Use of Milnacipran in a Patient with Hyponatremia under the Cover of Fludrocortisones

Abstract

Introduction: Hyponatremia is a known side effect of antidepressant medications.Usually management of hyponatremia in patients receiving antidepressants involves stopping of antidepressant and restriction of fluid intake. However, information is not clear with respect to use of antidepressant in patients with persistent hyponatremia. Objective: To describe a patient detected to have hyponatremia prior to starting of antidepressant. The hyponatremia was corrected with the use of fludrocortisone, but introduction of sertraline led to reemergence of hyponatremia. Later patient tolerated milnacipran along with fludrocortisone, without recurrence of hyponatremia. Conclusion: Fludrocortisone can be used for prevention and management of hyponatremia in patients at high risk of developing the same. Further, milnacipran may be considered as a viable option in patients who develop hyponatremia with SSRIs