Antidepressants and the risk of hyponatremia: a Danish register-based population study

ObjectiveTo examine the association between classes of antidepressants and hyponatremia, and between specific antidepressants and hyponatremia.DesignRetrospective register-based cohort study using nationwide registers from 1998 to 2012.SettingThe North Denmark Region.ParticipantsIn total, 638 352 in...

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Veröffentlicht in:BMJ open 2016-05, Vol.6 (5), p.e011200-e011200
Hauptverfasser: Leth-Møller, Katja Biering, Hansen, Annette Højmann, Torstensson, Maia, Andersen, Stig Ejdrup, Ødum, Lars, Gislasson, Gunnar, Torp-Pedersen, Christian, Holm, Ellen Astrid
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container_end_page e011200
container_issue 5
container_start_page e011200
container_title BMJ open
container_volume 6
creator Leth-Møller, Katja Biering
Hansen, Annette Højmann
Torstensson, Maia
Andersen, Stig Ejdrup
Ødum, Lars
Gislasson, Gunnar
Torp-Pedersen, Christian
Holm, Ellen Astrid
description ObjectiveTo examine the association between classes of antidepressants and hyponatremia, and between specific antidepressants and hyponatremia.DesignRetrospective register-based cohort study using nationwide registers from 1998 to 2012.SettingThe North Denmark Region.ParticipantsIn total, 638 352 individuals were included.Primary and secondary outcome measuresPlasma sodium was obtained from the LABKA database. The primary outcome was hyponatremia defined as plasma sodium (p-sodium) below 135 mmol/L and secondary outcome was severe hyponatremia defined as p-sodium below 130 mmol/L. The association between use of specific antidepressants and hyponatremia was analysed using multivariable Poisson regression models.ResultsAn event of hyponatremia occurred in 72 509 individuals and 11.36% (n=6476) of these events happened during treatment with antidepressants. Incidence rate ratios and CIs for the association with hyponatremia in the first p-sodium measured after initiation of treatment were for citalopram 7.8 (CI 7.42 to 8.20); clomipramine 4.93 (CI 2.72 to 8.94); duloxetine 2.05 (CI 1.44 to 292); venlafaxine 2.90 (CI 2.43 to 3.46); mirtazapine 2.95 (CI 2.71 to 3.21); and mianserin 0.90 (CI 0.71 to 1.14).ConclusionsAll antidepressants except mianserin are associated with hyponatremia. The association is strongest with citalopram and lowest with duloxetine, venlafaxine and mirtazapine.
doi_str_mv 10.1136/bmjopen-2016-011200
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The primary outcome was hyponatremia defined as plasma sodium (p-sodium) below 135 mmol/L and secondary outcome was severe hyponatremia defined as p-sodium below 130 mmol/L. The association between use of specific antidepressants and hyponatremia was analysed using multivariable Poisson regression models.ResultsAn event of hyponatremia occurred in 72 509 individuals and 11.36% (n=6476) of these events happened during treatment with antidepressants. Incidence rate ratios and CIs for the association with hyponatremia in the first p-sodium measured after initiation of treatment were for citalopram 7.8 (CI 7.42 to 8.20); clomipramine 4.93 (CI 2.72 to 8.94); duloxetine 2.05 (CI 1.44 to 292); venlafaxine 2.90 (CI 2.43 to 3.46); mirtazapine 2.95 (CI 2.71 to 3.21); and mianserin 0.90 (CI 0.71 to 1.14).ConclusionsAll antidepressants except mianserin are associated with hyponatremia. The association is strongest with citalopram and lowest with duloxetine, venlafaxine and mirtazapine.</description><identifier>ISSN: 2044-6055</identifier><identifier>EISSN: 2044-6055</identifier><identifier>DOI: 10.1136/bmjopen-2016-011200</identifier><identifier>PMID: 27194321</identifier><language>eng</language><publisher>England: BMJ Publishing Group LTD</publisher><subject>Adult ; Aged ; Antidepressants ; Antidepressive Agents, Tricyclic - therapeutic use ; Citalopram - therapeutic use ; Clomipramine - therapeutic use ; Denmark - epidemiology ; Drug dosages ; Drug therapy ; Duloxetine Hydrochloride - therapeutic use ; Electrolytes ; Female ; Heart failure ; Humans ; Hyponatremia ; Hyponatremia - blood ; Hyponatremia - epidemiology ; Incidence ; Kidneys ; Laboratories ; Male ; Mianserin - analogs &amp; derivatives ; Mianserin - therapeutic use ; Middle Aged ; Mirtazapine ; Patients ; Pharmacology and Therapeutics ; Plasma ; Population ; Prescription drugs ; Registration ; Registries ; Retrospective Studies ; Risk Factors ; Serotonin and Noradrenaline Reuptake Inhibitors - therapeutic use ; Serotonin Uptake Inhibitors - therapeutic use ; Sodium ; Sodium - blood ; Venlafaxine Hydrochloride - therapeutic use</subject><ispartof>BMJ open, 2016-05, Vol.6 (5), p.e011200-e011200</ispartof><rights>Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing</rights><rights>Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/ 2016 This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/ Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><rights>Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/ 2016</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-b538t-7a8d67c811cf8d1329bf12bd53fbe04fb50ea1678f94845bf7a6778dfb04249e3</citedby><cites>FETCH-LOGICAL-b538t-7a8d67c811cf8d1329bf12bd53fbe04fb50ea1678f94845bf7a6778dfb04249e3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttp://bmjopen.bmj.com/content/6/5/e011200.full.pdf$$EPDF$$P50$$Gbmj$$Hfree_for_read</linktopdf><linktohtml>$$Uhttp://bmjopen.bmj.com/content/6/5/e011200.full$$EHTML$$P50$$Gbmj$$Hfree_for_read</linktohtml><link.rule.ids>230,314,723,776,780,860,881,27526,27527,27901,27902,53766,53768,77570,77601</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/27194321$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Leth-Møller, Katja Biering</creatorcontrib><creatorcontrib>Hansen, Annette Højmann</creatorcontrib><creatorcontrib>Torstensson, Maia</creatorcontrib><creatorcontrib>Andersen, Stig Ejdrup</creatorcontrib><creatorcontrib>Ødum, Lars</creatorcontrib><creatorcontrib>Gislasson, Gunnar</creatorcontrib><creatorcontrib>Torp-Pedersen, Christian</creatorcontrib><creatorcontrib>Holm, Ellen Astrid</creatorcontrib><title>Antidepressants and the risk of hyponatremia: a Danish register-based population study</title><title>BMJ open</title><addtitle>BMJ Open</addtitle><description>ObjectiveTo examine the association between classes of antidepressants and hyponatremia, and between specific antidepressants and hyponatremia.DesignRetrospective register-based cohort study using nationwide registers from 1998 to 2012.SettingThe North Denmark Region.ParticipantsIn total, 638 352 individuals were included.Primary and secondary outcome measuresPlasma sodium was obtained from the LABKA database. The primary outcome was hyponatremia defined as plasma sodium (p-sodium) below 135 mmol/L and secondary outcome was severe hyponatremia defined as p-sodium below 130 mmol/L. The association between use of specific antidepressants and hyponatremia was analysed using multivariable Poisson regression models.ResultsAn event of hyponatremia occurred in 72 509 individuals and 11.36% (n=6476) of these events happened during treatment with antidepressants. Incidence rate ratios and CIs for the association with hyponatremia in the first p-sodium measured after initiation of treatment were for citalopram 7.8 (CI 7.42 to 8.20); clomipramine 4.93 (CI 2.72 to 8.94); duloxetine 2.05 (CI 1.44 to 292); venlafaxine 2.90 (CI 2.43 to 3.46); mirtazapine 2.95 (CI 2.71 to 3.21); and mianserin 0.90 (CI 0.71 to 1.14).ConclusionsAll antidepressants except mianserin are associated with hyponatremia. The association is strongest with citalopram and lowest with duloxetine, venlafaxine and mirtazapine.</description><subject>Adult</subject><subject>Aged</subject><subject>Antidepressants</subject><subject>Antidepressive Agents, Tricyclic - therapeutic use</subject><subject>Citalopram - therapeutic use</subject><subject>Clomipramine - therapeutic use</subject><subject>Denmark - epidemiology</subject><subject>Drug dosages</subject><subject>Drug therapy</subject><subject>Duloxetine Hydrochloride - therapeutic use</subject><subject>Electrolytes</subject><subject>Female</subject><subject>Heart failure</subject><subject>Humans</subject><subject>Hyponatremia</subject><subject>Hyponatremia - blood</subject><subject>Hyponatremia - epidemiology</subject><subject>Incidence</subject><subject>Kidneys</subject><subject>Laboratories</subject><subject>Male</subject><subject>Mianserin - analogs &amp; derivatives</subject><subject>Mianserin - therapeutic use</subject><subject>Middle Aged</subject><subject>Mirtazapine</subject><subject>Patients</subject><subject>Pharmacology and Therapeutics</subject><subject>Plasma</subject><subject>Population</subject><subject>Prescription