Correspondence

Sertraline and Hyponatremia

N Engl J Med 1996; 335:524August 15, 1996

Article

To the Editor:

Hyponatremia and the syndrome of inappropriate secretion of antidiuretic hormone have been reported in patients treated with sertraline (Zoloft).1-3 We describe the rapid onset of hyponatremia in an 82-year-old woman who was hospitalized for progressive alcohol dependence, delirium due to alcohol intoxication, and severe depressive symptoms that had begun after her husband's death three years earlier. Initially, she was treated with lorazepam, thiamine, folate, and ranitidine. On the third hospital day, she was given 25 mg of sertraline for her depression, and 50 mg daily thereafter. On the second day of sertraline therapy we began to withdraw the lorazepam, but it was not totally discontinued. The patient had no signs of alcohol withdrawal, autonomic hyperactivity, or sertraline-induced toxic effects. Her serum sodium concentration was 134 mmol per liter on the day sertraline was begun and fell to 127 mmol per liter three days later, at which time the urine sodium concentration was 36 mmol per liter and urine osmolality was 373 mOsm per kilogram. The serum sodium concentration reached a nadir of 123 mmol per liter after eight days of sertraline therapy, at which time the drug was discontinued. The serum sodium concentration was 134 mmol per liter six days later.

This course of events suggests that the patient's hyponatremia was related to sertraline therapy and was due to the inappropriate secretion of antidiuretic hormone. None of the other known causes of hyponatremia, including diuretic therapy, drugs, tumors, and respiratory and central nervous system disease,4 were present.

Although the patient had no symptoms attributable to hyponatremia, low serum sodium concentrations may cause malaise, weakness, confusion, impaired functional ability, and when severe, somnolence, seizures, and coma. Sertraline should be added to the list of drugs that can cause hyponatremia. We believe serum sodium should be measured periodically in elderly patients soon after they start taking this medication.

Joseph Kessler, D.O.
Steven C. Samuels, M.D.
Mount Sinai Medical Center, New York, NY 10029

4 References

1. 1

   Thornton SL, Resch DS. SIADH associated with sertraline therapy. Am J Psychiatry 1995;152:809-809
   Web of Science | Medline

2. 2

   Jackson C, Carson W, Markowitz J, Mintzer J. SIADH associated with fluoxetine and sertraline therapy. Am J Psychiatry 1995;152:809-810
   Web of Science | Medline

3. 3

   Doshi D, Borison R. Association of transient SIADH with sertraline. Am J Psychiatry 1994;151:779-780
   Web of Science | Medline

4. 4

   Davis KM, Minaker KL. Disorders of fluid balance: dehydration and hyponatremia. In: Hazzard WR, Bierman EL, Blass JP, Ettinger WH Jr, Halter JB, eds. Principles of geriatric medicine and gerontology. 3rd ed. New York: McGraw-Hill, 1994:1187-9.
   

Citing Articles (7)

Citing Articles

1. 1

   C Egger, M Muehlbacher, M Nickel, C Geretsegger, C Stuppaeck. (2006) A review on hyponatremia associated with SSRIs, reboxetine and venlafaxine. International Journal of Psychiatry in Clinical Practice 10:1, 17-26
   CrossRef

2. 2

   Dianne Kirby, David Ames. (2001) Hyponatraemia and selective serotonin re-uptake inhibitors in elderly patients. International Journal of Geriatric Psychiatry 16:5, 484-493
   CrossRef

3. 3

   Majed Odeh, AHUVA Beny, Arie Oliven. (2001) Severe Symptomatic Hyponatremia during Citalopram Therapy. The American Journal of the Medical Sciences 321:2, 159-160
   CrossRef

4. 4

   Maria C. Catalano, Glenn Catalano, Steven N. Kanfer, Laura C. Toner, Saundra L. Stock, Warren D. Taylor. (2000) The Effect of Sertraline on Routine Blood Chemistry Values. Clinical Neuropharmacology 23:5, 267-270
   CrossRef

5. 5

   J.G. Velut, P. Darmon, R.N. Raharimanana, A.L. Demoux, D. Bagnères, F. Dadoun, I. Tonolli, Y. Frances. (2000) Hyponatrémie et sertraline. La Revue de Médecine Interne 21:3, 300-301
   CrossRef

6. 6

   John Strachan, John Shepherd. (1998) Hyponatraemia associated with the use of selective serotonin re-uptake inhibitors. Australian and New Zealand Journal of Psychiatry 32:2, 295-298
   CrossRef

7. 7

   &NA;. (1996) Sertraline. Reactions Weekly &NA;:615, 12
   CrossRef