Syndrome of inappropriate antidiuretic hormone secretion is associated with different proton pump inhibitor use: a pharmacovigilance study

Diagnostic assistance provided by a pharmacist for the syndrome of inappropriate antidiuretic hormone secretion caused by carboplatin plus nab-paclitaxel chemotherapy in an elderly patient with lung cancer: a case report

BACKGROUND

Syndrome of inappropriate antidiuretic hormone secretion (SIADH) is the most common cause of hyponatremia. Although SIADH induced by carboplatin (CBDCA) plus nab-paclitaxel (nab-PTX) has been reported, there is limited evidence for SIADH being suspected by pharmacists during chemotherapy in elderly patients and contributing to early intervention through diagnostic support for physicians.

CASE PRESENTATION

An 84-year-old man was diagnosed with stage 3A squamous cell carcinoma of the right lung. Genetic mutations and expression of programmed cell death protein ligand 1 were < 1%. The patient was started on CBDCA area under the curve of 5 mg/mL·min on day 1 plus nab-PTX 70 mg/m2 on days 1, 8 and 15 once every 3 weeks. The serum sodium level immediately before the start of chemotherapy was 141 mmol/L. On day 8, it decreased to 119 mmol/L, and the physician started oral sodium chloride (3 g/day) administration. Because the pharmacist suspected that this hyponatremia may be due to chemotherapy-induced SIADH, the pharmacist suggested an examination of plasma and urine osmolality and urinary sodium levels to the physician. The serum creatinine level, plasma osmolality, urine osmolality, and urinary sodium level were 1.06 mg/dL, 253 mOsm/kg, 355 mOsm/kg, and 59 mEq/L, respectively; furthermore, the patient was not dehydrated. Based on the findings, a diagnosis of chemotherapy-induced SIADH was made. The physician and pharmacist conferred and decided to continue chemotherapy with frequent monitoring of serum sodium levels. Subsequently, the serum sodium level improved to 139 mmol/L on day 20 without additional treatment, and oral administration of sodium chloride was discontinued on day 22. The patient completed five cycles of chemotherapy. Computed tomography revealed a partial response throughout chemotherapy. Furthermore, sodium levels did not decrease again throughout chemotherapy. The Naranjo Adverse Drug Reaction Probability Scale score was 5 points, which is categorized as "probable."

CONCLUSIONS

We encountered a case in which the patient developed chemotherapy-induced SIADH but was able to continue chemotherapy because of early pharmacist intervention. In elderly patients without genetic mutations and few treatment options, even if they develop SIADH, chemotherapy should be continued with monitoring of serum sodium levels by physicians and pharmacists.

Renal injury in NSAIDs: a real-world analysis based on the FAERS database

OBJECTIVE

This study aims to evaluate the reporting risk of renal injury associated with non-steroidal anti-inflammatory drugs (NSAIDs), with a particular focus on the reporting risk levels and onset times of different NSAIDs.

METHODS

A pharmacovigilance study was conducted using data from the FAERS database from January 2004 to December 2023. Reports of renal injury were identified, and signal detection was performed using reporting odds ratio (ROR) and Bayesian confidence propagation neural network (BCPNN) methods. The study compared the incidence, mortality rates, and onset times of renal injury across five NSAIDs.

RESULTS

Among the 7436 cases of NSAID-associated renal injury analyzed, elderly patients are at an increased risk of renal injury associated with NSAID usage. Ibuprofen had the highest number of reports (3475 cases, 46.7%), while celecoxib had the lowest (542 cases, 7.3%). Ibuprofen showed the highest signal with renal injury (ROR 3.3, IC025 1.7), whereas celecoxib exhibited the lowest (ROR 1.4, IC025 0.4). Aspirin had the highest mortality rate associated with renal injury (18.7%), while ibuprofen had the lowest (3.8%). The median onset time for renal injury was 6 days, with 79.3% of adverse events occurring within the first 30 days of use.

CONCLUSION

The study indicates that ibuprofen presents the highest signal of renal injury, while celecoxib shows the lowest signal. The likelihood of NSAID-associated renal injury is heightened in elderly patients, and all five studied NSAIDs are linked to an increased likelihood of acute renal injury. NSAID-related renal damage tends to occur early in the treatment process, potentially leading to serious consequences. Due to the inherent limitations of pharmacovigilance studies, certain findings require additional validation like cohort studies. Nonetheless, the potential for an increased risk of renal injury must be taken into account in patient care.

