ModerateLoop diuretics×Selective serotonin reuptake inhibitors (SSRIs)
Updated · Methodology
Mechanism
Both can cause hyponatraemia: furosemide via natriuresis, sertraline via SIADH-like mechanism. Additive risk, especially in older women with low body weight.
Symptoms
Headache, nausea, confusion, drowsiness; severe cases: seizures. Develops slowly over 1–2 weeks and is often missed in older patients.
Management
Check sodium 2 weeks after sertraline start, then every 6 months. If sodium falls below 130 mmol/L, switch sertraline to mirtazapine or agomelatine (do not cause hyponatraemia). In older patients with moderate hyponatraemia, fluid restriction to 1.5 L/day.
Check the full regimen, not just this pair
Opens the checker with these two drugs prefilled. Add the rest of the regimen and recompute additive risks.
Summary of a multi-drug list →
Medicine list: everything you take in one place →
Sources
- Lexicomp: Lexicomp Drug Interactions (2024)– Wolters Kluwer Clinical Drug Information, Inc. Lexi-Interact Online, 2024
- AGS: American Geriatrics Society Beers Criteria for Potentially Inappropriate Medication Use (2023)– By the 2023 American Geriatrics Society Beers Criteria Update Expert Panel. AGS Beers Criteria for Potentially Inappropriate Medication Use in Older Adults. J Am Geriatr Soc 2023;71(7):2052-2081.
- AEMPS: Ficha técnica: Sertralina (nº registro 66057), sección 4.4 (2025)– AEMPS, CIMA, nº registro 66057, revisión 08/2025, sección 4.4