From the Guidelines
Medications that can cause Syndrome of Inappropriate Antidiuretic Hormone secretion (SIADH) include chemotherapeutic agents, opioids, non-steroidal anti-inflammatory drugs (NSAIDs), anticonvulsants, and antidepressants, as well as other medications such as vinca alkaloids and platinum-based chemotherapy 1.
Common Medications Associated with SIADH
- Chemotherapy agents: platinum-based chemotherapy, vinca alkaloids
- Opioids
- Non-steroidal anti-inflammatory drugs (NSAIDs)
- Anticonvulsants
- Antidepressants
Mechanism of SIADH
These medications can cause SIADH by either directly stimulating ADH release from the pituitary, enhancing ADH effects on the kidneys, or through other mechanisms that disrupt normal water balance.
Diagnosis and Management
Patients taking these medications should be monitored for symptoms of hyponatremia such as headache, confusion, seizures, and in severe cases, coma, and managed accordingly with treatments such as free water restriction, hypertonic saline, and vasopressin receptor antagonists 1.
Risk Factors
Risk increases in elderly patients and those with other predisposing conditions, and early detection and appropriate management can prevent severe hyponatremia, which can lead to seizures, coma, and death 1.
From the FDA Drug Label
Hyponatremia — Hyponatremia may occur as a result of treatment with SSRIs and SNRIs, including Prozac. In many cases, this hyponatremia appears to be the result of the syndrome of inappropriate antidiuretic hormone secretion (SIADH) Endocrine – Rare occurrences of a syndrome attributable to inappropriate antidiuretic hormone secretion have been observed in patients treated with vincristine sulfate.
The following medications can cause SIADH:
From the Research
Medications that can cause SIADH
The following medications have been associated with the development of Syndrome of Inappropriate Antidiuretic Hormone (SIADH):
- SSRIs (Selective Serotonin Reuptake Inhibitors) such as sertraline 4, escitalopram 5, and fluoxetine 6
- SNRIs (Serotonin-Norepinephrine Reuptake Inhibitors) 7
- Antipsychotics 7
- Carbamazepine 7
- Oxcarbazepine 7
Risk Factors and Recommendations
Patients at higher risk of developing SIADH, such as the elderly or those taking diuretics, should be closely monitored for serum sodium levels 8. A risk score has been proposed to guide clinical decision-making, and substitution with medications that are less likely to cause SIADH should be considered when appropriate 7. An algorithmic approach to monitoring hyponatremia with SIADH and corresponding treatment depending on symptom severity has been proposed 7.
Mechanisms and Associations
Several mechanisms may relate SIADH and vasopressin release to serotonin 4. The use of SSRIs can disrupt the action of antidiuretic hormone in the body, leading to SIADH 8. Further studies are needed to determine whether baseline and serial Na+ monitoring reduces morbidity and mortality 7.