People’s Pharmacy: Antidepressant depleted sodium to crisis level

Q. You’ve written about problems with low sodium levels due to blood pressure pills or even very low-sodium diets. Don’t overlook the dangers of fluoxetine in older people.

I took this antidepressant (as Prozac) when I was in my 30s and had no trouble. In my early 60s, my doctor prescribed it again, and it lowered my blood sodium. I became confused and thirsty and started to drink more water. As a result of the low sodium, I had to spend six days in the hospital. If I’d been in a rural community, there might not have been a kidney doctor available to figure out what was going on. I could have died.

A. Thanks for bringing this serious side effect of antidepressants to our attention. We fear that many health care providers are not aware of this life-threatening complication.

A recent meta-analysis of 10 studies found that antidepressants like venlafaxine (Effexor), paroxetine (Paxil), sertraline (Zoloft), citalopram (Celexa), escitalopram (Lexapro) and fluoxetine (Prozac) are all associated with low blood sodium (Journal of Endocrinological Investigation, April 22, 2025). Doctors call this condition hyponatremia. Symptoms may include confusion, anxiety, fatigue, trouble walking, muscle spasms and nausea.

Although blood pressure pills containing diuretics are the most common culprits, antidepressants and proton pump inhibitors for heartburn may also trigger this condition (European Journal of Internal Medicine, May 5, 2025). People should be especially cautious when the weather gets hot. A blood test can reveal sodium levels.

Q. Long ago, I took Celebrex for my arthritis and then was switched to celecoxib. Most of the generics do not work for me, but Greenstone was great. It made an authorized generic that was just like Celebrex.

Then suddenly, I could not find any pharmacy to fill my much-needed script with Greenstone brand celecoxib. Greenstone had been absorbed into a company called Viatris, which discontinued it. I’m completely frustrated. Pharmacies have been filling my prescription with generic celecoxib from a lot of different manufacturers. All of these medicines are practically useless. It would be helpful if somewhere there was a central, continually updated site to find authorized generic manufacturers.

I continually question why I’m taking something that doesn’t work but still has potential NSAID risks. However, going cold turkey has turned out badly for me every time I’ve tried!

A. An authorized generic is a medicine licensed from the brand name company and made to the exact same specifications, including the inactive ingredients. Sometimes an authorized generic might be made on the same manufacturing line as the brand name.

One company, Prasco, has made a list of authorized generics (authorizedgenerics.com). Unfortunately, it is not up to date. Greenstone, which used to make an authorized generic version of the NSAID Celebrex, has indeed disappeared. You might want to consider purchasing brand name Celebrex from a legitimate Canadian pharmacy. While this would run $460 to $600 for a month’s supply in the U.S., a Canadian online pharmacy can provide 100 pills for around $200, sourced from Canada. You can find that information through PharmacyChecker.com, which vets its sources. That is important because not every online pharmacy proclaiming itself “Canadian” is legitimate.

You can learn more about finding and utilizing Canadian pharmacies in our “eGuide to Saving Money on Medicines.” This online resource is available under the Health eGuides tab at www.PeoplesPharmacy.com.

Email Joe and Teresa Graedon via their website: www.PeoplesPharmacy.com.