Published: 2019-04-23

Relation between hyponatremia and alteration in gross metabolic parameters after atypical antipsychotic therapy

K. K. Daryani, Gargi Sethi, Shivank Sethi


Background: Weight gain and hyponatremia which is dilutional in nature, has been well known adverse effects associated with use of atypical antipsychotic medication but the plausible impact of dilutional hyponatremia on weight gain has not been explored.

Methods: One hundred and three patients more than 18 years of age of either gender who were prescribed, olanzapine or risperidone, were tested for serum electrolytes (Na+ and K+) and gross metabolic parameters (weight and waist circumference) were measured for baseline and post drug testing.

Results: Most common age group was 30-39 years of age in the patient study sample (n=103) with 38 (36.90%) patients were females while rest 63 (63.10%) were males. There was no significant association between serum sodium levels and weight gain was observed (p >0.05). It was observed that in olanzapine group 64% of the studied cases had weight gain whereas in risperidone group only 20.8% reported weight gain (p <0.001). There was significant association between olanzapine and increase in waist circumference over risperidone, irrespective to serum sodium status (x2=0.0148, p >0.05).

Conclusions: Olanzapine was primarily responsible for weight gain and increase in waist circumference over risperidone. These gross metabolic parameters were not influenced by hyponatremia.


Atypical antipsychotic, Hyponatremia, Weight gain, Waist circumference

Full Text:



Charlson FJ, Ferrari AJ, Santomauro DF, Diminic S, Stockings E, Scott JG, et al. Global epidemiology and burden of schizophrenia: findings from the global burden of disease study 2016. Schizophrenia Bull. 2018;44(6):1195-203.

Gandhi S, McArthur E, Reiss JP, Mamdani MM, Hackam DG, Weir MA, et al. Atypical antipsychotic medications and hyponatremia in older adults: a population-based cohort study. Can J Kidney Heal Dis. 2016;3(1):21.

Collins A, Anderson J. SIADH induced by two atypical antipsychotics. Int J Geriatric Psychiatry. 2000;15(3):282-3.

Meulendijks D, Mannesse CK, Jansen PA, Marum RJ, Egberts TC. Antipsychotic-Induced Hyponatraemia. Drug Safety. 2010;33(2):101-14.

Whitten JR, Ruehter VL, Pharm BS. Risperidone and hyponatremia: a case report. Ann Clin Psychiatry. 1997;9(3):181-3.

Dudeja SJ, McCormick M, Dudeja RK. Olanzapine induced hyponatraemia. Ulster Med J. 2010;79(2):104.

Bakhla AK, Guria RT, Kumar A. A suspected case of olanzapine induced hyponatremia. Ind J Pharmacol. 2014;46(4):441.

Ranga GS, Tomar LR, Narang S, Tripathi P, Jirwal OP. Risperidone causing hyponatremia. J Acute Med. 2014;4(3):133-4.

Lareb. The Netherlands Pharmacovigilance Centre. Olanzapine and hyponatraemia. Holland: Hertogenbosch, 2006. Available at: Accessed 03 Aug 2013.

Foreyt J, Goodrick K. The ultimate triumph of obesity. Lancet. 1995;346(8968):134-5.

Kalucy RS. Drug-induced weight gain. Drugs. 1980;19(4):268-78.

Pijl H, Meinders AE. Bodyweight change as an adverse effect of drug treatment. Drug Safety. 1996;14(5):329-42.

Umbricht D, Kane JM. Medical complications of new antipsychotic drugs. Schizophrenia Bull. 1996;22(3):475-83.

Stanton JM. Weight gain associated with neuroleptic medication: a review. Schizophrenia Bull. 1995;21(3):463-72.

Mannesse CK, Puijenbroek EP, Jansen PA, Marum RJ, Souverein PC, Egberts TC. Hyponatraemia as an adverse drug reaction of antipsychotic drugs. Drug Safety. 2010;33(7):569-78.

Orsolini L, Tomasetti C, Valchera A, Vecchiotti R, Matarazzo I, Vellante F, et al. An update of safety of clinically used atypical antipsychotics. Expert Opinion Drug Safety. 2016;15(10):1329-47.

Kumar S, Berl T. Sodium. Lancet. 1998;352(9123):220-8.

Wald R, Jaber BL, Price LL, Upadhyay A, Madias NE. Impact of hospital-associated hyponatremia on selected outcomes. Arch Int Med. 2010;170(3):294-302.

Wannamethee SG, Shaper AG, Lennon L, Papacosta O, Whincup P. Mild hyponatremia, hypernatremia and incident cardiovascular disease and mortality in older men: a population-based cohort study. Nutrition Metab Cardiovascular Dis. 2016;26(1):12-9.

Simpson MM, Goetz RR, Devlin MJ, Goetz SA, Walsh BT. Weight gain and antipsychotic medication: differences between antipsychotic-free and treatment periods. J Clin Psychiatry. 2001;62(9):694-700.

Ader M, Garvey WT, Phillips LS, Nemeroff CB, Gharabawi G, Mahmoud R, et al. Ethnic heterogeneity in glucoregulatory function during treatment with atypical antipsychotics in patients with schizophrenia. J Psychiatric Res. 2008;42(13):1076-85.