Hyponatremia Associated with Antiepileptic Drug Therapies

Hyponatraemia is one of the most common electrolyte disturbances encountered in patients receiving antiepileptic drug (AED) therapy. It arises when serum sodium concentration falls below 135 mmol/L, leading to symptoms ranging from mild fatigue and dizziness to severe neurological impairment and seizures. Several AEDs—most notably carbamazepine, oxcarbazepine and eslicarbazepine—can provoke hyponatraemia through enhancement of antidiuretic hormone activity or modulation of renal sodium handling. Risk factors include older age, female sex, high daily dosage, long duration of treatment and concomitant use of other sodium‐lowering medications. Clinical management hinges on early detection through routine monitoring of serum sodium, dose adjustment or drug substitution and, in severe cases, fluid restriction or hypertonic saline. Recent work has explored the molecular pathways that underlie drug‐induced water retention, the genetic predisposition to sodium imbalance and the utility of predictive algorithms to stratify patients by risk. With the global rise in epilepsy prevalence and expanding indications for AEDs beyond seizure control, understanding and mitigating hyponatraemia has major implications for patient safety, quality of life and health‐care resource utilisation. Practical guidelines now emphasise individualised risk assessment, patient education and interprofessional collaboration to ensure prompt intervention and minimise hospital admission rates.

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Hyponatremia Associated with Antiepileptic Drug Therapies publication trend

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Technical terms

Hyponatraemia: Serum sodium concentration below 135 mmol/L, indicating excess water relative to sodium in the body.

Antiepileptic drug (AED): A medication used to prevent or reduce the frequency of epileptic seizures.

Syndrome of inappropriate antidiuretic hormone secretion (SIADH): A disorder in which excessive release of antidiuretic hormone leads to water retention and dilutional hyponatraemia.

References

1. Symptomatology of carbamazepine‐ and oxcarbazepine‐induced hyponatremia in people with epilepsy. Epilepsia (2021).
2. Eslicarbazepine‐induced hyponatremia: A retrospective single‐center real clinical practice study. Epilepsia Open (2023).
3. Oxcarbazepine and Hyponatremia. Medicina (2022).