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Initiating Treatment With Most PPIs Linked to Hyponatremia
Researchers found an association between the first 3 months of most proton pump inhibitor treatments and hospitalization due to hyponatremia, according to findings recently published in European Journal of Internal Medicine.
“Very little — an occasional case report and two minor observational studies — has previously been published in this area,” Henrik Falhammar, MD, FRACP, PhD, of the department of endocrinology, metabolism and diabetes at Karolinska Institutet in Stockholm, told Healio Family Medicine.
“Since we had a data set of all admissions with a principal diagnosis of hyponatremia in Sweden [over a period] of 9 years, including all prescribed medications and a large control group, we decided to do a proper study to see if there is an association between PPIs and severe hyponatremia,” he continued.
Researchers compared 14,359 patients hospitalized primarily for hyponatremia and having started PPI treatment within the past 3 months with 57,383 controls. Of all participants, 72% were women and the median age was 76 years.
Falhammar and colleagues found that in hyponatremia group, the adjusted ORs for new initiation of PPIs were: 1.19 for lansoprazole (95% CI, 0.72–1.94); 2.06 for pantoprazole (95% CI, 1.32–3.19); 2.67 for omeprazole (95% CI, 2.37–3.01); and 2.89 for esomeprazole (95% CI, 2.21–3.79). No association with hyponatremia was reported in patients receiving lansoprazole.
Among all patients studied, elderly female patients with many other comorbidities and taking PPIs seemed most at risk for hospitalization due to hyponatremia, Falhammer said in the interview. There was no significant risk found between ongoing PPI use and hyponatremia.
The findings did not discourage him from recommending PPIs to patients, so long as these medications are used properly.
“PPIs are generally safe but should only be used if indicated. If severe hyponatremia occurs within the first 3 months of use, the PPI should be ceased or if deemed necessary, lansoprazole could be used instead,” Falhammer said. – by Janel Miller
Disclosure: Falhammar reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.