From the FDA Drug Label
Hyponatremia may occur as a result of treatment with SSRIs and SNRIs, including sertraline. In many cases, this hyponatremia appears to be the result of the syndrome of inappropriate antidiuretic hormone secretion (SIADH). Elderly patients may be at greater risk of developing hyponatremia with SSRIs and SNRIs Also, patients taking diuretics or who are otherwise volume depleted may be at greater risk
To prevent hyponatremia in patients taking Lustral (sertraline), consider the following key points:
- Monitor patients for signs and symptoms of hyponatremia, such as headache, difficulty concentrating, memory impairment, confusion, weakness, and unsteadiness.
- Be cautious when prescribing sertraline to elderly patients or those taking diuretics, as they may be at greater risk of developing hyponatremia.
- Assess patients for volume depletion and manage it accordingly to reduce the risk of hyponatremia.
- Discontinue sertraline and institute appropriate medical intervention if symptomatic hyponatremia occurs 1.
From the Research
To prevent hyponatremia in patients taking Lustral (sertraline), monitor serum sodium levels regularly, especially during the first few weeks of treatment and after dose adjustments, as the risk of hyponatremia is highest during this period 2.
Prevention Strategies
- Patients should maintain adequate fluid intake without overhydration
- Healthcare providers should consider lower starting doses in high-risk individuals such as elderly patients, those with pre-existing hyponatremia, or patients taking other medications that can affect sodium levels (like diuretics) 3
- Educate patients to recognize early symptoms of hyponatremia including headache, confusion, nausea, and weakness, and instruct them to seek medical attention if these occur
Risk Factors
- Increased age
- Female gender
- Previous history of hyponatremia
- Concomitant use of other medications known to include hyponatraemia 4
Monitoring and Treatment
- For patients with risk factors, sodium levels should be checked before starting sertraline and periodically thereafter, typically at 1-2 weeks, 1 month, and then every 3-6 months during treatment
- If hyponatremia develops, treatment options include sertraline dose reduction, switching to an antidepressant with lower risk of hyponatremia, or implementing fluid restriction depending on the severity 5
Key Considerations
- Sertraline can cause hyponatremia through the syndrome of inappropriate antidiuretic hormone secretion (SIADH), which leads to water retention and sodium dilution 2
- The association between newly initiated treatment with SSRIs or venlafaxine and hospitalization due to hyponatremia is strong, while the association for tricyclic antidepressants and mirtazapine is small to moderate 2