Syndrome of inappropriate antidiuretic hormone associated with escitalopram therapy (original) (raw)
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Case reports in nephrology, 2018
Hyponatremia is a well-known medication related side effect of selective serotonin reuptake inhibitors; despite its association with escitalopram, the newest SSRI is very rare. We did a review of literature and came across only 14 reported case of this rare association of SIADH with escitalopram. We hereby report a case of a 93-year-old female who presented with generalized tonic-clonic seizure and was diagnosed with severe hyponatremia due to escitalopram-induced syndrome of inappropriate antidiuretic hormone secretion (SIADH). With this article, we want to emphasize clinicians about this rare side effect of escitalopram use and look for the risk factors leading to SIADH.
American Journal of Case Reports, 2020
Rare co-existance of disease or pathology Background: Use of selective serotonin reuptake inhibitors (SSRIs) has been reported to be associated with the syndrome of inappropriate antidiuretic hormone (SIADH), although it is uncommon. Nonsteroidal anti-inflammatory drugs (NSAIDs), as a sole agent, are an even rarer cause of SIADH. Despite being documented in the literature, the understanding of the mechanism of both agents is limited. Here, we report a case of a patient taking both of these medications, a dangerous combination that led to the development of SIADH. Case Report: An 88-year-old woman with a history of asymptomatic chronic hyponatremia presented to our facility with symptomatic acute-on-chronic hyponatremia after she started using naproxen in addition to her daily citalopram. Her hyponatremia symptoms resolved after discontinuing these 2 offending agents, along with administration of fluid restriction and oral sodium supplements. Conclusions: Naproxen is commonly prescribed and is often taken by elderly patients to control long-term or short-term pain. SSRIs, on the other hand, are a first-line treatment for depression and are usually prescribe by a psychiatrist. Hyponatremia is a rare medication adverse effect that should be kept in mind when treating these patients with either of these medications, and should especially be considered when combining them. Medication reconciliation should be done carefully by the provider to avoid adverse effects and drug interactions. When hyponatremia is encountered, options for future medication prescriptions include rechallenging with the same medication, switching to a different medication with the same mechanism of action, or using a medication from another class altogether. Monitoring of serum sodium level is warranted when titrating the offending agent.
Arquivos de Neuro-Psiquiatria, 2006
Hyponatremia is a significant complication of treatment with serotonin selective reuptake inhibitors (SSRI). We describe a case of a 53-year-old woman that was started on fluoxetine 20 mg/day for depression. Nine days later, the patient started with weakness, nausea, progressing to confusion, inapetence and vomit. Three hours later she became unresponsive and had a generalized seizure. She was brought to our emergency service. On admission, the patient was normovolemic, without focal motor deficits, but had mild generalized muscle rigidity and Babinski's sign bilaterally. Serum sodium was 105 mmol/L, serum osmolality, 220 mmol/L, and urinary osmolality, 400 mmol/L. The other laboratory exams, chest X-ray, cerebrospinal fluid and cranium tomography were normal. She was found to have fluoxetine-induced SIADH and it was descontinued. We started the hyponatremia correction and, in 5 days, the mental status of the patient gradually returned to a normal baseline, paralleling the resol...
Citalopram-induced severe hyponatremia
Journal of Acute Medicine, 2014
Citalopram-induced syndrome of inappropriate antidiuretic hormone secretion (SIADH) causing hyponatremia is well documented; however, severe hyponatremia with small doses has not been previously reported. An 84-year-old woman presented with acute confusion and gait disturbance of 3e4 days' duration and a 2-day history of vomiting but managed to maintain fluid intake. Seven days earlier she was started on citalopram 10 mg per day for low mood. On examination, she was euvolemic, drowsy, and confused; her serum sodium level was 100 mmol/L. A working diagnosis of SIADH was proposed. Citalopram was stopped and the patient was treated over 24 hours with hypertonic saline, which led to clinical improvement, and she was discharged from the hospital 6 days later with a serum sodium level of 131 mmol/L. This case highlights that citalopram can cause severe hyponatremia (serum sodium as low as 100 mmol/L), even at a low dose, and that such biochemical abnormalities can potentially occur within days of starting therapy. It also raises important questions and learning points about the management of severe hyponatremia.
Severe symptomatic hyponatremia during citalopram therapy - a case report
BMC Nephrology, 2004
Background: Hyponatremia secondary to the syndrome of inappropriate secretion of antidiuretic hormone is an uncommon complication of treatment with the new class of antidepressant agents, the selective serotonin reuptake inhibitors. The risk of hyponatremia seems to be highest during the first weeks of treatment particularly, in elderly females and in patients with a lower body weight.
