From the Research
Pantoprazole is associated with a risk of hyponatremia, a condition characterized by abnormally low sodium levels in the blood, as evidenced by a case report published in 2020 1. This adverse effect is a class effect seen with all proton pump inhibitors (PPIs), including pantoprazole. The risk is generally low but increases in elderly patients, those taking other medications that can affect sodium levels (such as diuretics or SSRIs), and with longer duration of therapy. The mechanism involves PPI-induced inhibition of hydrogen-potassium ATPase in the kidneys, which can lead to inappropriate antidiuretic hormone secretion and reduced sodium reabsorption. Some key points to consider include:
- Clinicians should monitor sodium levels in high-risk patients taking pantoprazole, especially during the first few weeks of therapy.
- Symptoms of hyponatremia may include headache, confusion, nausea, fatigue, and in severe cases, seizures or coma.
- If hyponatremia develops, dose reduction or discontinuation of pantoprazole may be necessary, along with appropriate sodium correction based on the severity of the condition.
- A study published in 2016 2 reported a case of an 83-year-old man with symptomatic severe hyponatremia due to Syndrome of Inappropriate Antidiuretic Hormone Secretion (SIADH) related to pantoprazole, highlighting the importance of considering this potential side effect in clinical practice.
- Another study published in 2020 1 reported a case of a 67-year-old man who developed asymptomatic hyponatremia while taking omeprazole, and later developed hyponatremia again after switching to pantoprazole, suggesting a class effect of PPIs in inducing hyponatremia. Overall, while the risk of hyponatremia associated with pantoprazole is generally low, clinicians should be aware of this potential side effect and monitor patients accordingly, particularly those at high risk.