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Paroxetine-induced
hyponatremia in older adults: a 12-week prospective
study.
Fabian TJ, Amico JA, Kroboth PD, Mulsant BH,
Corey SE, Begley AE, Bensasi SG, Weber E, Dew MA, Reynolds CF 3rd,
Pollock BG.
Department of Pharmaceutical Sciences, University
of Pittsburgh, Pittsburgh, PA 15261, USA.
fabiant@msx.upmc.edu
BACKGROUND: Older depressed patients are at
high risk for development of hyponatremia after initiation of the
selective serotonin reuptake inhibitor paroxetine, despite clinical
monitoring and preventive management. The purposes of this study were to
determine the incidence and etiology of paroxetine-induced hyponatremia
in older patients and to identify patient characteristics that may
account for variability in susceptibility to this adverse event.
METHODS: This prospective, longitudinal study was conducted in a
university-based ambulatory psychiatric research clinic from August 1999
through September 2001. Patients included 75 men and women aged 63
through 90 years (mean +/- SD age, 75.3 +/- 6.0 years) who received a
diagnosis of a current Diagnostic and Statistical Manual of Mental
Disorders, Fourth Edition, major depressive episode and were prescribed
paroxetine. We monitored plasma sodium levels before initiating
paroxetine therapy and after 1, 2, 4, 6, and 12 weeks of treatment. In a
subset of individuals, we measured levels of antidiuretic hormone,
glucose, serum urea nitrogen, and creatinine. Hyponatremia was defined
as a plasma sodium level of less than 135 mEq/L after initiation of
paroxetine therapy. RESULTS: Hyponatremia developed in 9 (12%) of the 75
patients after initiation of paroxetine treatment. Mean +/- SD time to
development of hyponatremia was 9.3 +/- 4.7 days (median, 9 days; range,
1-14 days; n = 8). In the multivariate regression, lower body mass index
and lower baseline plasma sodium level (<138 mEq/L) were significant
risk factors for the development of hyponatremia in these patients.
CONCLUSIONS: Hyponatremia is an under recognized and potentially serious
complication of paroxetine treatment in older patients. Our results
provide a foundation for understanding the etiology and risk factors
associated with paroxetine-induced hyponatremia.
PMID: 14769630
[PubMed - indexed for MEDLINE]
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