Reported Cases of Lexapro-Associated Hyponatremia
I cannot provide specific case numbers for 2025, as this data is not available in the provided evidence or in any published surveillance database at this time.
What We Know About Escitalopram (Lexapro) and Hyponatremia Risk
The American Academy of Family Physicians identifies escitalopram as carrying significant hyponatremia risk, with an odds ratio of 3.3 compared to other antidepressant classes, particularly affecting elderly patients, women, and those on concurrent diuretics 1.
Incidence and Timing
- Hyponatremia occurs in 0.5-12% of elderly patients treated with SSRIs, including escitalopram 1
- Typical onset occurs within the first month of treatment 1, 2
- In published case series, 84% of citalopram-related hyponatremia cases were detected during the first month of therapy 2
High-Risk Patient Characteristics
The published case reports reveal a consistent pattern:
- Elderly patients (>70 years) represent 79% of symptomatic cases 2
- Women account for 74% of reported cases 2
- Concurrent use of diuretics or other psychotropic medications significantly increases risk 2
Clinical Severity in Reported Cases
Published case reports demonstrate the potential severity:
- Cases have presented with severe symptomatic hyponatremia (sodium as low as 122 mmol/L) 3, 4, 5
- Neurological manifestations including generalized tonic-clonic seizures, deep coma, and delirium have been documented 3, 2, 6
- One case documented recurrent hyponatremia upon rechallenge with escitalopram 5
Clinical Monitoring Recommendations
The American Academy of Family Physicians recommends suspending escitalopram immediately in cases of symptomatic hyponatremia and implementing appropriate medical intervention based on severity 1.
For patients initiating escitalopram therapy:
- Monitor serum sodium levels closely, especially during the first month 1, 4
- Exercise particular caution in elderly patients, women, and those on concurrent diuretics 1, 2
- Do not rechallenge with the same medication in patients who develop hyponatremia 5
Why Case Numbers Are Not Available for 2025
Hyponatremia surveillance data is typically:
- Reported through voluntary adverse event reporting systems with significant underreporting
- Published in aggregate form years after occurrence
- Not tracked in real-time by specific medication and calendar year
- Subject to reporting bias, with severe cases more likely to be documented
The evidence demonstrates that escitalopram-induced hyponatremia is a well-established but relatively uncommon adverse effect that requires clinical vigilance, particularly in high-risk populations 1, 3, 4, 2.