Sodium-Containing Pharmaceutical Products as Contributors to Cardiovascular Risk

Restricting sodium intake has been identified as one of the most cost-effective measures to improve public health. The substantial improvements in blood pressure and cardiovascular outcomes observed after dietary sodium restriction in clinical trials and observational studies provide evidence-based support for national strategies that recommend limits on daily sodium consumption. Although dietary sources of sodium account for most of an individual's intake, the sodium content of pharmaceutical products can also contribute to excess sodium intake, thereby increasing cardiovascular risk. Sodium is included in oral medications as an active ingredient (or as a cation for an active ingredient) or to enhance solubility. The sodium content of certain medications can exceed the daily recommended maximal sodium intake if higher doses are administered. In this contemporary review, we describe the basis of cardiovascular risk with increased sodium intake as it pertains to the clinical relevance of medications with a high-sodium content that are associated with increases in blood pressure, development of hypertension, and adverse cardiovascular outcomes. Improvements in approaches to sodium content labeling and prescriber education are warranted to ensure that patients receive appropriate therapeutic options.