Can Reglan (Metoclopramide) cause hyponatremia?

From the Guidelines

Reglan (Metoclopramide) can cause hyponatremia, a condition characterized by abnormally low sodium levels in the blood, primarily through its ability to stimulate the release of antidiuretic hormone (ADH). This occurs when metoclopramide increases ADH release from the pituitary gland, leading to increased water reabsorption by the kidneys and subsequent dilution of sodium concentration in the blood, similar to the mechanism in Syndrome of Inappropriate ADH Secretion (SIADH) 1.

Key Points to Consider

• Patients taking Reglan who develop symptoms such as headache, confusion, lethargy, muscle weakness, nausea, or seizures should seek medical attention as these could indicate hyponatremia.
• The risk of hyponatremia may be higher in elderly patients, those taking other medications that affect sodium levels, or those with certain medical conditions.
• Although the provided evidence primarily discusses the management of ascites in cirrhosis and does not directly address metoclopramide-induced hyponatremia, the general principles of managing hyponatremia, such as fluid restriction and the use of hypertonic saline in severe cases, can be applied 1.

Management Considerations

• Healthcare providers should monitor sodium levels in patients on long-term metoclopramide therapy, especially if they have risk factors for electrolyte disturbances.
• If hyponatremia develops, treatment may involve discontinuing metoclopramide and implementing strategies to correct sodium levels, such as fluid restriction and, in severe cases, administration of hypertonic saline, as suggested for the management of hypovolaemic hyponatraemia during diuretic therapy 1.

From the Research

Hyponatremia and Reglan (Metoclopramide)

• Hyponatremia is a condition characterized by low sodium levels in the blood, which can be caused by various factors, including certain medications 2, 3, 4, 5.
• Reglan (Metoclopramide) is an anti-emetic drug that has been shown to stimulate the secretion of antidiuretic hormone arginine vasopressin, which can potentially limit free water excretion and cause hyponatremia 6.
• However, a study found that metoclopramide is unlikely to cause significant water retention in a clinical setting or precipitate hyponatremia 6.
• The available evidence does not provide a clear link between Reglan (Metoclopramide) and hyponatremia, but it is essential to consider the potential risks and monitor patients taking this medication for any signs of hyponatremia 2, 3, 4, 5.

Medications and Hyponatremia

• Certain medications, such as thiazide or thiazide-like drugs, can cause hyponatremia, particularly in older adults 3.
• Other medications, like carbamazepine, have been reported to cause hyponatremia as a side effect 4.
• Vasopressin receptor antagonists, such as vaptans, have been shown to be effective in treating hyponatremia by increasing solute-free water excretion 5.

Treatment and Management of Hyponatremia

• Treatment of hyponatremia depends on the underlying cause and severity of the condition 2, 3, 4, 5.
• Fluid restriction, vasopressin receptor antagonists, and other medications may be used to manage hyponatremia, depending on the individual case 3, 5.
• It is crucial to monitor patients with hyponatremia closely and adjust treatment as needed to prevent complications and improve outcomes 2, 3, 4, 5.