Does Celexa cause hyponatremia? (+2 risk factors)

This article will discuss the query, “Does Celexa cause hyponatremia?” We will also cover the mechanism, risk factors, symptoms, management, and precautions to avoid hyponatremia associated with Celexa.

Does Celexa cause hyponatremia?

Yes, Celexa does cause hyponatremia. However, hyponatremia caused by Celexa (Citalopram) occurs as a result of SIADH (syndrome of inappropriate antidiuretic hormone) and can be effectively reversed with the discontinuation of Celexa (1).

Celexa (citalopram) is a selective serotonin reuptake inhibitor (SSRI) antidepressant. It is indicated for treating major depressive disorder in adults (1). Hyponatremia secondary to SIADH is a well-reported adverse effect of Celexa and other SSRIs (2).

Hyponatremia is an electrolyte imbalance with a serum sodium concentration of less than 135 mEq/L. The risk of hyponatremia associated with SSRIs such as Celexa has been reported to be between 0.5% – 32% (3).

It has been observed that the hyponatremia associated with Celexa and other SSRIs often occurs during the first few weeks of treatment with Celexa in the elderly, female population, and patients with low body weight (4).

What does research suggest?

Several cases of Celexa-induced hyponatremia have been reported so far. In the past, it was reported that Celexa at a dose of 20 mg/day was associated with mild to moderate hyponatremia. However, a few cases of hyponatremia have been reported with doses of only 10 mg/day (2).

An article published in the Journal of Acute Medicine in 2014 reported a case of severe hyponatremia with only a 10 mg/day dose of Celexa. An 84-year-old woman presented with acute confusion and gait disturbance for 3-4 days and vomiting for two days (2).

Seven days before this incident, the woman was prescribed Celexa at 10 mg/day. Her blood reports showed a serum sodium level of 100 mmol/L upon admission. Based on her laboratory results, the woman was diagnosed with SIADH (2).

Celexa was identified as the cause of hyponatremia secondary to SIADH, and therefore, it was discontinued. In addition to the discontinuation of Celexa, she was also managed with hypertonic saline, which improved her symptoms. The woman was discharged after six days with a sodium level of 131 mmol/L (2).

This suggested that Celexa can cause hyponatremia even at low doses.

Another case published in 2004 reported a 61-year-old diabetic male who was admitted to the hospital with complaints of malaise, progressive confusion, and tonic/clonic seizures. The symptoms appeared two weeks after starting Celexa at a dose of 20 mg/day (4).

The patient’s laboratory examination showed a serum sodium concentration of 124 mmol/L, indicating hyponatremia. The patient was diagnosed with SIADH based on hyponatremia, serum hypo-osmolality, urine hyperosmolarity, and elevated urine sodium concentration(4).

To manage the symptoms, Celexa was discontinued, and the patient was administered two litres of intravenous sodium chloride (NaCl) 0.9%, phenytoin (5 mg/kg), and subcutaneous insulin (4).

The patient was discharged after he became fully alert, had no more seizures, and had a serum sodium concentration of up to 134 mmol/L (4).

What are the risk factors for hyponatremia associated with Celexa?

The risk factors for hyponatremia associated with the use of SSRIs such as Celexa include the following:

Gender

One of the risk factors for developing hyponatremia or SIADH is the female gender. 60-80% of reported hyponatremia cases with SSRI use involve women. This may be due to a higher life expectancy or the occurrence of depression in females compared to males (5).

Age

Age is also a risk factor for Celexa-induced hyponatremia or SIADH. The majority of the patients who reported hyponatremia with SSRIs are 65 years of age or older. This might be due to declining renal efficiency or a high prevalence of depression and antidepressant use in older people (5).

Polypharmacy

Another risk factor for developing hyponatremia with Celexa is polypharmacy. Several patients who experienced hyponatremia or SIADH while using Celexa include those taking more than one medication that tends to cause hyponatremia (5).

Drugs that are known to cause hyponatremia or SIADH when used in combination with SSRIs include (5):

• Diuretics.
• Neuroleptics.
• Narcotics.
• Oral hypoglycemic agents.

