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Drug-induced hyponatraemia

Authoring team

Drug-induced hyponatraemia occurs in approximately 5% of outpatients and 15% of inpatients. The commonest drugs causing hyponatraemia are: (1,2)

  • desmopressin, oxytocin
  • medications that stimulate vasopressin release or potentiate the effects of vasopressin: selective serotonin-reuptake inhibitors and most other antidepressants,​​ morphine and other opioids
  • medications that impair urinary dilution such as thiazide diuretics
  • medications that cause hyponatraemia by an uncertain mechanism of action such as carbamazepine, vincristine, nicotine, antipsychotics, chlorpropamide, cyclophosphamide, non-steroidal anti-inflammatory drugs
  • illicit drugs: MDMA or ecstasy causes vasopressin release, and has been associated with acute, life-threatening hyponatraemia
  • bowel preparations for colonoscopy

Most patients with hyponatraemia are diagnosed incidentally on routine blood tests

Example causes of drug induced hyponatraemia:

Diuretics

  • thiazide diuretics
    • indapamide
    • chlorothiazide
  • combination diuretics
    • amiloride/hydrochlorothiazide
  • loop diuretics
    • furosemide

Anticonvulsants

  • carbamazepine

ACE inhibitor

  • enalapril
  • ramipril

COX2 inhibitor

  • celecoxib

Hypnotics

  • temazepam

Sulphonylureas

  • gliclazide
  • glimepiride
  • glibenclamide
  • glipizide

Proton pump inhibitor

  • omeprazole
  • pantoprazole

Hormonal analogue

  • desmopressin
  • oxytocin

Antidepressants

  • SSRIs
    • sertraline
    • fluoxetine
    • citalopram
    • paroxetine
    • venlafaxine
  • MAOI
    • moclobemide

Recreational drugs

  • ecstasy

 

Reference:

  1. Adrogué HJ, Tucker BM, Madias NE. Diagnosis and management of hyponatremia: a review. JAMA. 2022 Jul 19;328(3):280-91.
  2. Grant P, Ayuk J, Bouloux PM, et al. The diagnosis and management of inpatient hyponatraemia and SIADH. Eur J Clin Invest. 2015 Aug;45(8):888-94.

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