Table 5. Details From Published Reports of Hyponatremia and SIADH Associated with SSRI Use
ReferenceAge/SexDaily
Dose
(mg)		Lowest
Serum
Sodium Level
(mmol/L)		Serum
Osmolality
(mmol/kg)		Urine
Osmolality
(mmol/kg)		Urine
Sodium
Level
(mmol/L)		Days
to Onset (n)		Days
to Recovery
after Drug
Withdrawal (n)		Other medicationsComments
Citalopram
Spigset et al.1969/F40121NRNRNR548

(42 after buspirone start)

5BuspironePatient had consumed more than prescribed amounts of both drugs in last few days before admission; renal and CT results normal
Voegeli et al.2073/F20128NRNRNR724NRPrior history of hyponatremia due to diuretics; R results normal; no recurrence with maprotiline and flupenthixol
Fluoxetine
Hwang et al.2175/M20126264417NR1010NRSwitched to trazodone, no further hyponatremia
Cohen et al.2282/F40125265NR7437NRR, TFT and Adr results normal
79/F20129NRNR46425NRR, TFT and Adr results normal;
positive rechallenge with fluoxetine
84/F40124264NR5421SSRI
continued		NRR, TFT and Adr results normal
85/M20126272NR84714NRThalamic infarct; R and TFT results
normal, ACTH stimulation test results
normal
Gommans et al.23v75/F2011624233791126RanitidineR and TFT results normal, cortisol
level normal
Marik et al.2460/FNR1062254525012014LorazepamCXR, abdominal ultrasound, TFT and Adr results normal
Staab et al.2559/M8012526950945213NoneR, TFT and Adr results normal; no
occult malignant disease; negative
rechallange with fluoxetine
Vishwanath et al.2653/F20122258385102142NRTFT result, CXR and CT of head
normal
Blacksten et al.2792/F2098214465114138Indapamide‡,
levothyroxine,
alprazolam		R, TFT and Adr results normal; CXR
and head CT normal
Kazal et al.2883/F2012425657385613Trimethoprim-
sulfamethoxazole,
timolol, calcium		TFT and Adr results normal; CXR and
head CT normal
Ball et al.2974/F20116NRNR421414Thioridazine‡ (two
doses only)		R, TFT and liver function results
normal; CXR and head CT normal; MRI scan
of head showed multiple white-matter lesions
Pillans et al.3076/F20116242337911322Ranitidine,
paracetamol-
dextropropoxyphene
furosemide,‡		R results normal
81/F20128NRNRNR84Cyclopenthiazide,‡captopril,
chlormethiazole‡		R and TFT results normal
76/F20120NRNRNR19NRNifedipine
Pillans et al.3088/F20121253456NR15NRPrednisone,
salbutamol,
verapamil,
hydrochloro-
thiazide/amiloride‡		No improvement after withdrawal of
diuretic
68/F20120NRNRNR60NRNR
87/F20114NRNRNR42NRAcetaminophenR results normal
84/F20117NRNRNR13NRAllopurinolR results normal
Druckenbrod et al.3183/F401092425304612028Calcium carbonate,
ferrous sulfate,
vitamins		TFT and Adr results normal; CXR and
MRI scan of head normal;
demeclocycline required to control
hyponatremia; positive rechallenge
with fluoxetine
Jackson et al.32†77/F20104216334NR12NRNoneR results normal; hyponatremia
recurred after switch to sertraline
Burke et al.3374/M40124256350512320Haloperidol,
pilocarpine eyedrops,
dipivefrin eyedrops,
allopurinol		CXR, R, TFT, and head CT results
normal
82/F2012628147031710Omeprazole,
levothyroxine		R, head CT, and CXR results normal;
hypothyroid despite treatment
89/F20123250364NR207Oxazepam,
nifedipine		R, TFT, CXR, and head CT results
normal
Bell et al.3469/F20125NRNRNR144NRRechallenge produced a less marked

hyponatremia (Na = 131 mmol/L)
which spontaneously normalized
within 14 days. No hyponatremia with
paroxetine or citalopram.
Girault et al.670/F201062054201328NRHaloperidol,

tropatepine,
nadolol,
guanfacine		R, TFT, and head CT results normal
81/F20104NRNR9525Prazepam,
flunarizine,
buflomedil,
captopril,
hydrochlorothiazide‡		R and TFT results normal
Taylor et al.35†83/F20120NRNRNR3514Temazepam,CXR, TFT, and R results normal
73/F2011825231416147vitaminsCXR, R, TFT, and Adr results normal
Schattner et al.3684/F40105235590NR109NRTFT, Adr, CXR, R, and CT results
normal
Flint et al.37†78/F201182557052315014RanitidineTFT and R results normal
ten Holt et al.3878/F201034042093042NRMethyldopa,
hydrochlorothiazide/
triamterene,‡acetylcysteine,
gliclazide
ten Holt et al.3873/F20110230247615NRLabetalol,
hydrochlorothiazide/
amiloride‡
Fluvoxamine
McHardy3970/F100114239392NR53Trimethoprim-
sulfamethoxazole,
oxprenolol,
bendrofluazide,‡
triazolam, potassium		R, Adr and liver function results
normal; CXR normal; no improvement
after discontinuation of trimethoprim-
sulfamethoxazole, bendrofluazide, and
triazolam
Paroxetine
Goddard et al.4069/F40126NRNRNR162Aspirin,
lactulose		Head CT showed multiple infarcts
Chua et al.4178/FNR115256369NR510LisinoprilR results normal; CXR normal
76/MNR112246292NR74Nitrazepam
(overdose)		CXR showed signs of pneumonia
Johnsen et al.4283/F10 x 3 days
360 mg
overdose		112269200235NRVerapamil,
bendroflumethiazide‡		R and Adr results normal;
hypothyroid
Meynaar et al.989/F10116250410587NRTemazepam,
azapropazone,
cetirizine,
flavoxate		R, CXR, Adr, and TFT results
normal
van der Kloosteret al.4355/F20118263455106213Simvastatin,

