Immediate Administration of Tolvaptan Prevents the Exacerbation of Acute Kidney Injury and Improves the Mid-Term Prognosis of Patients With Severely Decompensated Acute Heart Failure

Association between plasma concentration of tolvaptan and urine volume in acute decompensated heart failure patients with fluid overload

“…In addition, these days, TLV is generally started as part of the early phase of treatment of ADHF with fluid overload Note that values were based on the next day's measurements, e.g., 24-h urine volume shown for day 1 was actually determined in the morning of day 2. The graph clearly depicts the significant increase in urine volume and decrease in body weight after the addition of tolvaptan and that these clinical effects continued until the tolvaptan was stopped on day 7. rather than the late phase of treatment [9,13]. Our hypothesis is that patients' digestive ducts remain swollen, which affects the absorption of TLV and results in various plasma concentrations of the drug, accounting for the various clinical effects we see in patients with ADHF even though they have all been given the same dose of TLV.…”

“…Some clinical investigators have reported the safety and efficacy of immediate use of TLV for ADHF [9,13]. In our study, we used 7.5 mg of TLV during the early phase of treatment for 92 decompensated heart failure patients who showed fluid overload after intravenous administration of 40 mg furosemide.…”

“…Tolvaptan (TLV), a selective V2-vasopressin receptor antagonist, is known for its excellent diuretic effect, and in Japan, it has been essential for intensive treatment of patients hospitalized for acute decompensated heart failure (ADHF) with fluid overload [1][2][3][4][5][6][7][8][9]. Since its approval for clinical use, we have noticed that the response to TLV varies from patient to patient, and the mechanism of action has been discussed, which may be affected by renal function, anemia and low cardiac output.…”

A Safety and Efficacy Study of Tolvaptan Following Open Heart Surgery in 109 Cases

“…Several studies have reported the efficacy of tolvaptan in patients with chronic congestive heart failure and acute heart failure. [1][2][3][4][5] According to previous reports, the use of tolvaptan for acute heart failure at an early stage of hospitalization prevents exacerbation of acute kidney injury, improves patient prognosis, 6) is superior to carperitide in terms of treatment cost of acute heart failure, 7) and is effective for correcting hyponatremia. [8][9][10] Although there are case reports indicating the efficacy of tolvaptan after open heart surgery, the number of patients reported is small.…”

Combination of Urinary Sodium/Creatinine Ratio and Plasma Brain Natriuretic Peptide Level Predicts Successful Tolvaptan Therapy in Patients With Heart Failure and Volume Overload

“…Recent clinical and experimental studies have demonstrated that selective vasopressin V2 receptor antagonism by oral tolvaptan administration inhibits free water reabsorption in the kidney's collecting tubules, and therefore stabilizes hemodynamic state, ameliorates congestion and edema, and corrects hyponatremia. [1][2][3][4][5][6][7][8][9][10] Successful oral tolvaptan therapy can support early ambulation, and can minimize the need for and duration of hospitalization.…”