From the FDA Drug Label
Rare occurrences of a syndrome attributable to inappropriate antidiuretic hormone secretion have been observed in patients treated with vincristine sulfate. The medication that can cause SIADH (Syndrome of Inappropriate Antidiuretic Hormone Secretion) is vincristine sulfate 1.
- Key points about SIADH caused by vincristine sulfate include:
- Characterized by high urinary sodium excretion in the presence of hyponatremia
- Renal or adrenal disease, hypotension, dehydration, azotemia, and clinical edema are absent
- Improvement occurs in the hyponatremia and in the renal loss of sodium with fluid deprivation
From the Research
Selective serotonin reuptake inhibitors (SSRIs), such as fluoxetine, sertraline, and paroxetine, are among the most common medications that can cause Syndrome of Inappropriate Antidiuretic Hormone secretion (SIADH). According to the study published in the British journal of clinical pharmacology 2, five drug classes (antidepressants, anticonvulsants, antipsychotic agents, cytotoxic agents, and pain medications) were implicated in 82.3% of patients diagnosed with drug-associated SIADH.
Medications that can cause SIADH
- Selective serotonin reuptake inhibitors (SSRIs) such as fluoxetine, sertraline, and paroxetine
- Tricyclic antidepressants like amitriptyline
- Antipsychotics including haloperidol and phenothiazines
- Certain anticonvulsants (carbamazepine, oxcarbazepine, valproic acid)
- Chemotherapeutic agents (cyclophosphamide, vincristine, cisplatin)
- Some pain medications, particularly opioids and NSAIDs
- Certain antibiotics like trimethoprim-sulfamethoxazole and ciprofloxacin
Mechanism of SIADH
These medications cause SIADH by either directly stimulating ADH release from the posterior pituitary, enhancing ADH effects at the kidney level, or through other mechanisms that disrupt normal water homeostasis. The study published in The American journal of nursing 3 highlights the importance of monitoring serum sodium levels closely in patients at higher risk, such as the elderly or those taking diuretics.
Patient Monitoring
Patients taking these medications should be monitored for symptoms of hyponatremia, such as headache, confusion, nausea, and in severe cases, seizures or coma. The risk of SIADH increases in elderly patients, those with renal impairment, and when multiple SIADH-inducing medications are used concurrently, as noted in the study published in the British journal of clinical pharmacology 2.