Journal
INTERNATIONAL JOURNAL OF NEUROPSYCHOPHARMACOLOGY
Volume 15, Issue 6, Pages 739-748Publisher
OXFORD UNIV PRESS
DOI: 10.1017/S1461145711001192
Keywords
Adverse drug reactions; anticonvulsants; antidepressants; drug surveillance; hyponatraemia
Funding
- AstraZeneca Osterreich GmbH
- Boehringer Ingelheim Austria
- Bristol Myers Squibb GmbH
- CSC Pharmaceuticals GmbH
- Eli Lilly GmbH
- Germania Pharma GmbH
- GlaxoSmithKline Pharma GmbH
- Janssen-Cilag Pharma GmbH
- Lundbeck GmbH
- Novartis Pharma GmbH
- Pfizer Med Inform
- Wyeth Lederle Pharma GmbH
- Abbott GmbH Co. KG
- AstraZeneca GmbH
- Aventis Pharma Deutschland GmbH GE-O/R/N
- Bayer Vital GmbH Co. KG
- Boehringer Mannheim GmbH
- Bristol-Myers-Squibb
- Ciba Geigy GmbH
- Desitin Arzneimittel GmbH
- Duphar Pharma GmbH Co. KG
- Eisai GmbH
- esparma GmbH Arzneimittel
- GlaxoSmithKline Pharma GmbH Co. KG
- Hoffmann-La Roche AG Medical Affairs
- Janssen-Cilag GmbH
- Janssen Research Foundation
- Knoll Deutschland GmbH
- Lilly Deutschland GmbH Niederlassung Bad Homburg
- Lundbeck GmbH Co. KG
- Nordmark Arzneimittel GmbH
- Organon GmbH
- Otsuka-Pharma Frankfurt
- Pfizer GmbH
- Pharmacia Upjohn GmbH
- Promonta Lundbeck Arzneimittel
- Rhone-Poulenc Rohrer
- Sanofi-Synthelabo GmbH
- Sanofi-Aventis Deutschland
- Schering AG
- SmithKlineBeecham Pharma GmbH
- Solvay Arzneimittel GmbH
- Synthelabo Arzneimittel GmbH
- Dr Wilmar Schwabe GmbH Co.
- Thiemann Arzneimittel GmbH
- Troponwerke GmbH Co. KG
- Upjohn GmbH
- Wander Pharma GmbH
- Wyeth-Pharma GmbH
- AHP (Schweiz) AG
- AstraZeneca AG
- Bristol Myers Squibb AG
- Desitin Pharma GmbH
- Eli Lilly (Suisse) S.A.
- Essex Chemie AG
- GlaxoSmithKline AG
- Janssen-Cilag AG
- Lundbeck (Suisse) AG
- Organon AG, Pfizer AG
- Pharmacia
- Sanofi-Aventis (Suisse) S.A.
- Sanofi-Synthelabo SA
- Servier SA
- SmithKlineBeecham AG
- Solvay Pharma AG
- Wyeth AHP (Suisse) AG
- Wyeth Pharmaceuticals AG
- Bristol-Myers Squibb
- Eli Lilly
- GlaxoSmithKline
- Lundbeck
- Organon
- Sepracor
- Servier
Ask authors/readers for more resources
Hyponatraemia (FIN) can be a life-threatening medical condition which may lead to severe neurological and psychiatric symptoms. The AMSP (Arzneimittelsicherheit in der Psychiatrie) is a multicentre drug surveillance programme that assesses severe or new adverse drug reactions during psychopharmacological treatment in psychiatric inpatients. We report on a total of 263 864 psychiatric inpatients monitored from 1993 to 2007 in 80 psychiatric hospitals in Germany, Switzerland and Austria. During this period plasma sodium levels below 130 mmol/l (severe HN according to AMSP) were reported in 93 patients (relative frequency 0.04%). On average, the plasma sodium levels of all cases were 119.7 mmol/l (+/- 5.8 S.D.); median 121 mmol/l (range 104-129 mmol/l). Patients who showed no clinical signs (n=65, 70%) had a mean sodium level of 121.3 mmol/l (+/- 5.0 S.D.); median 122 mmol/l (range 114-129 mmol/l). By contrast, patients with clinical symptoms (n=28, 30%) had a mean sodium level of 116.0 mmol/l (+/- 6.0 S.D.); median 117 mmol/l (range 104-125 mmol/l). HN was mainly observed during treatment with selective serotonin reuptake inhibitors (SSRIs) (0.06%), Serotonin noradrenaline reuptake inhibitors (SNRIs) (0.08%), carbamazepine (0.10%) and oxcarbazepine (1.29%); the highest rate was found for oxcarbazepine. Antipsychotics, mirtazapine and tricyclic antidepressants were only rarely involved in HN (0.003-0.005%). Combinations of several drugs known to induce HN significantly increased the risk of FIN, e.g. more than 10-fold for SSRI+diuretics+ACE inhibitors (0.37%) vs. SSRI given alone (0.02%). This is clinically relevant because such combinations, e.g. SSRI+diuretics may occur especially in elderly patients, who are in general at higher risk of developing HN.
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