Citalopram-induced hyponatraemia and parkinsonism: potentially fatal side-effects not to be missed.
The use of selective serotonin reuptake inhibitors (SSRIs), such as citalopram, is on the rise and, as such, clinicians must be vigilant of rare side-effects associated with this group of medications. We report the case of a 65-year-old man who presented to West Suffolk Hospital with a fall, confusion and movement abnormalities, and was found to have a serum sodium of 105 on admission. He was managed with hypertonic saline, dopamine agonists and intensive physiotherapy. Despite initially deteriorating neurologically, he made a remarkable recovery, and was discharged home at his pre-admission baseline. The learning points from this report are as follows: (1) regular monitoring of electrolytes on starting an SSRI (and similarly selective noradrenaline reuptake inhibitors-SNRIs) in SSRI/SNRIs naïve patients, (2) awareness of possible citalopram-induced parkinsonism and the potential benefits of dopamine agonists as one management strategy and (3) vigilant fluid/electrolyte monitoring in patients with profound hyponatraemia.
Department of Neurosciences, Addenbrookes Hospital, Cambridge, UK.
Negin
N
Damali Amiri
Department of Diabetes & Endocrinology, West Suffolk Hospital, Bury St Edmunds, UK.
Nishan
N
Wijenaike
D000368:Aged; D015283:Citalopram / Q000009:adverse effects*; D003221:Confusion / Q000139:chemically induced; D006801:Humans; D007010:Hyponatremia / Q000139:chemically induced*; D008297:Male; D020734:Parkinsonian Disorders / Q000139:chemically induced*; D017367:Selective Serotonin Reuptake Inhibitors / Q000009:adverse effects*
D015283:Citalopram; D017367:Selective Serotonin Reuptake Inhibitors