Hyponatremia Associated with the Use of Common Antidepressants in the All of Us Research Program

Selective serotonin reuptake inhibitor (SSRI), serotonin-norepinephrine reuptake inhibitor (SNRI), and norepinephrine-dopamine reuptake inhibitor (NRI) antidepressants can cause hyponatremia through syndrome of inappropriate antidiuretic hormone secretion (SIADH). This study assesses the differential risks of hyponatremia associated with commonly prescribed SSRIs (fluoxetine, paroxetine, sertraline, citalopram, escitalopram), SNRIs (duloxetine, venlafaxine) and NRI (bupropion), as well as omeprazole as a reference, with a retrospective observational cohort study in the All of Us Research Program, a national multicenter research cohort containing de-identified electronic health records (EHR). Participants who had been prescribed monotherapy with any of eight common antidepressants were included, with each drug considered as a separate arm indexed with a start date. Events were defined as the first occurrence of a low plasma sodium measurement or a clinical diagnosis recorded for either hyponatremia or SIADH. Those who did not have events were censored at their last plasma sodium measurement. A total of 17,439 individuals were exposed to one of the eight antidepressants as monotherapy. The overall incidences for hyponatremia were 0.87% in the first 30 days and 10.5% in the first 3 years in the antidepressant arms. Compared to sertraline, duloxetine (hazard ratio [HR] = 1.37 [1.19-1.58]) and escitalopram (HR = 1.16 [1.01-1.33]) were associated with the highest overall risk of hyponatremia, and bupropion (HR = 0.83 [0.73-0.94]) and paroxetine (HR = 0.78 [0.65-0.93]) were associated with the lowest risk. The risks were unchanged after adjusting for comorbidity and polypharmacy. Such information could help guide providers in managing patients and their risks of hyponatremia when on common antidepressants.

Clinical Factors Affecting Daily Dosage of Desmopressin Orally Disintegrating Tablets in Arginine Vasopressin Deficiency

CONTEXT

Desmopressin orally disintegrating tablets (ODTs) are widely used to treat arginine vasopressin deficiency (AVP-D). However, limited information is available on the dosage regimen; the dosage for each patient is selected based on their response to the initiation dose.

OBJECTIVE

To investigate the relationships between clinical characteristics and the daily dose of ODTs and to identify factors that affect ODT dosages.

METHODS

This retrospective study included 209 adult patients with AVP-D. Patients were administered ODTs sublingually and instructed to restrict eating and drinking for 30 minutes after taking ODTs using a patient leaflet. ODT dose titration was conducted during hospitalization with close monitoring of urine output, body weight, and serum sodium levels. Multivariable linear regression models were applied to identify clinical factors associated with the daily dose of ODTs at discharge. We also evaluated the dosage at 1 year in 134 patients who were followed up in our hospital.

RESULTS

The median daily dose of ODTs at discharge was 90 µg (IQR 60-120 µg). Multivariable linear regression models identified sex, age, and estimated creatinine clearance (eCCr) as significant factors associated with the daily dose of ODTs, with eCCr having the strongest effect. After excluding patients recovering from AVP-D, 71% of those followed up at our hospital took the same daily dose at 1 year after discharge.

CONCLUSION

To achieve the safe and stable treatment of AVP-D, the daily dose of ODT needs to be selected based on a patient's sex, age, and eCCr under appropriate sublingual administration by patient education.

The Impact of Sex on the Response to Proton Pump Inhibitor Treatment

Proton pump inhibitor (PPI) treatment is responsible for substantial gastrin elevation secondary to reduced intragastric acidity. Due to the increasing global prevalence of PPI users, concerns have been raised about the clinical significance of continuous gastrin elevation and its potential long-term side effects. Hypergastrinemia secondary to PPIs has trophic effects on gastric mucosa, leading to enterochromaffin-like cell hyperplasia and gastric (fundic) polyp formation, and it is believed to provoke acid rebound following PPI withdrawal that induces PPI overutilization. Previous studies have found higher gastrin release following PPI therapy in females compared with males, and sex differences have also been demonstrated in pharmacokinetic parameters and dose requirements for acid reflux. It is conceivable that females might be at increased risk of PPI overuse, because they often receive higher milligram-per-kilogram doses. The prevalence of PPI use is more common among females, and the female sex is a risk factor for adverse drug reactions. This non-systematic review outlines the current knowledge of the impact of biological sex on the response to PPIs. The aim is to highlight the female sex as a potential risk factor that could be a step toward precision medicine and should be considered in future research on the response to PPI treatment.