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- Can Med Assoc J 1996 Oct
and the syndrome of inappropriate secretion of antidiuretic hormone
associated with the use of selective serotonin reuptake inhibitors: a
review of spontaneous reports.
Liu BA, Mittmann N,
Knowles SR, Shear NH.
Division of Clinical Pharmacology,
University of Toronto, Ont.
OBJECTIVE: To review reported cases
of hyponatremia and the syndrome of inappropriate secretion of
antidiuretic hormone (SIADH) associated with the use of selective
serotonin reuptake inhibitors (SSRIs). DATA SOURCES: A search of MEDLINE
for reports of hyponatremia and SIADH associated with the use of
fluoxetine, fluvoxamine, paroxetine or sertraline published between
January 1980 and May 1995. Unpublished reports of cases were requested
from the pharmaceutical industry, the Ontario Medical Association, the
Health Protection Branch of Health Canada, the US Food and Drug
Administration and the World Health Organization. DATA SELECTION AND
EXTRACTION: Spontaneous reports from postmarketing surveillance. DATA
SYNTHESIS: A total of 736 cases of hyponatremia [corrected] and SIADH
associated with SSRI use were reported. Fluoxetine was involved in 554
(75.3%) of the cases, paroxetine in 91 (12.4%), sertraline in 86 (11.7%)
and fluvoxamine in 11 (1.5%). Reports of 30 cases were published. The
remaining 706 cases were reported to monitoring bodies and the
pharmaceutical industry. According to information in the published
reports, the median time to onset of hyponatremia was 13 days (range 3
to 120 days). Most (83%) of the published cases involved patients 65
years of age or more, as compared with 74% of the unpublished cases.
CONCLUSION: Elderly people may be at increased risk for hyponatremia
associated with SSRI use. Physicians caring for elderly patients should
be aware of this potentially serious but reversible adverse effect.
Further research is required to determine the incidence of this adverse
effect, the relative risk of hyponatremia and SIADH in different age
groups and the risk associated with different SSRI
PMID: 8804257 [PubMed - indexed for