Hyponatremia (HN) is the most common electrolyte imbalance (defined as a serum sodium concentration Na(S) of < 130 mmol/l) and often induced by drugs including psychotropic drugs. AMSP (Arzneimittelsicherheit in der Psychiatrie) is a multicenter drug surveillance program that assesses severe or unusual adverse drug reactions (ADRs) occurring during treatment with psychotropic drugs. This study presents data from 462,661 psychiatric inpatients treated in participating hospitals between 1993 and 2016 and serves as an update of a previous contribution by Letmaier et al. (JAMA 15(6):739–748, 2012). A total of 210 cases of HN were observed affecting 0.05% of patients. 57.1% of cases presented symptomatically; 19.0% presented with severe symptoms (e.g., seizures, vomiting). HN occurred after a median of 7 days following the first dose or dose increase. Incidence of HN was highest among the two antiepileptic drugs oxcarbazepine (1.661% of patients treated) and carbamazepine (0.169%), followed by selective serotonin-norepinephrine reuptake inhibitors (SSNRIs, 0.088%) and selective serotonin reuptake inhibitors (0.071%). Antipsychotic drugs, tricyclic antidepressants, and mirtazapine exhibited a significantly lower incidence of HN. The risk of HN was 16–42 times higher among patients concomitantly treated with other potentially HN-inducing drugs such as diuretic drugs, angiotensin-converting-enzyme inhibitors, angiotensin II receptor blockers, and proton pump inhibitors. Female SSNRI-users aged ≥ 65 years concomitantly using other HN-inducing drugs were the population subgroup with the highest risk of developing HN. The identification of high-risk drug combinations and vulnerable patient subgroups represents a significant step in the improvement of drug safety and facilitates the implementation of precautionary measures.

低钠血症 (HN) 是最常见的电解质失衡（定义为血清钠浓度 Na(S) < 130 mmol/l），通常由包括精神药物在内的药物诱发。AMSP (Arzneimittelsicherheit in der Psychiatrie) 是一项多中心药物监测计划，用于评估精神药物治疗期间发生的严重或异常药物不良反应 (ADR)。本研究提供了 1993 年至 2016 年间在参与医院接受治疗的 462,661 名精神病住院患者的数据，并作为对 Letmaier 等人先前贡献的更新。(JAMA 15(6):739–748, 2012)。共观察到 210 例 HN，影响 0.05% 的患者。57.1% 的病例有症状；19.0% 出现严重症状（如癫痫发作、呕吐）。HN 在首次给药或剂量增加后中位数 7 天后发生。HN 的发生率在两种抗癫痫药物奥卡西平（占接受治疗的患者的 1.661%）和卡马西平（0.169%）中最高，其次是选择性 5-羟色胺-去甲肾上腺素再摄取抑制剂（SSNRI，0.088%）和选择性 5-羟色胺再摄取抑制剂（0.071%）。抗精神病药、三环类抗抑郁药和米氮平的 HN 发生率显着降低。在同时使用其他可能诱发 HN 的药物（如利尿药、血管紧张素转换酶抑制剂、血管紧张素 II 受体阻滞剂和质子泵抑制剂）治疗的患者中，HN 的风险要高 16-42 倍。年龄 ≥ 65 岁的女性 SSNRI 使用者同时使用其他 HN 诱导药物是发生 HN 风险最高的人群亚组。