Losartan potassium/hydrochlorothiazide (Preminent®) and hyponatremia: case series of 40 patients.
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.
Department of Internal Medicine, Tokyo Metropolitan Bokutoh Hospital, Tokyo, Japan. hkinoshita-tky@umin.ac.jp
Hiroyuki
H
Kinoshita
Kenichiro
K
Kobayashi
Touru
T
Yaguramaki
Mutsuko
M
Yasuda
Kazuhiko
K
Fujiki
Junji
J
Tomiyama
Nobunori
N
Koga
Fumiatsu
F
Yakushiji
D000368:Aged; D000369:Aged, 80 and over; D000959:Antihypertensive Agents / Q000008:administration & dosage / Q000009:adverse effects*; D004338:Drug Combinations; D005260:Female; D006801:Humans; D006852:Hydrochlorothiazide / Q000008:administration & dosage / Q000009:adverse effects*; D006973:Hypertension / Q000188:drug therapy; D007010:Hyponatremia / Q000139:chemically induced* / Q000175:diagnosis / Q000628:therapy; D019808:Losartan / Q000008:administration & dosage / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D012206:Rhabdomyolysis / Q000139:chemically induced / Q000175:diagnosis / Q000628:therapy; D016896:Treatment Outcome
D000959:Antihypertensive Agents; D004338:Drug Combinations; D006852:Hydrochlorothiazide; D019808:Losartan