Hyponatremia Associated with Escitalopram
New England Journal of Medicine, 2007
HIGHLIGHTS OF PRESCRIBING INFORMATION These highlights do not include all the information needed to use ARICEPT safely and effectively. See full prescribing information for ARICEPT. ARICEPT ® (donepezil hydrochloride) tablets, for oral use ARICEPT ODT (donepezil hydrochloride) orally disintegrating tablets Initial U.S. Approval: 1996 *Sections or subsections omitted from the full prescribing information are not listed. FULL PRESCRIBING INFORMATION 1 INDICATIONS AND USAGE ARICEPT is indicated for the treatment of dementia of the Alzheimer's type. Efficacy has been demonstrated in patients with mild, moderate, and severe Alzheimer's disease. 2 DOSAGE AND ADMINISTRATION 2.1 Dosing in Mild to Moderate Alzheimer's Disease The recommended starting dosage of ARICEPT is 5 mg administered once per day in the evening, just prior to retiring. The maximum recommended dosage of ARICEPT in patients with mild to moderate Alzheimer's disease is 10 mg per day. A dose of 10 mg should not be administered until patients have been on a daily dose of 5 mg for 4 to 6 weeks. 2.2 Dosing in Moderate to Severe Alzheimer's Disease The recommended starting dosage of ARICEPT is 5 mg administered once per day in the evening, just prior to retiring. The maximum recommended dosage of ARICEPT in patients with moderate to severe Alzheimer's disease is 23 mg per day. A dose of 10 mg should not be administered until patients have been on a daily dose of 5 mg for 4 to 6 weeks. A dose of 23 mg per day should not be administered until patients have been on a daily dose of 10 mg for at least 3 months. 2.3 Administration Information ARICEPT should be taken in the evening, just prior to retiring. ARICEPT can be taken with or without food. The ARICEPT 23 mg tablet should not be split, crushed, or chewed. Allow ARICEPT ODT to dissolve on the tongue and follow with water. 3 DOSAGE FORMS AND STRENGTHS ARICEPT is supplied as film-coated, round tablets containing 5 mg, 10 mg, or 23 mg of donepezil hydrochloride. The 5 mg tablets are white. The strength, in mg (5), is debossed on one side and ARICEPT is debossed on the other side. The 10 mg tablets are yellow. The strength, in mg (10), is debossed on one side and ARICEPT is debossed on the other side. The 23 mg tablets are reddish. The strength, in mg (23), is debossed on one side, and ARICEPT is debossed on the other side. ARICEPT ODT is supplied as round tablets containing either 5 mg or 10 mg of donepezil hydrochloride. The 5 mg orally disintegrating tablets are white. The strength, in mg (5), is debossed on one side and ARICEPT is debossed on the other side. The 10 mg orally disintegrating tablets are yellow. The strength, in mg (10), is debossed on one side and ARICEPT is debossed on the other side. 4 CONTRAINDICATIONS ARICEPT is contraindicated in patients with known hypersensitivity to donepezil hydrochloride or to piperidine derivatives. 5 WARNINGS AND PRECAUTIONS 5.1 Anesthesia ARICEPT, as a cholinesterase inhibitor, is likely to exaggerate succinylcholine-type muscle relaxation during anesthesia. 5.2 Cardiovascular Conditions Because of their pharmacological action, cholinesterase inhibitors may have vagotonic effects on the sinoatrial and atrioventricular nodes. This effect may manifest as bradycardia or heart block in patients both with and without known underlying cardiac conduction abnormalities. Syncopal episodes have been reported in association with the use of ARICEPT. 5.3 Nausea and Vomiting ARICEPT, as a predictable consequence of its pharmacological properties, has been shown to produce diarrhea, nausea, and vomiting. These effects, when they occur, appear more frequently with the 10 mg/day dose than with the 5 mg/day dose, and more frequently with the 23 mg dose than with the 10 mg dose. Specifically, in a controlled trial that compared a dose of 23 mg/day to 10 mg/day in patients who had been treated with donepezil 10 mg/day for at least three months, the incidence of nausea in the 23 mg group was markedly greater than in the patients who continued on 10 mg/day (11.8% vs. 3.4%, respectively), and the incidence of vomiting in the 23 mg group was markedly greater than in the 10 mg group (9.2% vs. 2.5%, respectively). The percent of patients who discontinued treatment due to vomiting in the 23 mg group was markedly higher than in the 10 mg group (2.9% vs. 0.4%, respectively). Although in most cases, these effects have been transient, sometimes lasting one to three weeks, and have resolved during continued use of ARICEPT, patients should be observed closely at the initiation of treatment and after dose increases. 