Reactions 648 - 26 Apr 1997

Lofepramine/sertraline

Syndrome of inappropriate secretion of antidiuretichormone in an elderly patient: case report

A diagnosis of syndrome of inappropriate secretion ofantidiuretic hormone (SIADH) was made in a 78-year-oldwoman after treatment with sertraline, and then lofepraminefor major depression.

One week after the woman began sertraline 50 mg/day, shewas hospitalised with weakness and lethargy. Her serumsodium level was 117 mmol/L, her serum osmolality was 245mmol/kg, her urine sodium level was 21 mmol/L and her urineosmolality was 314 mmol/kg. Sertraline was stopped and shewas treated with fluid restriction. Her hyponatraemia hadresolved 1 week later.

The woman then began treatment with lofepramine 70mg/day and the dosage was increased to 140 mg/day after 3days. After 2 weeks of lofepramine therapy, her serum sodiumlevel decreased to 128 mmol/L, and her serum and urineosmolality were 259 and 581 mmol/kg, respectively.Lofepramine was discontinued and her fluids were restricted.Her laboratory abnormalities were normal 1 week later. Shewas subsequently treated with electroconvulsive therapy andcitalopram.

Author comment: ‘Our case demonstrates thathyponatraemia and SIADH are not necessarily class effects ofthe SSRIs [selective serotonin reuptake inhibitors]; there alsomight be a crossover effect with tricyclic antidepressants . . .From the current reports in the literature, it seems that elderlypatients are particularly at risk.’Bouman WP, et al. Recurrent hyponatremia associated with sertraline andlofepramine. American Journal of Psychiatry 154: 580, Apr 1997 -England 800523651

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Reactions 26 Apr 1997 No. 6480114-9954/10/0648-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved