A case series on drug induced hyponatremia: uncommon adverse effect of commonly used drugs

Harsh M. Joshi, Sapna Gupta, Supriya Malhotra, Pankaj Patel


Older patients suffering from depression and psychosis have markedly increased since last decade. So, has the use of antidepressants and antipsychotics. The prevalence of hyponatremia due to these drugs is common in general as well as psychiatric practice. It may also lead to life threatening morbidity and mortality. Loss of renal function, polypharmacy, dementia and other conditions of advanced age can either exacerbate the severity of hyponatremia or mask its onset. In this case series, total four cases were reported of hyponatremia and drugs causing it were escitalopram, quetiapine, tianeptine and oxcarbazepine. Due to polypharmacy, a chance of hyponatremia was more in these patients. Patients received infusion of hypertonic saline with salt added diet to treat hyponatremia. Symptoms of hyponatremia were improved after the treatment. In all four cases, WHO and Naranjo’s causality assessment revealed ‘possible’ causal relationship with the prescribed drug. Prescribers should be aware of such adverse effect due to these drugs.


Escitalopram, Hyponatremia, Oxcarbazepine, Polypharmacy, Quetiapine, Tianeptine

Full Text:



Adrogue HJ, Madias NE. Hyponatremia. N Engl J Med. 2000;(342):1581-9.

Boscoe A, Paramore C, Verbalis JG. Cost of illness of hyponatremia in the United States. Cost Eff Resour Alloc. 2006;4:10-3.

Kumar S, Berl T. Sodium. Lancet. 1998;(352):220-8.

Roxanas M, Hibbert E, Field M. Venlafaxine hyponatraemia: incidence, mechanism and management. Aust N Z J Psychiatry. 2007;(41):411-8.

Cosgray RE, Hanna V, Davidhizar RE, Smith J. The water-intoxicated patient. Arch Psychiatr Nurs. 1990;(4):308-12.

Kirby D, Harrigan S, Ames D. Hyponatraemia in elderly psychiatric patients treated with selective serotonin reuptake inhibitors and venlafaxine: a retrospective controlled study in an inpatient unit. Int J Geriatr Psychiatry. 2002;(17):231-7.

Bogunovic O, Sotelo J, Madhusoodanan S. Hyponatremia secondary to antidepressants. Psychiatric Annals. 2003;(33):333-9.

Letmaier M, Painold A, Holl AK, Vergin H, Engel R, Konstantinidis A, et al. Hyponatraemia during psychopharmacological treatment: results of a drug surveillance programme. Int J Neuropsychopharmacol. 2012;(15):739-48.

Turnheim K. When drug therapy gets old: pharmacokinetics and pharmacodynamics in the elderly. Exp Gerontol. 2003;(38):843-53.

Lin CH, Lu CH, Wang FJ, Tsai MH, Chang WN, Tsai NW, et al. Risk factors of oxcarbazepine-induced hyponatremia in patients with epilepsy. Clin Neuropharmacol. 2010;(33):293-6.

Grover S, Biswas P, Bhateja G, Kulhara P. Escitalopram‐associated hyponatremia. Psychiatry and Clinical Neurosciences. 2007 Feb 1;61(1):132-3.

Nahshoni E, Weizman A, Shefat D, Pik N. A case of hyponatremia associated with escitalopram. J Clin Psychiatry. 2004;(65):17-22.

DiPiro JT, Talbert RL, Yee GC, Matzke GR, Wells BG, Posey LM, eds. Pharmacotherapy: a pathophysiologic approach. 5th Ed. New York: McGraw Hill; 2002.

Pillai BP, Unnikrishnan AG, Pavithran PV. Syndrome of inappropriate antidiuretic hormone secretion: Revisiting a classical endocrine disorder Indian J Endocrinol Metabolism. 2011;(23):208-15.

Liu B, Mittman N, Knowles SR, Shear NH. Hyponatremia and syndrome of inappropriate secretion of antidiuretic hormone associated with the use of selective serotonin reuptake inhibitors: A review of spontaneous reports. Can Med Assoc J. 1996;(155):519-27.

Pendlebury SC, Moses DK, Eadie MJ. Hyponatraemia during Oxcarbazepine therapy. Hum Toxicol. 1989;(8):337-44.

Adrogue´ HJ, Madias NE. Hyponatremia. N Engl J Med. 2000;(342):1581-9.

Kim YS, Kim DW, Jung KH, Lee ST, Kang BS, Byun JI, et al. Frequency of and risk factors for oxcarbazepine-induced severe and symptomatic hyponatremia. Seizure-European J of Epile. 2014 Mar 1;23(3):208-12.

Peck V, Shenkman L. Haloperidol-induced syndrome of inappropriate secretion of antidiuretic hormone. Clin Pharmacol Ther. 2012;(26):442-4.

Meulendijks D, Mannesse CK, Jansen PA, van Marum RJ, Egberts TC. Antipsychotic-induced hyponatraemia: A systematic review of the published evidence. Drug Saf. 2010;(33):101-14.

Yamaguchi K, Hama H, Adachi C. Inhibitory role of periventricular dopaminergic mechanisms in hemorrhage induced vasopressin secretion in conscious rats. Brain Res. 1990;(513):335-8.