Hyponatremia risk may differ across second-generation antipsychotics
Antipsychotics are used to treat schizophrenia, along with bipolar disorder and major depressive disorder. However, these medications can be associated with hyponatremia, a serious reduction in blood sodium levels.
An analysis of hyponatremia risk associated with second-generation antipsychotic medications revealed potential differences among individual drugs. Associate Professor Masakazu Hatano and colleagues from Fujita Health University School of Medicine in Japan conducted a two-part study, first using FDA Adverse Event Reporting System data to generate hypotheses regarding hyponatremia risk, then evaluating these hypotheses using Japanese hospital-based claims data.
The U.S. safety reporting analysis included 17.8 million reports, of which 458,745 involved second-generation antipsychotic monotherapy. Several drugs showed lower reporting odds for hyponatremia than olanzapine, the reference antipsychotic, with brexpiprazole and lurasidone showing the lowest reporting odds. However, these findings were hypothesis-generating due to limitations in the spontaneous reporting data.
The Japanese claims database analysis included 55,394 patients prescribed antipsychotics, followed for up to 180 days. During follow-up, hyponatremia occurred in 366 patients (0.7%). After adjusting for differences in baseline characteristics and other factors, aripiprazole was associated with a significantly lower risk of hyponatremia compared to olanzapine, while other second-generation antipsychotics showed no significant differences.
These findings suggest that the risk of hyponatremia may vary among individual second-generation antipsychotics, potentially guiding treatment decisions for patients at higher risk. However, the study's observational nature means residual confounding and differences in hyponatremia detection may have influenced the results.
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