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Epilepsia. 2016 Dec;57(12):2067-2079. doi: 10.1111/epi.13593. Epub 2016 Nov 29.

Antiepileptic drugs and hyponatremia in older adults: Two population-based cohort studies.

Author information

1
Department of Epidemiology & Biostatistics, Western University, London, Ontario, Canada.
2
Division of Nephrology, Department of Medicine, Western University, London, Ontario, Canada.
3
Institute for Clinical Evaluative Sciences, London, Ontario, Canada.
4
Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, Ontario, Canada.
5
Division of Clinical Pharmacology, Department of Medicine, Western University, London, Ontario, Canada.
6
Epilepsy Program, Department of Clinical Neurological Sciences, Western University, London, Ontario, Canada.

Abstract

OBJECTIVE:

To examine the 30-day risk of hospitalization with hyponatremia associated with carbamazepine, valproic acid (V), phenytoin (P), or topiramate (T) use compared to nonuse in the outpatient setting among older adults.

METHODS:

We conducted two population-based, retrospective cohort studies in Ontario, Canada, between 2003 and 2015 using administrative health care databases of older adults. The first study compared carbamazepine users to a propensity-score matched group of antiepileptic drug nonusers, whereas the second compared V-P-T users to a propensity-score matched group of antiepileptic nonusers. The primary outcome was hospitalization with hyponatremia within 30 days of an antiepileptic prescription.

RESULTS:

The baseline characteristics between matched groups were similar in both cohorts. Carbamazepine use versus nonuse was associated with a higher 30-day risk of hospitalization with hyponatremia (82/21,191 [0.39%] versus 30/63,573 [0.05%]; relative risk [RR] 8.20, 95% confidence interval [CI] 5.40-12.46). Similarly, V-P-T use versus nonuse was associated with a higher 30-day risk of hospitalization with hyponatremia (34/20,155 [0.17%] versus 26/40,310 [0.06%]; RR 2.62, 95% CI 1.57-4.36).

SIGNIFICANCE:

Older adults prescribed carbamazepine and V-P-T have a higher risk of being hospitalized with hyponatremia compared to other adults with similar indicators of baseline health who were not prescribed antiepileptic drugs. Physicians should be mindful of this risk; when a patient presents to a hospital with symptomatic hyponatremia these drugs should be considered as potential causes.

KEYWORDS:

Adverse drug event; Antiepileptic drugs; Hyponatremia

PMID:
27896804
DOI:
10.1111/epi.13593
[Indexed for MEDLINE]
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