1.
Sertraline-Induced Rhabdomyolysis: A Case Report and Literature Review.
Snyder, M, Kish, T
American journal of therapeutics. 2016;(2):e561-5
Abstract
The objective of this study is to report a case of sertraline-induced rhabdomyolysis in a female patient with a history of depression. A 25-year-old Hispanic woman with a history of depression reported to the emergency department (ED) with a chief complaint of muscle swelling and soreness and dark urine. The patient's creatine phosphokinase was 15,103 U/L. Despite treatment with IV normal saline, the patient's symptoms persisted and the creatine phosphokinase continued to rise to a peak of 16,778 U/L on day 2. The patient reported completing a strenuous, although routine, exercise the day before arriving at the ED, and her medication history was only significant for sertraline. Of note, 6 weeks before her visit to the ED, sertraline was increased from 100 mg daily to 150 mg daily. The patient's rhabdomyolysis was attributed to sertraline in conjunction with recent exercise. Selective serotonin reuptake inhibitor (SSRI)-induced rhabdomyolysis has been documented in 5 case reports. Similar to most reports, our patient presented with rhabdomyolysis in the presence of both SSRI use and exercise. Unlike the majority of previous reports, our patient was not taking other medications with documented association to rhabdomyolysis and had performed routine exercise before presenting with rhabdomyolysis. Although the mechanism of SSRI-induced rhabdomyolysis is not known, a theory posits that sertraline may have a role in muscle contraction and relaxation, leading to shorter time to contracture and longer time of contraction. The use of sertraline and other SSRIs may be associated with development of rhabdomyolysis, especially in the presence of strenuous exercise.
2.
SSRIs and the syndrome of inappropriate antidiuretic hormone secretion.
Rottmann, CN
The American journal of nursing. 2007;(1):51-8; quiz 58-9
Abstract
Selective serotonin reuptake inhibitors, which include some of the mostly widely prescribed drugs in the United States, produce fewer adverse effects than other types of antidepressants. But their use can be associated with disruption of the action of antidiuretic hormone in the body, which wreaks havoc with homeostasis. This may lead to the syndrome of inappropriate antidiuretic hormone secretion (SIADH), which is characterized by hyponatremia, a potentially fatal condition that is typically asymptomatic until it becomes severe. SIADH is more likely in some populations, including people who are elderly or who take diuretics. Serum sodium levels should be monitored closely in those at higher risk.
3.
Delayed recurrent SIADH associated with SSRIs.
Arinzon, ZH, Lehman, YA, Fidelman, ZG, Krasnyansky, II
The Annals of pharmacotherapy. 2002;(7-8):1175-7
Abstract
BACKGROUND Depression is a common problem in elderly patients and is frequently treated with selective serotonin-reuptake inhibitors (SSRIs). OBJECTIVE To report a case of delayed recurrent hyponatremia after switching from one SSRI to another. CASE SUMMARY An 87-year-old depressed woman began treatment with fluvoxamine. One week later, she was diagnosed with hyponatremia, most likely syndrome of inadequate antidiuretic hormone. Following discontinuation of fluvoxamine, the serum sodium concentration normalized. Later, she began treatment with paroxetine. Sixteen months after initiating paroxetine, she developed symptomatic recurrent hyponatremia. After paroxetine was discontinued, the sodium concentration normalized. DISCUSSION In this case, unlike those previously reported, hyponatremia recurred 16 months after a different SSRI was initiated. The Naranjo probability scale indicates a probable relationship between recurrent hyponatremia and paroxetine. The mechanism of SSRI-induced hyponatremia is multifactorial. CONCLUSIONS This case illustrates that replacement of one SSRI with another can cause delayed, recurrent hyponatremia in elderly patients. Plasma sodium concentrations must be monitored, not only in the first weeks of treatment, but throughout the full course.