Can amitriptyline (tricyclic antidepressant) cause hyponatremia (low sodium)?

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Last updated: March 26, 2025View editorial policy

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From the Research

Amitriptyline can cause low sodium levels (hyponatremia) in some patients, particularly the elderly, those taking other medications that affect sodium levels, and individuals with certain medical conditions, as evidenced by a study published in 2018 1. This tricyclic antidepressant may lead to hyponatremia through a mechanism called the Syndrome of Inappropriate Antidiuretic Hormone secretion (SIADH), where the body retains too much water, diluting the sodium in the bloodstream. The risk is higher in:

  • Elderly patients
  • Those taking other medications that affect sodium levels
  • Individuals with certain medical conditions Symptoms of low sodium may include:
  • Confusion
  • Headache
  • Nausea
  • Muscle weakness
  • In severe cases, seizures or coma The effect is dose-dependent, with higher doses potentially increasing the risk, as suggested by a study published in 2013 2. Patients taking amitriptyline should be aware of these potential symptoms and seek medical attention if they occur. Regular monitoring of sodium levels may be recommended, especially when starting treatment or adjusting dosage, as noted in a study published in 2016 3. If hyponatremia develops, dose reduction or discontinuation of amitriptyline might be necessary, along with appropriate treatment to restore normal sodium levels, as indicated by a study published in 2002 4. It is essential to consider the potential risk of hyponatremia when prescribing amitriptyline, particularly in vulnerable populations, and to monitor sodium levels accordingly, as highlighted in a study published in 2018 1.

References

Research

Antidepressant-Induced Hyponatremia in Older Adults.

The Consultant pharmacist : the journal of the American Society of Consultant Pharmacists, 2016

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This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.

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