Mirtazapine-induced hyponatremia in an elderly hospice patient

Journal of Palliative Medicine
Marco LadinoMiguel Paniagua

Abstract

Mirtazapine, which enhances central noradrenergic and serotonergic activity, is a commonly prescribed drug for mood disorders in elderly patients due to the low incidence of adverse effects. A heterocyclic antidepressant, mirtazapine has pharmacodynamics similar to selective serotonin reuptake inhibitors (SSRIs) and tricyclic antidepressants. Nevertheless, geriatric patients in general are more prone to experience adverse drug effects. To report a case of hyponatremia in an elderly hospice patient associated with mirtazapine use. A 72-year-old Latino male with stage IV colon cancer entered into hospice care and was treated for major depressive disorder with mirtazapine. On day 6 of treatment, he was somnolent and confused. He was found to have severe hyponatremia (serum sodium of 116 mmol/L) without any immediately identifiable physiologic cause. His previous sodium levels were within normal limits over a 6-month period including when mirtazapine was started. Upon discontinuation of mirtazapine, the patient's mental status improved, and his sodium level returned to normal. Hyponatremia resulting from antidepressant use, particularly SSRIs, is rare in the general population, but in the elderly population the incidence increases ...Continue Reading

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Citations

Jan 25, 2008·Journal of the American Society of Nephrology : JASN·Alisa M SheaKevin A Schulman
Sep 30, 2014·Psychosomatics·Livia De PickerBernard G C Sabbe
Aug 5, 2008·The American Journal of Geriatric Pharmacotherapy·Chan Y CheahP Gerry Fegan
Aug 22, 2009·British Journal of Clinical Pharmacology·Sonja Kwadijk-de GijselBruno H Ch Stricker
May 16, 2007·Journal of Clinical Psychopharmacology·Astrid Catharina Dirks, Dirk Medard Helena van Hyfte
May 24, 2008·American Journal of Health-system Pharmacy : AJHP : Official Journal of the American Society of Health-System Pharmacists·Kim A Madewell, Phil Kuo

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