Medication-induced SIADH: distribution and characterization according to medication class

Br J Clin Pharmacol. 2017 Aug;83(8):1801-1807. doi: 10.1111/bcp.13256. Epub 2017 Mar 2.


Aims: The aims of the current study were to determine the distribution of aetiologies for the drug-induced syndrome of inappropriate antidiuretic hormone secretion (SIADH) in hospitalized patients, and to characterize them according to the different drug groups.

Methods: A single-centre retrospective study was carried out, including all patients diagnosed with SIADH in a large community hospital and tertiary centre between 1 January 2007 and 1 January 2013 who were treated with drugs known to be associated with SIADH. Two physicians reviewed every patient's medical file for predetermined relevant clinical data.

Results: The study cohort included 198 patients who had SIADH and received drugs associated with SIADH. Most patients [146 (73.7%)] were diagnosed with drug-associated SIADH, while 52 (26.3%) were diagnosed with SIADH due to other aetiologies. The Naranjo algorithm differentiated well between the two groups (P < 0.001). Five drug classes (antidepressants, anticonvulsants, antipsychotic agents, cytotoxic agents and pain medications) were implicated in 82.3% of patients diagnosed with drug-associated SIADH. Specific serotonin reuptake inhibitors and carbamazepine were commonly implicated. There were no clinically significant differences in the characteristics or severity of SIADH according to drug class.

Conclusions: The clinical characteristics of SIADH caused by different drugs are comparable. Patients with SIADH treated with drugs from five common medication classes will probably be diagnosed with drug-induced SIADH. Physicians should be aware of the significance of these medication classes as SIADH aetiologies.

Keywords: SIADH; distribution; hyponatraemia; medications.

Publication types

  • Comparative Study

MeSH terms

  • Aged
  • Aged, 80 and over
  • Analgesics / adverse effects
  • Anticonvulsants / adverse effects
  • Antidepressive Agents / adverse effects
  • Antineoplastic Agents / adverse effects
  • Antipsychotic Agents / adverse effects
  • Carbamazepine / adverse effects*
  • Female
  • Hospitalization / statistics & numerical data
  • Humans
  • Hyponatremia / blood
  • Hyponatremia / chemically induced
  • Hyponatremia / epidemiology*
  • Inappropriate ADH Syndrome / blood
  • Inappropriate ADH Syndrome / chemically induced
  • Inappropriate ADH Syndrome / epidemiology*
  • Male
  • Middle Aged
  • Retrospective Studies
  • Selective Serotonin Reuptake Inhibitors / adverse effects*
  • Tertiary Care Centers / statistics & numerical data


  • Analgesics
  • Anticonvulsants
  • Antidepressive Agents
  • Antineoplastic Agents
  • Antipsychotic Agents
  • Serotonin Uptake Inhibitors
  • Carbamazepine