drugs</subject><subject>Registration</subject><subject>Registries</subject><subject>Retrospective Studies</subject><subject>Risk Factors</subject><subject>Serotonin and Noradrenaline Reuptake Inhibitors - therapeutic use</subject><subject>Serotonin Uptake Inhibitors - therapeutic use</subject><subject>Sodium</subject><subject>Sodium - blood</subject><subject>Venlafaxine Hydrochloride - therapeutic use</subject><issn>2044-6055</issn><issn>2044-6055</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2016</creationdate><recordtype>article</recordtype><sourceid>9YT</sourceid><sourceid>ACMMV</sourceid><sourceid>EIF</sourceid><sourceid>BENPR</sourceid><recordid>eNqNkU1rHSEUhqU0NCHNLygUoZtuJlXHzy4KIf2EQDZJt6Kj5no7o1N1Avffd9J7G9Ku6kbB5305hweAVxidY9zzd3ba5tmnjiDMO4QxQegZOCGI0o4jxp4_eR-Ds1q3aD2UKcbIC3BMBFa0J_gEfL9ILTo_F1-rSa1CkxxsGw9LrD9gDnCzm3MyrfgpmvfQwI8mxbqBxd_F2nzprKnewTnPy2hazAnWtrjdS3AUzFj92eE-BbefP91cfu2urr98u7y46izrZeuEkY6LQWI8BOlwT5QNmFjH-mA9osEy5A3mQgZFJWU2CMOFkC5YRAlVvj8FH_a982In7wafWjGjnkucTNnpbKL--yfFjb7L95pKQTGia8HbQ0HJPxdfm55iHfw4muTzUjUWClFOCVcr-uYfdJuXktb1flNSccXFSvV7aii51uLD4zAY6Qd1-qBOP6jTe3Vr6vXTPR4zf0StwPkeWNP_1fgLzCCmRg</recordid><startdate>20160518</startdate><enddate>20160518</enddate><creator>Leth-Møller, Katja Biering</creator><creator>Hansen, Annette Højmann</creator><creator>Torstensson, Maia</creator><creator>Andersen, Stig Ejdrup</creator><creator>Ødum, Lars</creator><creator>Gislasson, Gunnar</creator><creator>Torp-Pedersen, Christian</creator><creator>Holm, Ellen Astrid</creator><general>BMJ Publishing Group LTD</general><general>BMJ Publishing Group</general><scope>9YT</scope><scope>ACMMV</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7RV</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>88G</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>BTHHO</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>K9-</scope><scope>K9.</scope><scope>KB0</scope><scope>M0R</scope><scope>M0S</scope><scope>M1P</scope><scope>M2M</scope><scope>NAPCQ</scope><scope>PHGZM</scope><scope>PHGZT</scope><scope>PIMPY</scope><scope>PJZUB</scope><scope>PKEHL</scope><scope>PPXIY</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>PSYQQ</scope><scope>Q9U</scope><scope>7X8</scope><scope>5PM</scope></search><sort><creationdate>20160518</creationdate><title>Antidepressants and the risk of hyponatremia: a Danish register-based population study</title><author>Leth-Møller, Katja Biering ; Hansen, Annette Højmann ; Torstensson, Maia ; Andersen, Stig Ejdrup ; Ødum, Lars ; Gislasson, Gunnar ; Torp-Pedersen, Christian ; Holm, Ellen Astrid</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-b538t-7a8d67c811cf8d1329bf12bd53fbe04fb50ea1678f94845bf7a6778dfb04249e3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2016</creationdate><topic>Adult</topic><topic>Aged</topic><topic>Antidepressants</topic><topic>Antidepressive Agents, Tricyclic - therapeutic use</topic><topic>Citalopram - therapeutic use</topic><topic>Clomipramine - therapeutic use</topic><topic>Denmark - epidemiology</topic><topic>Drug dosages</topic><topic>Drug therapy</topic><topic>Duloxetine Hydrochloride - therapeutic use</topic><topic>Electrolytes</topic><topic>Female</topic><topic>Heart failure</topic><topic>Humans</topic><topic>Hyponatremia</topic><topic>Hyponatremia - blood</topic><topic>Hyponatremia - epidemiology</topic><topic>Incidence</topic><topic>Kidneys</topic><topic>Laboratories</topic><topic>Male</topic><topic>Mianserin - analogs &amp; derivatives</topic><topic>Mianserin - therapeutic use</topic><topic>Middle Aged</topic><topic>Mirtazapine</topic><topic>Patients</topic><topic>Pharmacology and Therapeutics</topic><topic>Plasma</topic><topic>Population</topic><topic>Prescription drugs</topic><topic>Registration</topic><topic>Registries</topic><topic>Retrospective Studies</topic><topic>Risk Factors</topic><topic>Serotonin and Noradrenaline Reuptake Inhibitors - therapeutic use</topic><topic>Serotonin Uptake Inhibitors - therapeutic use</topic><topic>Sodium</topic><topic>Sodium - blood</topic><topic>Venlafaxine Hydrochloride - therapeutic use</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Leth-Møller, Katja Biering</creatorcontrib><creatorcontrib>Hansen, Annette Højmann</creatorcontrib><creatorcontrib>Torstensson, Maia</creatorcontrib><creatorcontrib>Andersen, Stig Ejdrup</creatorcontrib><creatorcontrib>Ødum, Lars</creatorcontrib><creatorcontrib>Gislasson, Gunnar</creatorcontrib><creatorcontrib>Torp-Pedersen, Christian</creatorcontrib><creatorcontrib>Holm, Ellen