Use of Milnacipran in a Patient with Hyponatremia under the Cover of Fludrocortisones

Hyponatremia (clinically defined as serum sodium levels of <135 meq/L) is considered to be the most common electrolyte abnormality seen in general hospital patients [1]. Hyponatremia is noted as a side effect associated with various psychotropic medications, especially the antidepressants. The risk of hyponatremia varies from one antidepressant to other. Evidence suggests that compared to other antidepressants the risk of hyponatremia is significantly greater with Selective Serotonin Reuptake Inhibitors (SSRIs) and Serotonin Norepinephrine Reuptake Inhibitors (SNRIs) [1-5]. Depending on the study design the incidence of SSRIs induced hyponatremia varies from 0.5 to 32% of the SSRIsand that for SNRIs is reported to be 4.2% [5,6]. Various risk factors for antidepressant induced hyponatremia include increasing age, female gender, presence of comorbid conditions like renal failure or other illnesses like hypertension, diabetes mellitus which can damage the kidneys, cardiac failure, volume depletion, hormonal imbalance and malignancies [1,3-5]. Further, hyponatremia with antidepressants is usually seen during the initial part of the therapy [4] and due to this some authors suggest that serum sodium levels must be monitored closely in patients who are at high risk of developing hyponatremia.