Department of Internal Medicine, Tokyo Metropolitan Bokutoh Hospital, Tokyo, Japan.
Hum Exp Toxicol. 2011 Sep;30(9):1409-14. doi: 10.1177/0960327110387455. Epub 2010 Oct 25.
The clinical course of losartan potassium/hydrochlorothiazide (Preminent(®))-induced hyponatremia has not been described. We summarized 40 patients with Preminent-induced hyponatremia. The study involved 15 (37.5%) men and 25 (62.5%) women (mean age [SD], 76.4 [8.3] years; range, 55-95). Their sodium levels before Preminent administration were 139.5 (4.9) mEq/L (range, 131-145; reference range, 135-147). The duration from the day of Preminent administration to the day with the lowest sodium level was 59.3 (64.9) days (range, 2-207; median, 24). Most patients for whom this duration was <50 days exhibited progressive symptoms, whereas most of those for whom this duration was >50 days did not exhibit progressive symptoms but exhibited symptoms after fever or appetite loss. The lowest sodium value was 114.4 (8.2) mEq/L (range, 99-133). The duration from the time of Preminent discontinuation to (1) the time of early recovery and (2) the time of final recovery was 6.8 (5.5) days (range, 1-20; median, 5) and 11.6 (7.6) days (range, 2-29; median, 7.5), respectively. Of the 40 patients, 36 (90.0%) achieved full recovery, 1 (2.5%) suffered from after-effects due to central pontine myelinolysis, 1 (2.5%) died, and 2 (5.0%) were unknown. In the analysis of other adverse effects of Preminent and the same adverse effects of other three angiotensin II receptor blocker (ARB)/thiazide combinations, hyponatremia was observed as a primary adverse effect of all ARB/thiazide combinations. However, hyperesthesia dermatitis was reported as an adverse effect of Preminent only.
尚未描述氯沙坦钾/氢氯噻嗪（Preminent(®)）引起的低钠血症的临床过程。我们总结了 40 例 Preminent 引起的低钠血症患者。该研究涉及 15 例男性（37.5%）和 25 例女性（平均年龄[标准差]，76.4[8.3]岁；范围，55-95）。他们在服用 Preminent 前的钠水平为 139.5（4.9）mEq/L（范围，131-145；参考范围，135-147）。从开始服用 Preminent 到达到最低钠水平的时间为 59.3（64.9）天（范围，2-207；中位数，24）。对于这一时间段<50 天的大多数患者，表现为进行性症状，而对于这一时间段>50 天的大多数患者，则没有表现出进行性症状，但在发烧或食欲不振后出现症状。最低的钠值为 114.4（8.2）mEq/L（范围，99-133）。从停止使用 Preminent 到（1）早期恢复和（2）最终恢复的时间分别为 6.8（5.5）天（范围，1-20；中位数，5）和 11.6（7.6）天（范围，2-29；中位数，7.5）。在 40 例患者中，36 例（90.0%）完全恢复，1 例（2.5%）因脑桥中央髓鞘溶解症而遗留后遗症，1 例（2.5%）死亡，2 例（5.0%）不详。在分析 Preminent 的其他不良反应和其他三种血管紧张素 II 受体阻滞剂（ARB）/噻嗪类药物联合使用的相同不良反应时，低钠血症被认为是所有 ARB/噻嗪类药物联合使用的主要不良反应。然而，仅有 Preminent 报告了感觉过敏性皮炎的不良反应。
