Department of Psychiatry, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.
Clin Neuropharmacol. 2021;44(6):243-244. doi: 10.1097/WNF.0000000000000481.
Atypical antipsychotic-induced hyponatremia has been reported in patients with psychiatric disorders. To date, hyponatremia due to lurasidone, an atypical antipsychotic approved for the treatment of schizophrenia and bipolar depression, has never been reported.
A female patient with bipolar depression and a history of subdural hematoma experienced a rapid onset of hyponatremia after the initiation of low-dose lurasidone. The hyponatremia worsened after the dose of lurasidone was increased and resolved only after lurasidone was ceased. According to the Naranjo Adverse Drug Reaction Probability Scale, this case report scores 6 as a possible drug reaction between lurasidone and hyponatremia.
Based on laboratory results, the syndrome of inappropriate antidiuretic hormone secretion and thyroid or adrenal dysfunction as differential diagnoses were excluded. Lurasidone-induced polydipsia complicated by hyponatremia was confirmed. Lurasidone was subsequently discontinued. The sodium level returned to normal within 1 week without any sodium supplementation.
This case report highlighted that low-dose lurasidone may induce polydipsia complicated by hyponatremia. Physicians should be aware of the adverse reactions of hyponatremia associated with lurasidone, particularly in patients with a history of intracranial hemorrhage.
已报道精神障碍患者使用非典型抗精神病药会引起低钠血症。迄今为止，用于治疗精神分裂症和双相情感障碍的非典型抗精神病药鲁拉西酮引起的低钠血症尚未见报道。
一名患有双相情感障碍且有硬膜下血肿病史的女性患者在开始服用低剂量鲁拉西酮后迅速出现低钠血症。增加鲁拉西酮剂量后，低钠血症恶化，仅在停用鲁拉西酮后才得以缓解。根据 Naranjo 药物不良反应概率量表，该病例报告评分为 6，提示鲁拉西酮与低钠血症之间可能存在药物反应。
根据实验室结果，排除了抗利尿激素分泌不当综合征以及甲状腺或肾上腺功能障碍等鉴别诊断。确诊为鲁拉西酮引起的多尿合并低钠血症。随后停用鲁拉西酮，1 周内钠水平恢复正常，无需补钠。
本病例报告强调了低剂量鲁拉西酮可能会引起多尿合并低钠血症。医生应注意与鲁拉西酮相关的低钠血症的不良反应，特别是在有颅内出血史的患者中。
