Drugs Causing Lowering of Sodium Level or Hyponatremia
Drugs that cause hyponatremia include:
- Diuretics: Thiazides, bumetanide, indapamide, ethacrynic acid, furosemide.
Diuretics affect the balance between sodium and water and are among the most common drugs implicated in the development of hyponatremia.
- Antidepressants: Selective serotonin reuptake inhibitors, tricyclic antidepressants (amitriptyline, protriptyline, desipramine), monoamine oxidase inhibitors, venlafaxine.
Among these, the selective serotonin uptake inhibitors are particularly implicated in causing hyponatremia.
- Antipsychotic drugs: Phenothiazines (thioridazine, trifluperazine), butyrophenones (haloperidol).
Antidepressant and antipsychotic drugs cause hyponatremia through the development of SIADH.
- Antiepileptic drugs: Carbamezepine, oxcarbazepine, sodium valproate, lamotrigine.
Carbamazepine, oxcarbazepine and sodium valproate cause an increase in production of ADH, whereas carbamazepine and lamotrigine cause potentiation of ADH effect. Oxcarbazepine has been found to cause hyponatremia more commonly as compared to carbamazepine.
- Anticancer drugs: Vinca alkaloids (vincristine, vinblastine), platinum compounds (cisplatin, carboplatin), alkylating agents (cyclophosphamide, melphalan, ifosfamide), and other anticancer agents (methotrexate, interferon alpha and gamma, levamisole, pentostatin, monoclonal antibodies).
The anticancer drugs increase the release of ADH. Cyclophosphamide in addition potentiates the effect of ADH. Vincristine and vinblastine exert a direct effect on the hypothalamus and pituitary to increase the release of ADH. Cisplatin probably causes hyponatremia by causing SIADH and through its effect on the kidneys.(5✔)
- Painkillers: Opiates, nonsteroidal anti-inflammatory agents, acetaminophen.
Opiates bring about hyponatremia by stimulating ADH release directly or indirectly by causing nausea or low blood pressure. Nonsteroidal anti-inflammatory drugs potentiate the effect of ADH.
- Antidiabetic drugs: Chlorpropamide, tolbutamide.
Chlorpropamide causes SIADH whereas tolbutamide decreases clearance of free water by the kidneys.
- Antidiuretic hormone analogues: Deamino-D-arginine vasopressin (DDAVP), oxytocin.
Deamino-D-arginine vasopressin (DDAVP) and oxytocin prevent the excretion of water by the kidneys, thus can cause hyponatremia especially when administered with electrolyte-free water.
Other drugs that could rarely cause hyponatremia include:
- Drugs that reduce blood pressure: Angiotensin-converting enzyme inhibitors, amlodipine
- Immune globulin (intravenous)
- 3, 4-Methylenedioxymethylamphetamine (ecstasy)
- Antibiotics: Trimethoprim-sulfamethoxazole, ciproﬂoxacin, cefoperazone/sulbactam, rifabutin
- Antiarrhythmic drugs: Amiodarone, lorcainide, propafenone
- Proton pump inhibitors
- Fluorescein angiography
- Hyponatremia: A Practical Approach - (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4192979/)
- Effects of Hyponatremia on the Brain - (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4470176/)
- Hyponatremia - (https://www.kidney.org/atoz/content/hyponatremia)
- Management of Hyponatremia - (https://www.aafp.org/afp/2004/0515/p2387.html)
- A Review of Drug-induced Hyponatremia - (https://www.ncbi.nlm.nih.gov/pubmed/18468754)