From the Guidelines
Medications that can contribute to Syndrome of Inappropriate Antidiuretic Hormone Secretion (SIADH) include chemotherapeutic agents, opioids, non-steroidal anti-inflammatory drugs (NSAIDs), anticonvulsants, and antidepressants. These medications can cause SIADH by either stimulating ADH release, enhancing ADH effects at the kidney level, or resetting the osmoregulatory system that controls ADH secretion, leading to excessive water retention and dilutional hyponatremia 1.
Common Medications Associated with SIADH
- Chemotherapeutic agents such as platinum-based chemotherapy or vinca alkaloids
- Opioids
- Non-steroidal anti-inflammatory drugs (NSAIDs)
- Anticonvulsants
- Antidepressants Patients taking these medications should be monitored for symptoms like headache, confusion, nausea, and seizures, particularly when initiating therapy or adjusting dosages. It is essential to diagnose SIADH accurately and exclude other potential causes of hyponatraemia, such as adrenal insufficiency 1.
Key Considerations
- SIADH can occur with many medications, not just those listed above
- Patients with SIADH are clinically euvolaemic with inappropriately high urine osmolality and reduced effective serum osmolality
- A diagnosis of SIADH should only be made after excluding other potential causes of hyponatraemia 1.
From the FDA Drug Label
Endocrine Hyperglycemia, hypoglycemia, and syndrome of inappropriate antidiuretic hormone secretion. The medication bupropion can contribute to SIADH (Syndrome of Inappropriate Antidiuretic Hormone Secretion), as stated in the drug label 2.
- Key points:
- Bupropion is associated with SIADH.
- This condition can lead to hyponatremia and other complications.
- Monitoring of sodium levels and clinical signs of SIADH is recommended when using bupropion.
From the Research
Medications that can Contribute to SIADH
- Selective serotonin reuptake inhibitors (SSRIs) such as citalopram 3, sertraline 4, and other SSRIs 5 have been reported to be associated with the syndrome of inappropriate antidiuretic hormone (SIADH)
- Nonsteroidal anti-inflammatory drugs (NSAIDs) like naproxen 3 can also contribute to SIADH, although it is a rare cause
- Serotonin norepinephrine reuptake inhibitors (SNRIs) such as duloxetine 6 have been reported to cause SIADH-induced hyponatraemia
- Antipsychotic drugs 7 have also been associated with the development of hyponatraemia, including SIADH
Key Points to Consider
- Elderly patients and those taking diuretics are at higher risk of developing SIADH 5
- Monitoring of serum sodium levels is warranted when prescribing medications that can contribute to SIADH 3, 5
- Medication reconciliation should be done carefully to avoid adverse effects and drug interactions 3
- Discontinuing the offending agent and administering fluid restriction and oral sodium supplements can help resolve hyponatremia symptoms 3