Hyponatremia Medication

Updated: Aug 18, 2022
  • Author: Seyed Mehrdad Hamrahian, MD; Chief Editor: Vecihi Batuman, MD, FASN  more...
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Medication

Medication Summary

The primary treatments used in the management of hyponatremic patients rely on the use of intravenous sodium-containing fluids (normal saline or hypertonic saline) and fluid restriction. This is followed by use of loop diuretics (eg, furosemide), arginine vasopressin (AVP) receptor antagonists (eg, tolvaptan), [53, 54] or urea [56] ; less commonly, salt tablets, or demeclocycline are used.

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Diuretics

Furosemide (Lasix)

Loop diuretics can increase renal free water excretion. It inhibits sodium/potassium/chloride cotransport system, thereby increasing solute delivery to distal renal tubules, which acts to increase free water excretion. Elderly patients may have greater sensitivity to effects of loop diuretics. 

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Antibiotics

Class Summary

Certain antibiotics may affect renal ADH action.

Demeclocycline (Declomycin)

Demeclocycline (Declomycin) can cause insensitivity of distal renal tubules to the action of ADH and produce a nephrogenic diabetes insipidus. Effects are seen within 5 days and are reversed within 2-6 days following cessation of therapy. Demeclocycline can be nephrotoxic, cause nausea, vomiting, and photosensitivity. 

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Arginine Vasopressin Antagonists

Class Summary

V2 receptor antagonism of AVP in the renal collecting duct results in aquaresis (excretion of free water). [53, 54, 55, 57, 58]

Conivaptan (Vaprisol)

Arginine vasopressin antagonist (V1A, V2), indicated for euvolemic (dilutional) and hypervolemic hyponatremia, increases urine output of mostly free water, with little electrolyte loss. Over 80% of conivaptan is excreted in feces and the rest in urine. Conivaptan is an intravenous injection that can be administered for up to 4 days.

Tolvaptan (Samsca)

Selective vasopressin V2-receptor antagonist is indicated for euvolemic or hypervolemic hyponatremia, associated with SIADH or congestive heart failure. Initiate or reinitiate in hospital environment only. Tolvaptan can cause serious and potentially fatal liver injury; hence, duration of use is limited to 30 days to minimize risk of liver injury.water). 

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Salt

Sodium chloride

Oral salt tablets in conjunction with loop diuretics can be used to help excrete urinary free water.

Sodium chloride tablets (1 gram) are osmotically active and ingesting 9 grams of sodium chloride in one day equals the addition of an extra 154 mEq each of sodium and chloride. Salt tablets should be avoided in the treatment of hypervolemic hyponatremia (e.g. heart failure).

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Urea Supplements

Class Summary

Oral urea is an osmotic agent that increases urinary free water excretion. It is effective, safe, well tolerated and cost effective for treatment of SIADH associated hyponatremia. A modest but expected elevation of BUN is the result of normal urea metabolism and should not be interpreted as a reduction in kidney function. Urea has been shown to have a direct antinatriuretic effect and free water excretion leading to increased serum sodium levels.  [50, 59]  The use of urea is contraindicated in patients with hypovolemic hyponatremia. Furthermore, urea is relatively contraindicated in patients with cirrhosis due to potential metabolization into ammonium by urease producing bacteria in the colon, which can lead to hyperammonemia.

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Vasopressin Analog

Desmopressin

Desmopressin (DDAVP), synthetic analogue of the antidiuretic hormone arginine vasopressin, increases cyclic adenosine monophosphate (cAMP), in a dose dependent manner, in renal tubular cells which increases water permeability resulting in decreased urine volume and increased urine osmolality.

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