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Mirtazapine associated with profound hyponatremia: two case reports
Chan Y Cheah1, Bronwyn Ladhams, P Gerry Fegan
1Department of General Medicine, Fremantle Hospital and Health Service, Fremantle, Western Australia. ccheah@iinet.net.au
The American Journal of Geriatric Pharmacotherapy
|August 5, 2008
Summary
Mirtazapine, an antidepressant, can cause severe hyponatremia (low sodium) in elderly patients. Monitoring sodium levels is crucial for older adults taking mirtazapine to prevent this adverse drug reaction.
Area of Science:
- Geriatric Medicine
- Clinical Pharmacology
- Neuroscience
Background:
- Depression is prevalent in the elderly, necessitating careful management.
- Selective serotonin reuptake inhibitors (SSRIs) are known to cause hyponatremia.
- The link between mirtazapine and hyponatremia is less established.
Observation:
- Two elderly patients developed severe hyponatremia (sodium levels 112-113 mEq/L) within 7-10 days of starting mirtazapine.
- Other causes of hyponatremia were ruled out.
- Discontinuation of mirtazapine led to recovery of sodium levels to >=132 mEq/L.
Findings:
- Mirtazapine use was deemed probable cause of hyponatremia in case reports.
- Literature review revealed mirtazapine-associated hyponatremia in patients over 60, with mean onset of 6.5 days.
- Mean sodium nadir was 117.2 mEq/L, with recovery taking a mean of 11 days after drug cessation.
Implications:
- Clinicians must consider mirtazapine as a potential cause of hyponatremia in elderly patients.
- Monitoring serum sodium levels is recommended for high-risk elderly patients initiating mirtazapine.
- Early recognition and discontinuation of mirtazapine can prevent severe hyponatremia.
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