Duloxetine/ramipril

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Duloxetine/ramipril Hyponatraemia: case report

A 45-year old woman developed hyponatraemia during treatment with duloxetine for migraine and anxiety disorder, and ramipril for hypertension. The woman presented with anxiety, fear of death, difficulty in falling asleep, fear and severe headache and nausea triggered by upsetting events. She had a 2-year history of similar symptoms and received sertraline for 6 months. She was diagnosed with migraine and anxiety disorder and started receiving duloxetine 30 mg/day [route not stated]. She also received ramipril 5 mg/day for hypertension. Within 1 week of duloxetine initiation, she presented with increased headache, dizziness, polyuria, dry mouth and polydipsia. She was admitted to the emergency services for blood shot eyes and numbness in the whole body. She had a generalised tonic-clonic seizure, agitation, deterioration in orientation and blurring of consciousness, and was admitted to the ICU. Laboratory investigations were as follows: sodium 121 mmol/L, blood urea nitrogen 5.61 mg/dL, creatinine 0.64 mg/dL, potassium 2.7 mmol/L, chlorine 87 mmol/L, glucose 167 mg/dL, plasma osmolarity 271 mOsm/L, urine sodium 74 mmol/L, urine osmolarity 280 mOsm/kg and urine density of 1007. Her BP was noted to be 170/90mm Hg. Brain MRI revealed cerebral oedema and ventricular dilatation. Duloxetine was discontinued, and the woman started receiving electrolyte treatment with sodium chloride [saline] infusion. Her daily fluid intake was restricted. After 6 weeks in ICU and 2 weeks in internal medicine inpatient clinic, she was discharged with ramipril for hypertension. She presented to the clinic again with a headache and other initial symptoms. She started receiving amitriptyline for migraine and anxiety disorder. At a follow-up after 3 months, the recurrence of hyponatraemia was not observed. Sahan E, et al. Duloxetine Induced Hyponatremia. Turk Psikiyatri Dergisi 30: 287-289, No. 4, Dec 2019. Available from: URL: https://doi.org/10.5080/u23394

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Reactions 17 Oct 2020 No. 1826

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