Henrik Falhammar1, Jonatan D Lindh2, Jan Calissendorff3, Jakob Skov4, David Nathanson5, Buster Mannheimer6. 1. Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden; Department of Endocrinology, Metabolism and Diabetes, Karolinska University Hospital, Stockholm, Sweden. Electronic address: henrik.falhammar@ki.se. 2. Department of Laboratory Medicine, Division of Clinical Pharmacology, Karolinska University Hospital Huddinge, Karolinska Institutet, Stockholm, Sweden. 3. Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden; Department of Endocrinology, Metabolism and Diabetes, Karolinska University Hospital, Stockholm, Sweden. 4. Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden. 5. Department of Endocrinology, Metabolism and Diabetes, Karolinska University Hospital, Stockholm, Sweden; Department of Clinical Science and Education at Södersjukhuset, Karolinska Institutet, Stockholm, Sweden. 6. Department of Clinical Science and Education at Södersjukhuset, Karolinska Institutet, Stockholm, Sweden.
Abstract
BACKGROUND: Small observational studies and case reports have indicated that proton pump inhibitors (PPIs) may cause hyponatremia. Whether there is a difference between the individual PPIs is yet unknown. Since PPIs are one of the most commonly prescribed groups of drugs, even a rare adverse reaction may have large implications. The objective was to study the association between PPIs and hospitalization due to hyponatremia. METHODS: This register-based case-control study was based on the general Swedish population. Patients hospitalized with a principal diagnosis of hyponatremia (n = 14,359) were compared to matched controls (n = 57,383). The association between newly initiated (≤90 days) and ongoing PPI use was explored using multivariable logistic regression adjusting for concomitant drugs, medical conditions, previous hospitalizations and socioeconomic factors. RESULTS: Adjusted ORs (95%CI) for hospitalization due to hyponatremia, compared to controls, were for newly initiated: omeprazole 2.67 (2.37-3.01); pantoprazole 2.06 (1.32-3.19); lansoprazole 1.19 (0.72-1.94); esomeprazole 2.89 (2.21-3.79) and any PPI 2.78 (2.48-3.11). Only one individual had been newly initiated on rabeprazole and had been hospitalized due to hyponatremia. Adjusted ORs (95%CI) for individuals with ongoing treatment were for: omeprazole 1.04 (0.97-1.11); pantoprazole 0.81 (0.62-1.05); lansoprazole 0.90 (0.70-1.15); rabeprazole 3.34 (0.84-11.43); esomeprazole 1.12 (0.94-1.33) and any PPI 1.04 (0.98-1.11). CONCLUSIONS: With the exception of lansoprazole, this study suggests an association between any newly initiated PPI-treatment and hospitalization due to hyponatremia. Ongoing PPI use was not associated with an increased risk.
BACKGROUND: Small observational studies and case reports have indicated that proton pump inhibitors (PPIs) may cause hyponatremia. Whether there is a difference between the individual PPIs is yet unknown. Since PPIs are one of the most commonly prescribed groups of drugs, even a rare adverse reaction may have large implications. The objective was to study the association between PPIs and hospitalization due to hyponatremia. METHODS: This register-based case-control study was based on the general Swedish population. Patients hospitalized with a principal diagnosis of hyponatremia (n = 14,359) were compared to matched controls (n = 57,383). The association between newly initiated (≤90 days) and ongoing PPI use was explored using multivariable logistic regression adjusting for concomitant drugs, medical conditions, previous hospitalizations and socioeconomic factors. RESULTS: Adjusted ORs (95%CI) for hospitalization due to hyponatremia, compared to controls, were for newly initiated: omeprazole 2.67 (2.37-3.01); pantoprazole 2.06 (1.32-3.19); lansoprazole 1.19 (0.72-1.94); esomeprazole 2.89 (2.21-3.79) and any PPI 2.78 (2.48-3.11). Only one individual had been newly initiated on rabeprazole and had been hospitalized due to hyponatremia. Adjusted ORs (95%CI) for individuals with ongoing treatment were for: omeprazole 1.04 (0.97-1.11); pantoprazole 0.81 (0.62-1.05); lansoprazole 0.90 (0.70-1.15); rabeprazole 3.34 (0.84-11.43); esomeprazole 1.12 (0.94-1.33) and any PPI 1.04 (0.98-1.11). CONCLUSIONS: With the exception of lansoprazole, this study suggests an association between any newly initiated PPI-treatment and hospitalization due to hyponatremia. Ongoing PPI use was not associated with an increased risk.
Authors: Jonatan D Lindh; David Nathanson; Buster Mannheimer; Jakob Skov; Henrik Falhammar; Jan Calissendorff Journal: Endocrine Date: 2019-09-02 Impact factor: 3.633
Authors: Henrik Falhammar; Jakob Skov; Jan Calissendorff; David Nathanson; Jonatan D Lindh; Buster Mannheimer Journal: J Clin Endocrinol Metab Date: 2020-10-01 Impact factor: 5.958