Can Lisinopril Cause Hyponatremia?

First a definition of hyponatremia – a deficiency of sodium in the blood or abnormally low concentration of sodium ions in blood. Lisinopril is an angiotensin converting enzyme (ACE) inhibiting drug administered as an antihypertensive and after heart attacks. This is used by many people for combating high blood pressure and often in combination with other drugs.

Hyponatremia is listed on the drug label insert as a potential adverse event but does not occur that frequently. The signs and symptoms of hyponatremia include nausea, malaise, headache, lethargy, seizures, coma, respiratory depression and decreased sodium levels.

Often the cause of hyponatremia was purported to be the result of a drug-induced syndrome of inappropriate secretion of anti-diuretic hormone (SIADH). When suppression of anti-diuretic hormone is impaired, which may be induced by ACE inhibitors, water is retained and sodium is lost. None of my test results have given any indication of this happening for me.

Although case reports suggest that ACE inhibitor therapy may cause hyponatremia (even at low doses), do not forget that other agents or medical conditions that may carry added risks for hyponatremia. For example, the risk for hyponatremia may be greater in patients also on diuretic therapy or who have congestive heart failure. There are limitations in drawing conclusions from case reports, it remains prudent to monitor electrolyte levels in patients on ACE inhibitor therapy, namely serum sodium and serum potassium. Hyponatremia is recognized as a potential adverse effect of ACE inhibitor therapy, with grave consequences if left uncorrected. Both patients and physicians should be aware of the signs and symptoms of hyponatremia.

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