Oxcarbazepine/hydrochlorothiazide
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Reactions 1271 - 26 Sep 2009 S Oxcarbazepine/hydrochlorothiazide SIADH with hyponatraemia in an elderly patient: case report A 79-year-old man with epilepsy and hypertension developed syndrome of inappropriate antidiuretic hormone secretion (SIADH) with hyponatraemia while receiving oxcarbazepine and hydrochlorothiazide. The man started receiving oxcarbazepine [dosage not stated], and his sodium level decreased to 128 mM/L two months later (baseline: 135 mM/L); his sodium level remained low, but he was asymptomatic. After an unclear treatment duration, he was advised to increase his water intake, and hydrochlorothiazide 25mg [frequency not stated] was added to his therapy. He developed dizziness, gait instability, vomiting, debility and confusion 2 days later. His condition progressed to stupor after another 2 days and he was referred to a hospital. On admission 6 days after hydrochlorothiazide addition, he had a BP of 110/70mm Hg and was confused. Laboratory investigations revealed the following: sodium 108 mM/L, uric acid 2 mg/dL, osmolality 223 mOsm/L, urinary osmolality 615 mOsm/L and urinary sodium 31 mM/L; his thyroid function, cortisol and ACTH levels were normal. Findings were suggestive of SIADH. The man received hypertonic saline and furosemide; his sodium level was maintained at 117 mM/L and his neurological status slightly improved. His water intake was restricted, and oxcarbazepine was replaced with levetiracetam. His sodium level slowly increased; on discharge, he was asymptomatic and had a sodium level of 138 mM/L. His sodium levels had remained stable at follow-up 4 months later. Author comment: Our patient began treatment with oxcarbazepine more than two years before being admitted, and during this period the Na concentrations remained slightly low, but with no associated symptoms. However, six days prior to admission, hydrochlorothiazide was added to his treatment, which probably contributed to the clinical aggravation of his hyponatraemia. We may conclude that the oxcarbazepine-induced hyponatraemia in our patient was associated with a SIADH, aggravated by the ingestion of water and the use of a thiazide. Valentini S, et al. Severe hyponatremia by oxcarbazepine in an elderly. Revista de Neurologia 48: 614-615, No. 11, 1-15 Jun 2009 [Spanish; summarised from a translation.] - Italy 801150504 1 Reactions 26 Sep 2009 No. 1271 0114-9954/10/1271-0001/$14.95 © 2010 Adis Data Information BV. All rights reserved
Transcript of Oxcarbazepine/hydrochlorothiazide
Reactions 1271 - 26 Sep 2009
SOxcarbazepine/hydrochlorothiazide
SIADH with hyponatraemia in an elderly patient:case report
A 79-year-old man with epilepsy and hypertensiondeveloped syndrome of inappropriate antidiuretichormone secretion (SIADH) with hyponatraemia whilereceiving oxcarbazepine and hydrochlorothiazide.
The man started receiving oxcarbazepine [dosage notstated], and his sodium level decreased to 128 mM/L twomonths later (baseline: 135 mM/L); his sodium levelremained low, but he was asymptomatic. After an uncleartreatment duration, he was advised to increase his waterintake, and hydrochlorothiazide 25mg [frequency notstated] was added to his therapy. He developed dizziness,gait instability, vomiting, debility and confusion 2 dayslater. His condition progressed to stupor after another2 days and he was referred to a hospital. On admission6 days after hydrochlorothiazide addition, he had a BP of110/70mm Hg and was confused. Laboratoryinvestigations revealed the following: sodium 108 mM/L,uric acid 2 mg/dL, osmolality 223 mOsm/L, urinaryosmolality 615 mOsm/L and urinary sodium 31 mM/L; histhyroid function, cortisol and ACTH levels were normal.Findings were suggestive of SIADH.
The man received hypertonic saline and furosemide; hissodium level was maintained at 117 mM/L and hisneurological status slightly improved. His water intake wasrestricted, and oxcarbazepine was replaced withlevetiracetam. His sodium level slowly increased; ondischarge, he was asymptomatic and had a sodium level of138 mM/L. His sodium levels had remained stable atfollow-up 4 months later.
Author comment: Our patient began treatment withoxcarbazepine more than two years before being admitted,and during this period the Na concentrations remainedslightly low, but with no associated symptoms. However, sixdays prior to admission, hydrochlorothiazide was added tohis treatment, which probably contributed to the clinicalaggravation of his hyponatraemia. We may conclude that theoxcarbazepine-induced hyponatraemia in our patient wasassociated with a SIADH, aggravated by the ingestion of waterand the use of a thiazide.Valentini S, et al. Severe hyponatremia by oxcarbazepine in an elderly. Revista deNeurologia 48: 614-615, No. 11, 1-15 Jun 2009 [Spanish; summarised from atranslation.] - Italy 801150504
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Reactions 26 Sep 2009 No. 12710114-9954/10/1271-0001/$14.95 © 2010 Adis Data Information BV. All rights reserved
