Reactions 387 - 8 Feb 1992

Imipramine

Inappropriate antidiuretic hormone secretion: casereport

Several classes of psychotropic agents, including thetricyclic antidepressants, have been associated with thesyndrome of inappropriate antidiuretic hormone secretion(SIADH). However, the authors believe this is only the thirdreport of imipramine inducing this condition.

A 64-year-old woman with a long history of endogenousdepression was hospitalised in a state of mental confusion andlethargy. Imipramine 150 mg/day had been initiated 3 monthsearlier.

Laboratory values on admission included low serum levelsof sodium (113 mEq/L) and chloride (80 mEq/L), and a serumantidiuretic hormone level of 1.9 pg/ml at a serum osmolalityof 236 mOsm/kg. Persistent urinary excretion of sodium waspresent despite the hyponatraemia. SIADH was diagnosed andimipramine was discontinued and fluids restricted. Thehyponatraemia resolved over the next 8 days.

Several years prior to the current hospitalisation, she had anepisode of hyponatraemia (serum sodium 120 mEq/L) duringthioridazine treatment.

’In patients with a known history of SIADH, antidepressantsor antipsychotic drugs should be administered with caution,and patients should be monitored for recurrent SIADH.’Adlakha A, et al. Imipramine-induced syndrome of inappropriate antidiuretichormone secretion. Southern Medical Journal 84: 1507-1509, Dec 1991 -USA 800115744

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Reactions 8 Feb 1992 No. 3870114-9954/10/0387-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved