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Antipsychotics and severe hyponatremia: A Swedish population–based case–control study

  • Henrik Falhammar
    Correspondence
    Corresponding author at: Department of Molecular Medicine and Surgery, D02:04, Karolinska Institutet, SE-171 76 Stockholm, Sweden.
    Affiliations
    Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden

    Department of Endocrinology, Metabolism and Diabetes, Karolinska University Hospital, Stockholm, Sweden
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  • Jonatan D. Lindh
    Affiliations
    Department of Laboratory Medicine, Division of Clinical Pharmacology, Karolinska University Hospital Huddinge, Karolinska Institutet, Stockholm, Sweden
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  • Jan Calissendorff
    Affiliations
    Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden

    Department of Endocrinology, Metabolism and Diabetes, Karolinska University Hospital, Stockholm, Sweden
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  • Jakob Skov
    Affiliations
    Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
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  • David Nathanson
    Affiliations
    Department of Endocrinology, Metabolism and Diabetes, Karolinska University Hospital, Stockholm, Sweden

    Department of Clinical Science and Education at Södersjukhuset, Karolinska Institutet, Stockholm, Sweden
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  • Buster Mannheimer
    Affiliations
    Department of Clinical Science and Education at Södersjukhuset, Karolinska Institutet, Stockholm, Sweden
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Published:December 01, 2018DOI:https://doi.org/10.1016/j.ejim.2018.11.011

      Highlights

      • There was an association between antipsychotics, and hospitalization due to hyponatremia
      • The association was stronger for first-generation than second-generation antipsychotics
      • Risperidone was not associated with an increased risk
      • In severe hyponatremia with antipsychotics, consider an alternative
      • If the indication for antipsychotic use remains, risperidone could here be an option

      Abstract

      Background

      Antipsychotics have been claimed to cause hyponatremia. The risk associated with individual antipsychotics, or groups (first-generation [FGAs] or second-generation [SGAs] antipsychotics), is not well-documented. The objective of this study was to investigate the association between antipsychotics and hospitalization due to hyponatremia.

      Methods

      The general Swedish population was the base of this register–based case–control study. Comparisons were made between patients hospitalized with a principal diagnosis of hyponatremia (n = 14,359) and matched controls (n = 57,383). Multivariable logistic regression adjusting for concomitant drugs, medical conditions, previous hospitalizations and socioeconomic factors was performed to investigate the association between hyponatremia and antipsychotic use. In addition newly initiated (≤90 days) or ongoing use was analysed separately.

      Results

      Compared to controls, the adjusted OR (95%CI) for hospitalization due to hyponatremia was for any antipsychotic 1.67(1.5–1.86). Individuals on FGA were more likely to experience severe hyponatremia (2.12[1.83–2.46]) than those on any SGA (1.32[1.15–1.51]). No increased risks, neither as newly initiated nor ongoing therapy, were found for risperidone (0.86[0.56–1.31] and 0.83[0.67–1.02]) and aripiprazole (1.16[0.30–4.46] and 0.62[0.27–1.34]), respectively.

      Conclusions

      There was an association between antipsychotic therapy and hospitalization due to hyponatremia. The association was stronger for FGAs than SGAs. Risperidone was not associated with an increased risk.

      Keywords

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