5.4 Peptic Ulcer Disease and GI Bleeding Through their primary action, cholinesterase inhibitors may be expected to increase gastric acid secretion due to increased cholinergic activity. Therefore, patients should be monitored closely for symptoms of active or occult gastrointestinal bleeding, especially those at increased risk for developing ulcers, e.g., those with a history of ulcer disease or those receiving concurrent nonsteroidal anti-inflammatory drugs (NSAIDs). Clinical studies of ARICEPT in a dose of 5 mg/day to 10 mg/day have shown no increase, relative to placebo, in the incidence of either peptic ulcer disease or gastrointestinal bleeding. Results of a controlled clinical study with 23 mg/day showed an increase, relative to 10 mg/day, in the incidence of peptic ulcer disease (0.4% vs. 0.2%) and gastrointestinal bleeding from any site (1.1% vs. 0.6%). 5.5 Weight Loss Weight loss was reported as an adverse reaction in 4.7% of patients assigned to ARICEPT in a dose of 23 mg/day compared to 2.5% of patients assigned to 10 mg/day. Compared to their baseline weights, 8.4% of patients taking 23 mg/day were found to have a weight decrease of ≥ 7% by the end of the study, while 4.9% of patients taking 10 mg/day were found to have weight loss of ≥ 7% at the end of the study. 5.6 Genitourinary Conditions Although not observed in clinical trials of ARICEPT, cholinomimetics may cause bladder outflow obstruction. 5.7 Neurological Conditions: Seizures Cholinomimetics are believed to have some potential to cause generalized convulsions. However, seizure activity also may be a manifestation of Alzheimer's disease. ARICEPT ODT 5 mg and 10 mg tablets: carrageenan, mannitol, colloidal silicon dioxide, and polyvinyl alcohol. The 10 mg tablet contains yellow iron oxide (synthetic) as a coloring agent. ARICEPT ® is a registered trademark used by Eisai Inc. under license from Eisai R&D Management Co., Ltd.
Escitalopram Induced Serotonin Syndrome: A Case Report
Indian Journal of Pharmacy Practice, 2019
Escitalopram is a selective serotonin reuptake inhibitor (SSRI) and S-enantiomer of racemic escitalopram, enhances serotonergic activity in the central nervous system (CNS). It is indicated for the Major depressive disorder and Generalized Anxiety Disorder. It is having SEROTONIN SYNDROME as a major side effect. Other uses are OCD, panic disorder, premenstrual dysphoric disorder, social phobia, depression due to severe trauma and mix anxiety and depressive disorder. A 13 year old female child had complain of headache and the hiccups for that she went to hospital from their she was prescribed with the Tab. CLONAZEPAM (2.5 mg, ½ Tab, hs) and Tab. ESCITALOPRAM (5 mg, ½ Tab, hs) for 4 days and followed by 1 Tab. hs. Patient had completed duration of half tablet of ESCITALOPRAM and took full tablet and after 1-2 hour she developed up rolling of eye balls and involuntary movements of both upper and lower limb. Afterwards she was admitted in ICU. Better vigilance is necessary for implementation of safe and effective treatment for each individual patient. In-order to prevent serious adverse drug reactions of this drug, close monitoring during treatment course, creating awareness, recognition of the problem and careful management of all patients who receive this medication are essential.
Serotonin Syndrome Precipitated by Escitalopram
Indian Journal of Forensic Medicine & Toxicology, 2020
Depression is characterized by symptoms like sad mood, loss of interest and pleasure, low energy, worthlessness, guilt, psychomotor retardation or agitation, change in appetite and/or sleep and suicidal thoughts, etc. It may be a unipolar or a bipolar cyclic disorder in which cycles of mood swings from mania to depression occur over time. Fluoxetine, Fluvoxamine, Paroxetine, Sertraline, Citalopram and Escitalopram are the various SSRIs(Selective Serotonin Reuptake Inhibitors) preferred as first line of drug in such conditions. Among the SSRIs, Escitalopram exerts a highly selective, potent, and dose-dependent inhibitory effect on the human serotonin transport. By inhibiting the reuptake of serotonin into presynaptic nerve endings, this drug enhances the activity of serotonin in the central nervous system. Herein we report a case of a 82 year old male who presented with altered sensorium, tachycardia, hypertension and restlessness to emergency department of our hospital. Patient was known case of Adjustment disorder with Depressed mood and was on treatment with Tablet Escitalopram 10 mg OD and Tablet Zolpidem 10 mg OD since 1 month. Patient overdosed himself with 4 Escitalopram tablets of 10 mg. He presented with features similar to serotonin syndrome.