Severe hyponatraemia due to mirtazapine

Severe hyponatraemia due to mirtazapine

The risk factors for developing SIADH (previously presented as relating to mirtazapine only) are applicable to most psychotropic medications, including duloxetine, venlafaxine, fluoxetine, paroxetine, citalopram, escitalopram, tricyclic antidepressants, neuroleptics and carbamazepine.2,3,4 Thus, to...

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Bibliographic Details
Published in:Australian prescriber Vol. 32; no. 1; p. 5
Main Authors: Franke, Alexander, Kostov, Slav H, Cheah, Chan, Ladhams, Bronwyn
Format: Journal Article
Language:English
Published: Melbourne Therapeutic Guidelines Limited 01-02-2009
Subjects:
Antidepressants
Committees
Health services
Hyponatremia
Patients
Psychiatrists
Sodium
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Summary:The risk factors for developing SIADH (previously presented as relating to mirtazapine only) are applicable to most psychotropic medications, including duloxetine, venlafaxine, fluoxetine, paroxetine, citalopram, escitalopram, tricyclic antidepressants, neuroleptics and carbamazepine.2,3,4 Thus, to rechallenge the patient with mirtazapine would be necessary and acceptable, both to disprove the null hypothesis and because the occurrence of the adverse event cannot be predicted when using another drug.2,3 The relevant question is how to treat depression in the elderly, who have a greater probability of developing SIADH. A review suggests that hyponatraemia induced by selective serotonin reuptake inhibitors, in particular, may be a transient effect to which the patient develops tolerance.2 Alexander D Franke Intern Slav H Kostov Consultant Psychiatrist Royal Perth Hospital Authors' comments Dr Cheah and Ms Ladhams, authors of the Medicinal mishap, comment: [...]most patients who develop severe hyponatraemia have more than one contributing cause.5 While many antidepressant drugs are associated with hyponatraemia,6 we argue that rechallenge with mirtazapine in this setting is neither safe nor appropriate given the profound and rapid fall in serum sodium precipitating hospital admission.
ISSN:0312-8008
1839-3942
DOI:10.18773/austprescr.2009.002