carvedilol,
oxazepam,
diazepam		R, TFT, CXR, and Adr results
normal
Leung et al.4474/F2011624065379145Sulindac,
paracetamol-dextropropoxyphene,
dextropropoxyphene,
antacid		R and TFT results normal;
no recurrence on mianserin
76/F2012325242038105Prazosin,
trimethoprim-
sulfamethoxazole,
cefuroxime,
amoxicillin,
famotidine,
metoclopramide		CXR and TFT results normal
Ayonrinde et al.4567/F201142323724979AtenololR and TFT results normal.
Isolated SIADH on prior fluoxetine
(129 mmol/L). No SIADH while
on desipramine
van Campen et al.4666/M20107230361NR1414Captopril,
lormetazepam,
domperidone		R, CXR, TFT, and Adr results normal
John et al.4751/F20114NRNRNR2NRValproic acid,
zopiclone,
nefazodone		Head CT results normal;
no recurrence on
paroxetine rechallenge
Flint et al.37†78/F10125NRNRNR710RanitidineSubsequent moclobemide therapy was
not associated with hyponatremia
Monmany et al.4872/M20118262940539NRClarithromycin,
prednisone,
albuterol,
ipratropium,		R, TFT, and Adr results normal
Sertraline
Jackson et al.32†77/F50126246518NR43NR Previous reaction when treated with
fluoxetine
noshade size=1>
Crews et al.4973/M50118251511335NRDiazepam, quinine,
ranitidine, nifedipine		R, TFT and Adr results normal; head
CT normal; previous use of
nortriptyline and amitriptyline resulted
in hyponatremia
Doshi et al.5047/M1001182372293812014Carbamazepine‡R, TFT and Adr results normal; no
evidence of malignant disease;
negative rechallenge with sertraline
Llorente et al.5192/M501222603615977Doxepin‡R, Adr and TFT results normal;presented after overdose of sertraline
(350 mg)
Thornton et al.5260/M50126256389NR5NRNRTFT and Adr results normal; head CT

normal; positive rechallenge with
sertraline, serum sodium level
controlled with fluid restriction
72/F75105217393NR4NRNRTFT and Adr results normal; head CT
normal
Levsky et al.5387/M50122NRNRNR7-10
(rechallenge)		2
(rechallenge)		Trazodone,
aspirin,
diclofenac,
vitamins,
laxatives		R, TFT, and head CT results normal;
confirmed by rechallenge with
sertraline alone.
Bouman et al.5478/F501172453142177NRRecurred on lofepramine
(TCA) but not citalopram
Kessler et al.5582/F50123NR3733636Lorazepam,

thiamine,
folate,
ranitidine
Goldstein et al.5624/F100120259571130NR1NoneR, TFT, head CT, Adr results normal
Robinson et al.5770/M50129NRNRNR83NRTerazosin,

ranitidine,
enalapril		R results normal
Bluff et al.5859/F25117233465189214Aspirin,

metoprolol,
nitroglycerin
patch		R results normal
Catalano et al.5975/F100126250
(rechallenge)		695
(rechallenge)		74
(rechallenge)		415Propafenone,Positive rechallenge with paroxetine
docusate,
glyburide,
nitrofurantoin
ADRAC1277/F50121253482NR57Atenolol,
digoxin,
sublingual
nitroglycerin,
timolol eyedrops,
mianserin
Taylor et al.35†89/F5011223622251357Cyclopenthiazide‡
amiloride,‡
etidronate,
aspirin,
sodium cellulose
phosphate,
omeprazole		R, CXR, TFT, and Adr results normal
Leung et al.6087/M501182585011672014LoxapineR and Adr results normal;
TSH slightly increased
Bradley et al.6178/F5011926247412533Levothyroxine,
nizatidine,
thiamine,
calcium carbonate,
magnesium oxide,
ceftriaxone		R, TFT, and Adr results normal
Abbreviations: R = renal test, TFT = thyroid function test, Adr = adrenal function test, ACTH = adrenocorticotropin, CXR = chest x-ray, CT = computed tomogram, MRI = magnetic resonance imagining, NR = no report, TCA = tricyclic antidepressant, TSH = thyroid stimulating hormone.
† Single case appears twice in this table.
‡ Medications associated with SIADH.
Source: Modified with permission from Liu et al.62