From the Guidelines
Psychiatric medications that can cause Syndrome of Inappropriate Antidiuretic Hormone secretion (SIADH) include selective serotonin reuptake inhibitors (SSRIs), tricyclic antidepressants, monoamine oxidase inhibitors (MAOIs), and certain antipsychotics. The medications most commonly associated with SIADH are SSRIs, such as fluoxetine, sertraline, paroxetine, escitalopram, and citalopram. Other medications that can cause SIADH include:
- Tricyclic antidepressants like amitriptyline and imipramine
- Monoamine oxidase inhibitors (MAOIs)
- Certain antipsychotics such as haloperidol and phenothiazines
- Carbamazepine, used as a mood stabilizer These medications can stimulate inappropriate ADH release from the posterior pituitary or enhance ADH effects at the kidney, leading to water retention, hyponatremia, and symptoms like headache, confusion, seizures, and in severe cases, coma 1. Key risk factors for SIADH include:
- Older age
- Female gender
- Low body weight
- Concomitant use of diuretics Clinicians should monitor sodium levels when starting these medications, especially in high-risk patients, and consider dose reduction or medication change if SIADH develops. It is essential to note that the provided study 1 focuses on drug-induced atrial fibrillation, but it does not directly address SIADH; however, the medications listed can still cause SIADH, as supported by other evidence.
From the FDA Drug Label
Hyponatremia — Hyponatremia may occur as a result of treatment with SSRIs and SNRIs, including Prozac. In many cases, this hyponatremia appears to be the result of the syndrome of inappropriate antidiuretic hormone secretion (SIADH)
- Fluoxetine (Prozac) is a psych med that can cause SIADH 2.
- Elderly patients may be at greater risk of developing hyponatremia with SSRIs and SNRIs, including Prozac.
- Patients taking diuretics or who are otherwise volume depleted may be at greater risk.
From the Research
Psychotropic Medications Associated with SIADH
The following psychotropic medications have been associated with the Syndrome of Inappropriate Antidiuretic Hormone Secretion (SIADH):
- SSRIs (Selective Serotonin Reuptake Inhibitors) 3, 4
- SNRIs (Serotonin-Norepinephrine Reuptake Inhibitors) 3, 4, 5
- Antipsychotics 3, 6
- Carbamazepine 3
- Oxcarbazepine 3
- Venlafaxine 4, 5
Risk Factors for SIADH
Risk factors for developing SIADH include:
Management of SIADH
Management of SIADH includes:
- Discontinuation of the offending medication 3, 4, 5
- Fluid restriction 3, 7, 5
- Hypertonic saline 7
- Urea 7
- Demeclocycline 7
- Vasopressin receptor antagonists (vaptans) 7, 5
Monitoring and Treatment
Monitoring of sodium levels is crucial in the treatment of SIADH 3, 7, 5. Treatment should aim to correct hyponatremia at a rate of less than 8-10 mmol/liter per day to prevent osmotic demyelination 7.