From the Guidelines
Zoloft (sertraline) can indeed induce Syndrome of Inappropriate Antidiuretic Hormone Secretion (SIADH), as evidenced by its mention as a causative medication in the context of euvolemic hyponatremia 1. This is a recognized but uncommon adverse effect of selective serotonin reuptake inhibitors (SSRIs) including sertraline.
- SIADH occurs when the medication causes excessive release of antidiuretic hormone (ADH) from the pituitary gland, leading to water retention and dilutional hyponatremia (low sodium levels in the blood).
- The condition typically develops within the first few weeks of starting sertraline or after a dose increase.
- Symptoms of SIADH may include headache, confusion, lethargy, nausea, and in severe cases, seizures or coma.
- Healthcare providers should monitor sodium levels in patients starting sertraline who have risk factors for hyponatremia or who develop concerning symptoms.
- If SIADH occurs, management may involve sertraline discontinuation, fluid restriction, and in some cases, sodium replacement therapy depending on the severity of hyponatremia, as part of the broader approach to managing hyponatremia in patients with cirrhosis and ascites 1.
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). Yes, Zoloft (sertraline) can induce Syndrome of Inappropriate Antidiuretic Hormone Secretion (SIADH), which may lead to hyponatremia.
- Key points to consider:
- Elderly patients may be at greater risk of developing hyponatremia with SSRIs and SNRIs.
- Patients taking diuretics or who are otherwise volume depleted may be at greater risk.
- Discontinuation of sertraline should be considered in patients with symptomatic hyponatremia and appropriate medical intervention should be instituted. 2
From the Research
Zoloft and SIADH
- Zoloft, also known as sertraline, is a selective serotonin reuptake inhibitor (SSRI) used to treat depression and other mental health conditions.
- There have been reports of SSRIs, including sertraline, inducing the Syndrome of Inappropriate Antidiuretic Hormone Secretion (SIADH), a condition characterized by excessive secretion of antidiuretic hormone, leading to hyponatremia (low sodium levels in the blood) 3.
- A review of spontaneous reports found that sertraline was involved in 86 (11.7%) of 736 cases of hyponatremia and SIADH associated with SSRI use 3.
- The median time to onset of hyponatremia was 13 days (range 3 to 120 days), and most cases involved patients 65 years of age or more 3.
- Elderly people may be at increased risk for hyponatremia associated with SSRI use, including sertraline 3.
Risk Factors and Mechanism
- Advanced age and concomitant use of medications known to cause SIADH or hyponatremia are potential risk factors for developing SIADH with sertraline 4.
- The mechanism of SIADH induced by SSRIs, including sertraline, is not fully understood, but it is thought to be related to the increased levels of serotonin in the body 5.
- Monitoring of serum sodium levels is recommended in elderly patients taking sertraline, especially in the first few weeks of therapy and during dose escalation 4.
Clinical Implications
- Physicians should be aware of the risk of hyponatremia when prescribing sertraline, especially in elderly patients with multiple drug therapies 5.
- If hyponatremia is suspected, sertraline should be discontinued, and fluid restrictions and other treatments may be necessary to manage the condition 6, 4.
- Alternative medications or dose adjustments may be considered to minimize the risk of SIADH and hyponatremia 6.