Can meveverine cause hyponatremia?

Mebeverine and Hyponatremia: Evidence Assessment

Based on the available evidence, there is no established association between mebeverine and hyponatremia.

Mechanism of Action and Metabolism of Mebeverine

Mebeverine is an antispasmodic drug used in the treatment of irritable bowel syndrome. Its pharmacological profile shows:

• Rapid metabolism to mebeverine-alcohol and veratric acid 1
• High instability in esterase-containing biological fluids, particularly blood and plasma 1
• No documented mechanism that would affect sodium homeostasis

Medications Known to Cause Hyponatremia

The evidence clearly identifies several medication classes associated with hyponatremia:

• Diuretics: Particularly thiazides, responsible for 94% of severe diuretic-induced hyponatremia 2
• Psychotropic drugs: Including antidepressants 3
• Anticonvulsants: Such as carbamazepine 4
• Other medications: Proton pump inhibitors, certain antibiotics, ACE inhibitors, and hypoglycemic agents have been infrequently associated with hyponatremia 5

Clinical Guidelines on Hyponatremia Management

Guidelines for managing hyponatremia focus on:

• Discontinuation of diuretics and expansion of plasma volume with normal saline in hypovolemic hyponatremia 6
• Fluid restriction (1-1.5 L/day) for hypervolemic hyponatremia with severe sodium levels (<125 mmol/L) 6
• Hypertonic sodium chloride (3%) administration reserved for severely symptomatic acute hyponatremia 6
• Careful correction of serum sodium to avoid central pontine myelinolysis (no more than 8 mmol/L per day) 6

Diagnostic Approach to Hyponatremia

When evaluating hyponatremia, guidelines recommend:

1. Review of medications, focusing on known culprits (thiazide diuretics, antidepressants, antiepileptics) 2, 5
2. Assessment for underlying conditions such as heart failure, liver disease, and SIADH 2
3. Measurement of serum sodium, serum osmolality, and urine osmolality 6

Conclusion

Mebeverine is not listed among medications known to cause hyponatremia in any of the guidelines or research studies provided. When investigating hyponatremia, clinicians should focus on more established causes such as diuretic therapy, heart failure medications, psychotropic drugs, and anticonvulsants rather than mebeverine.

If a patient on mebeverine develops hyponatremia, other more likely causes should be investigated before attributing it to mebeverine therapy.