prozac.

Several cases of hyponatremia (some with serum sodium lower than 110 mmol/l) have been reported (with fluoxetine). The hyponatremia appeared to be reversible when fluoxetine was discontinued. Although these cases were complex... some were possibly due to the syndrome of inappropriate antidiuretic hormone secretion (SIADH). The majority of these occurrences have been in older patients and in patients taking diuretics or ... otherwise volume depleted. In a placebo-controlled, double-blind trial, 10 of 313 fluoxetine patients and 6 of 320 placebo recipients had a lowering of serum sodium below the reference range; this difference was not statistically significant. The lowest observed concentration was 129 mmol/l. The observed decreases were not clinically significant.

Date: Wed, 4 Jun 1997 16:36:55 +1200
From: david.menkes@stonebow.otago.ac.nz (David Menkes)
Subject: SIADH related to SSRIs

The use of SSRIs has been associated with reports of hyponatraemia. In most cases the presentation is compatible with the syndrome of inappropriate secretion of antidiuretic hormone (SIADH). Elderly people, especially if taking diuretics, may be at increased risk.

Liu et al have recently reviewed published and unpublished cases. The median time for onset of hyponatraemia was 13 days (range 3-120 days). Recovery usually occured within two weeks of stopping the SSRI.

Liu BA, Mittmann N, Knowles SR, Shear NH. Hyponatremia and the syndrome of inappropriate secretion of antidiuretic hormone associated with the use of selective serotonin reuptake inhibitors: a review of spontaneous reports. Canadian Medical Association Journal. 155 (5): 519-27, 1996 Sep 1.

--Paul Larson, Drug Information Pharmacist

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