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Citalopram and SIADH – Case Study

Citalopram is a very commonly used antidepressant and is part of the Selective Serotonin Reuptake Inhibitor (SSRI) class.  SSRI’s do have the potential to contribute to SIADH (basically a reduction in sodium levels in the body).  The case:

A 68 year old female is currently receiving the following medicaitons:

  • omeprazole
  • bumetanide
  • docusate
  • naproxen
  • acetaminophen
  • aspirin
  • citalopram

Past medical history includes:

  • Edema
  • GERD
  • Constipation
  • Osteoarthritis
  • CAD
  • Depression

This patient was started on citalopram 10 mg daily about 6-12 months ago for symptoms of depression.  In the previous month she had her dose increased to 20 mg daily.  Within a few weeks of the increase, this patient had began experiencing some generalized confusion, and not “feeling right”.  She had been getting quarterly BMP’s drawn and the BMP drawn after this increase in Celexa revealed a drop in sodium from 142 to 134.  The dose of bumetanide had not changed.

Is this a case of Citalopram and SIADH?  Or is this simply a case of a patient not tolerating the citalopram?  If I had to take my guess based upon my experience, I would tend to believe that it would be adverse effects versus the low sodium.  I doubt that a drop from 142 to 134 would cause worsening confusion and symptoms of hyponatremia, but I would suspect that many folks out there would disagree with me on that point.

Maybe a better question is what would be a possible solution in this case to resolve the problem?  The easiest answer would be to reduce the dose of the citalopram back to the previous 10 mg daily and see if the slight hyponatremia resolved.  We can also monitor the patient’s confusion with a reduction in the dose.

What do you think?

Need more free clinical pharmacy info?  Check out the 30 medication mistakes, a free 6 page PDF based upon my real world experiences as a clinical pharmacist!

Written By Eric Christianson

July 26, 2015

Free PDF – Top 30 Medication Mistakes

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