The above drugs have the potential to cause hyponatremia, and when used in combination with Celexa, the risk of hyponatremia, or SIADH, is increased (5)

Electrolyte imbalance

Patients with a low serum sodium concentration are at a higher risk of developing symptoms of hyponatremia, or SIADH while using Celexa (6).

Comorbidities

Patients with a history of hypertension or hypothyroidism are more likely to develop hyponatremia, or SIADH while using Celexa (6).

Mechanism of Celexa-induced hyponatremia

There are three possible mechanisms of drug-induced hyponatremia or SIADH; these mechanisms include (5):

• Increased antidiuretic hormone (ADH) secretion.
• Enhancing ADH activity.
• Reduction in the threshold for ADH secretion by resetting the osmostat.

The mechanism of SSRI-induced hyponatremia has not been completely understood. It is suggested that hyponatremia or SIADH associated with using Celexa or other SSRIs might occur due to an elevated serotonin concentration, leading to an increased ADH secretion (5).

Another explanation of hyponatremia that occurs due to drug interaction between Celexa and other medications that cause hyponatremia is that Celexa and other SSRIs inhibit the metabolism of these medications through CYP2D6 (5).

This leads to an increased serum concentration of these medications and eventually enhances their effect on sodium regulation, resulting in hyponatremia (5).

What are the symptoms of hyponatremia?

The symptoms of mild (<132 mmol/L) to moderate (<128 mmol/L) hyponatremia include the following (6):

• Nausea.
• Fatigue.
• Confusion.
• Cramping.
• Unsteadiness.
• Dizziness.
• Depressed reflexes.

However, in the case of severe hyponatremia, which is characterized by a serum sodium concentration of < 125 mmol/L, the symptoms include seizures, coma, or even death (6).

It is, therefore, recommended to immediately contact your healthcare provider if you experience any of these symptoms of hyponatremia.

Management of hyponatremia associated with Celexa

The treatment and management of hyponatremia, or SIADH, induced by Celexa usually depends on the severity and duration of hyponatremia. However, in clinical practice, the management of hyponatremia includes the following (5):

• Hyponatremia, or SIADH, induced by psychotropic drugs such as Celexa is resolved by the discontinuation of the causative drug along with fluid restriction.

• Severe hyponatremia that involves CNS symptoms is usually managed by serum sodium correction. For this, hypertonic saline (NaCl 3%) and furosemide are used. This will prevent the neurological damage associated with hyponatremia.

• For acute and severe hyponatremia, hypertonic saline (NaCl 3%) is administered to increase the serum concentration by 1-2 mEq/L/h and not more than 25-30 mEq/L within the first two days of treatment.

• In chronic severe hyponatremia, hypertonic saline is administered to increase the serum sodium levels by 0.5 mEq/L per hour.

• Patients with asymptomatic hyponatremia and a serum sodium concentration less than 120 mEq/L are often managed using intravenous sodium chloride 0.9% (NaCl 0.9%).

• Mild hyponatremia cases are usually managed by fluid restriction (less than 1L per day).

• In cases where the cause of hyponatremia or SIADH cannot be treated, fluid restriction is the choice of therapy. However, if restricting fluid does not work, treatment with oral demeclocycline, tablets of NaCl 0.9% with furosemide, lithium, or fludrocortisone can be used.

Precautions to avoid Celexa-induced hyponatremia

The following precautions can help you prevent hyponatremia associated with the use of Celexa:

• It is recommended to examine your baseline sodium levels before starting Celexa, as low serum sodium levels increase the risk of Celexa-induced hyponatremia.
• Elderly patients, especially females, should be cautious while taking Celexa.
• Patients with an underlying heart or renal disease should also be cautious while taking Celexa.
• It is recommended to keep yourself hydrated while using Celexa.
• If you experience vomiting or diarrhea while using Celexa, it is strongly recommended to maintain your fluid intake and use electrolyte replacements to prevent hyponatremia or SIADH.

Conclusion

In this article, we have discussed the query, “Does Celexa cause hyponatremia?” We have also explored the mechanism, risk factors, symptoms, management, and precautions to avoid hyponatremia associated with Celexa.

References