Case ReportsSevere Hyponatremia Associated with the Combined Use of Thiazide Diuretics and Selective Serotonin Reuptake Inhibitors
Section snippets
Case 1
An 84-year-old woman with long-standing hypertension treated with amlodipine 10 mg/day and hydrochlorothiazide 25 mg/day was prescribed paroxetine 20 mg/day for symptomatic depression. Other medications included: 325 mg of aspirin per day and 20 mg of famotidine per day. Laboratory work before the initiation of paroxetine revealed a serum sodium level of 135 mmol/L, potassium of 3.8 mmol/L, and normal renal function. Two weeks later, the patient presented to the emergency room with lethargy, headache,
Discussion
Both thiazide diuretics and SSRIs have been associated with hyponatremia through different but possibly complementary and synergistic mechanisms. Thiazide diuretics, by inhibiting sodium chloride reabsorption in the distal convoluted tubule, impair urinary diluting capacity and lead to modest volume depletion and stimulation of ADH secretion. Because thiazide diuretics act after the ascending limb of the loop of Henle, the hypertonic medullary interstitium is not affected and urinary
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Elevated High-Density Lipoprotein Cholesterol Is Associated with Hyponatremia in Hypertensive Patients
2017, American Journal of MedicineCitation Excerpt :Based on the analysis models that we performed in the present study, it appears that HDL-C levels are more important than these previously described factors: this is first demonstrated by the fact that HDL-C holds more information content in the GBM predictive model than BMI, age, and sex altogether; second, when lipid levels are not used to build the predictive model, the prediction accuracy decreases significantly, and the BMI takes HDL-C's place as the most informative factor. Several drugs, such as selective serotonin reuptake inhibitors and carbamazepine, are associated with hyponatremia, particularly when they are combined with thiazides.23,24 By performing multivariable logistic models for hyponatremia using drug usage information from the NHANES study, we found significant effects for many of the known drug associations.
Severe hyponatremia associated with thiazide diuretic use
2015, Journal of Emergency MedicineCitation Excerpt :Hyponatremia can also occur years after taking a thiazide and is likely due to subsequent contributory factors such as a decline in renal function with aging, changes in water or sodium intake, or the ingestion of other drugs that affect free water clearance. Drugs known to increase the likelihood of developing TIH include nonsteroidal antiinflammatory drugs, carbamazepine, and selective serotonin reuptake inhibitors (13–15). Polydipsia caused by psychotropic medications may also predispose to TIH (16).
The syndrome of inappropriate antidiuresis
2012, Revue de Medecine InterneDiuretic-associated hyponatremia
2011, Seminars in NephrologyCitation Excerpt :Chow et al76 did not find a correlation between thiazide dose factored for body weight and the incidence of hyponatremia. Concomitant use of thiazides with other agents that cause hyponatremia, such as selective serotonin reuptake inhibitors or seizure medication, may predispose to hyponatremia but often are difficult to avoid.82,83 Hyponatremia in the setting of psychosis and associated polydipsia has been well described, and development of severe hyponatremia may occur when a thiazide is added to the regimen of patients with psychogenic polydipsia and mild hyponatremia.18,84,85
Hyponatraemia during psychopharmacological treatment: Results of a drug surveillance programme
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