Rapid-onset hyponatremia and delirium following duloxetine treatment for postherpetic neuralgia: Case report and literature review

Medicine (Baltimore). 2018 Nov;97(46):e13178. doi: 10.1097/MD.0000000000013178.


Rationale: Hyponatremia following duloxetine treatment has been reported in patients with major depressive disorder, fibromyalgia, diabetic neuropathy, or sciatic pain. The manifestations of duloxetine-induced hyponatremia are varying in different individuals. The overall prognosis for this type of hyponatremia is favorable if properly managed.

Patient concerns and diagnoses: Herein, we reported rapid-onset hyponatremia and delirium in an older patient after 2 doses of duloxetine, which was used to control his postherpetic neuralgia. Laboratory examinations revealed a rapid decline in serum sodium level and indicated the possibility of syndrome of inappropriate antidiuretic hormone (SIADH).

Interventions: Discontinuation of duloxetine, restriction of water intake, and intravenous supplement of normal saline were adopted to manage the hyponatremia.

Outcomes: Serum concentration of sodium gradually normalized following aforementioned strategies.

Lessons: Special attention to the electrolyte abnormality is recommended in old patients undergoing duloxetine treatment.

Publication types

  • Case Reports
  • Review

MeSH terms

  • Aged
  • Analgesics / adverse effects*
  • Delirium / chemically induced*
  • Duloxetine Hydrochloride / adverse effects*
  • Humans
  • Hyponatremia / chemically induced*
  • Inappropriate ADH Syndrome / chemically induced
  • Male
  • Neuralgia, Postherpetic / drug therapy*
  • Sodium / blood
  • Sodium Chloride / therapeutic use


  • Analgesics
  • Sodium Chloride
  • Duloxetine Hydrochloride
  • Sodium