Drug General Information (ID: DDIDZ3SBF0)
Drug Name			Hydrochlorothiazide		Drug Info		Levomilnacipran		Drug Info
Drug Type		Small molecule				Small molecule
Therapeutic Class		Diuretics				Snris/Antidepressants
Structure

Mechanism of Hydrochlorothiazide-Levomilnacipran Interaction (Severity Level: Moderate)
Increased risk of hyponatremia Click to Show/Hide Mechanism Graph
Drug Name		Hydrochlorothiazide				Levomilnacipran
Mechanism		Hyponatremia				Hyponatremia
Key Mechanism Factor 1
		Factor Name		Hyponatremia
		Factor Description		Hyponatremia is a condition in which the amount of sodium in the blood is lower than normal. Symptoms of hyponatremia may include: nausea and vomiting, fatigue, headache or confusion, muscle cramps, weakness, irritability and restlessness.
Mechanism Description		Increased risk of hyponatremia by the combination of Hydrochlorothiazide and Levomilnacipran

Recommended Action
Management		Caution is recommended if SSRIs or SNRIs are prescribed in combination with diuretics, particularly in the elderly. Patients should be advised to seek medical attention if they experience potential signs and symptoms of hyponatremia such as nausea, vomiting, headache, malaise, lethargy, irritability, difficulty concentrating, memory impairment, confusion, weakness, muscle spasm, and unsteadiness (which may lead to falls). More severe and/or acute cases may include hallucination, syncope, seizure, coma, respiratory arrest, and death. Discontinuation of SSRI/SNRI therapy should be considered in patients who develop symptomatic hyponatremia, and appropriate medical intervention instituted as necessary. Patients should also have their blood pressure and pulse monitored before and during SSRI/SNRI therapy, especially during the first few weeks and following a dosage increase. Patients should be advised to avoid rising abruptly from a sitting or recumbent position and to notify their doctor if they experience dizziness, lightheadedness, syncope, orthostasis, or tachycardia.

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