Astrid</creatorcontrib><collection>BMJ Open Access Journals</collection><collection>BMJ Journals:Open Access</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Nursing &amp; 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Medical Complete (Alumni)</collection><collection>Nursing &amp; Allied Health Database (Alumni Edition)</collection><collection>Consumer Health Database</collection><collection>Health &amp; Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Psychology Database</collection><collection>Nursing &amp; Allied Health Premium</collection><collection>ProQuest Central (New)</collection><collection>ProQuest One Academic (New)</collection><collection>Publicly Available Content Database</collection><collection>ProQuest Health &amp; Medical Research Collection</collection><collection>ProQuest One Academic Middle East (New)</collection><collection>ProQuest One Health &amp; Nursing</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>ProQuest One Psychology</collection><collection>ProQuest Central Basic</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>BMJ open</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Leth-Møller, Katja Biering</au><au>Hansen, Annette Højmann</au><au>Torstensson, Maia</au><au>Andersen, Stig Ejdrup</au><au>Ødum, Lars</au><au>Gislasson, Gunnar</au><au>Torp-Pedersen, Christian</au><au>Holm, Ellen Astrid</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Antidepressants and the risk of hyponatremia: a Danish register-based population study</atitle><jtitle>BMJ open</jtitle><addtitle>BMJ Open</addtitle><date>2016-05-18</date><risdate>2016</risdate><volume>6</volume><issue>5</issue><spage>e011200</spage><epage>e011200</epage><pages>e011200-e011200</pages><issn>2044-6055</issn><eissn>2044-6055</eissn><abstract>ObjectiveTo examine the association between classes of antidepressants and hyponatremia, and between specific antidepressants and hyponatremia.DesignRetrospective register-based cohort study using nationwide registers from 1998 to 2012.SettingThe North Denmark Region.ParticipantsIn total, 638 352 individuals were included.Primary and secondary outcome measuresPlasma sodium was obtained from the LABKA database. The primary outcome was hyponatremia defined as plasma sodium (p-sodium) below 135 mmol/L and secondary outcome was severe hyponatremia defined as p-sodium below 130 mmol/L. The association between use of specific antidepressants and hyponatremia was analysed using multivariable Poisson regression models.ResultsAn event of hyponatremia occurred in 72 509 individuals and 11.36% (n=6476) of these events happened during treatment with antidepressants. Incidence rate ratios and CIs for the association with hyponatremia in the first p-sodium measured after initiation of treatment were for citalopram 7.8 (CI 7.42 to 8.20); clomipramine 4.93 (CI 2.72 to 8.94); duloxetine 2.05 (CI 1.44 to 292); venlafaxine 2.90 (CI 2.43 to 3.46); mirtazapine 2.95 (CI 2.71 to 3.21); and mianserin 0.90 (CI 0.71 to 1.14).ConclusionsAll antidepressants except mianserin are associated with hyponatremia. The association is strongest with citalopram and lowest with duloxetine, venlafaxine and mirtazapine.</abstract><cop>England</cop><pub>BMJ Publishing Group LTD</pub><pmid>27194321</pmid><doi>10.1136/bmjopen-2016-011200</doi><oa>free_for_read</oa></addata></record>
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subjects Adult
Aged
Antidepressants
Antidepressive Agents, Tricyclic - therapeutic use
Citalopram - therapeutic use
Clomipramine - therapeutic use
Denmark - epidemiology
Drug dosages
Drug therapy
Duloxetine Hydrochloride - therapeutic use
Electrolytes
Female
Heart failure
Humans
Hyponatremia
Hyponatremia - blood
Hyponatremia - epidemiology
Incidence
Kidneys
Laboratories
Male
Mianserin - analogs & derivatives
Mianserin - therapeutic use
Middle Aged
Mirtazapine
Patients
Pharmacology and Therapeutics
Plasma
Population
Prescription drugs
Registration
Registries
Retrospective Studies
Risk Factors
Serotonin and Noradrenaline Reuptake Inhibitors - therapeutic use
Serotonin Uptake Inhibitors - therapeutic use
Sodium
Sodium - blood
Venlafaxine Hydrochloride - therapeutic use
title Antidepressants and the risk of hyponatremia: a Danish register-based population study
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