Subscribe to RSS
DOI: 10.1055/s-2005-871243
© Georg Thieme Verlag Stuttgart · New York
Citalopram Therapy as a Risk Factor for Symptomatic Hyponatremia Caused by the Syndrome of Inappropriate Secretion of Antidiuretic Hormone (SIADH)
A Case ReportPublication History
Reveived: 31.8.2004
Revised: 18.10.2004
Accepted: 31.1.2005
Publication Date:
18 July 2005 (online)
![](https://www.thieme-connect.de/media/pharmaco/200504/lookinside/thumbnails/10.1055-s-2005-871243-1.jpg)
We report the case of an 81-year old woman with stupor, confusion, somnolence, vomiting, and reduced food intake for 5 days. Laboratory investigations revealed low serum concentrations of sodium and potassium with a serum osmolality of 225 mOsm/kg H2O in the face of an inappropriately concentrated urine with an osmolality in the normal range, suggesting the syndrome of inappropriate antidiuretic hormone secretion (SIADH) in the absence of renal insufficiency, adrenal insufficiency, and hypothyroidism. Careful drug evaluation revealed amitriptyline and citalopram as possible inciters of antidiuretic hormone secretion. Subsequently, these drugs were withdrawn. Under continuous sodium substitution and fluid restriction serum sodium normalized and the patient’s symptoms resolved. She was fully alert by day 15. We conclude that hyponatremia secondary to SIADH was the cause of the patient’s neurologic symptoms. Clinicians should be aware of this possible side effect of central acting agents such as amitriptyline and citalopram, drugs that are often used to treat elderly patients suffering from depression or chronic pain.
References
- 1 Abbott R. Hyponatremia due to antidepressant medications. Ann Emerg Med. 1983; 12 708-710
- 2 Barclay T S, Lee A J. Citalopram-associated SIADH. Ann Pharmacother. 2002; 36 1558-1563
- 3 Bender S, Grohmann R, Engel R R, Degner D, Dittmann-Balcar A, Ruther E. Severe adverse drug reactions in psychiatric inpatients treated with neuroleptics. Pharmacopsychiatry. 2004; 37 (Suppl 1) S46-53
- 4 Bouman W P, Pinner G, Johnson H. Incidence of selective serotonin reuptake inhibitor (SSRI) induced hyponatraemia due to the syndrome of inappropriate antidiuretic hormone (SIADH) secretion in the elderly. Int J Geriatr Psychiatry. 1998; 13 12-15
- 5 Brownfield M S, Greathouse J, Lorens S A, Armstrong J, Urban J H, van de Kar L D. Neuropharmacological characterization of serotoninergic stimulation of vasopressin secretion in conscious rats. Neuroendocrinology. 1988; 47 277-283
- 6 Cooney J A. Carbamazepine and SIADH. Am J Psychiatry. 1990; 147 1101-1102
- 7 Davison P, Wardrope J. Acute amitriptyline withdrawal and hyponatraemia. A case report. Drug Saf. 1993; 8 78-80
- 8 Degner D, Grohmann R, Kropp S, Ruther E, Bender S, Engel R R, Schmidt L G. Severe adverse drug reactions of antidepressants: results of the German multicenter drug surveillance program AMSP. Pharmacopsychiatry. 2004; 37 (Suppl 1) S39-45
- 9 Fisher A, Davis M, Croft-Baker J, Purcell P, McLean A. Citalopram-induced severe hyponatremia with coma and seizure. Case report with literature and spontaneous reports review. Adverse Drug React Toxicol Rev. 2002; 21 179-187
- 10 Flores G, Perez-Patrigeon S, Cobos-Ayala C, Vergara J. Severe symptomatic hyponatremia during citalopram therapy - a case report. BMC Nephrol. 2004; 16 2
- 11 Henkin Y, Kaplan Z, Alkan M. Psychiatric presentation of hyponatremia associated with the use of amitriptyline: a report of two cases. Isr J Med Sci. 1989; 25 587-589
- 12 Iraqi A, Baikle E. A case report of hyponatremia with citalopram use. J Am Med Dir Assoc. 2004; 5 64-65
- 13 Izzedine H, Fardet L, Launay-Vacher V, Dorent R, Petitclerc T, Deray G. Angiotensin-converting enzyme inhibitor-induced syndrome of inappropriate secretion of antidiuretic hormone: case report and review of the literature. Clin Pharmacol Ther. 2002; 71 503-507
- 14 Leung V P, Chiu H F, Lam L C. Hyponatremia associated with paroxetine. Pharmacopsychiatry. 1998; 31 32-34
- 15 Liberopoulos E N, Alexandridis G H, Christidis D S, Elisaf M S. SIADH and hyponatremia with theophylline. Ann Pharmacother. 2002; 36 1180-1182
- 16 Malaterre H R, Kallee K, Daver L M. Hyponatremia and amlodipine therapy. Cardiovasc Drugs Ther. 1999; 13 171-172
- 17 Odeh M, Beny A, Oliven A. Severe symptomatic hyponatremia during citalopram therapy. Am J Med Sci. 2001; 321 159-160
-
18 Roth J, Koch C A, Rother K I. Aging, endocrinology, and the elderly patient. In: DeGroot LJ, Jameson JL, editors
Endocrinology . 4th edition Philadelphia, PA; WB Saunders 2001: pp 529-555 - 19 Spigsett O, Hedenmalm K. Hyponatremia and the syndrome of inappropriate antidiuretic hormone secretion (SIADH) induced by psychotropic drugs. Drug Saf. 1995; 12 209-225
- 20 Tilly-Gentric A. Severe hyponatremia associated with ramipril therapy in an old woman. J Am Geriatr Soc. 1995; 43 1448-1449
- 21 Verbalis J G. Disorders of body water homeostasis. Best Pract Res Clin Endocrinol Metab. 2003; 17 471-503
Prof. Christian A. Koch, MD
FACP, FACE
Department of Endocrinology and Nephrology
University of Leipzig
04103 Leipzig
Germany
Email: christian.koch@medizin.uni-leipzig.de