Intravenous conivaptan for the treatment of hyponatraemia caused by the syndrome of inappropriate secretion of antidiuretic hormone in hospitalized patients: a single-centre experience

Velez, Juan Carlos Q.; Dopson, Shirley J.; Sanders, Donna S.; Delay, Tracie A; Arthur, John M.

doi:10.1093/ndt/gfp731

Cited by 65 publications

(63 citation statements)

References 41 publications

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“…Change in serum sodium from baseline obtained with vaptans is generally around 3-6 mEq/L during the first 24 hours of correction depending on the degree of water restriction (2,16,20). Incidence of hypernatremia was not significantly increased.…”

Section: Discussionmentioning

confidence: 88%

“…Several vaptans have been studied in patients with SIADH, including satavaptan (selective V 2 ), tolvaptan (V 2 ), lixivaptan (V 2 ), and conivaptan (V 1 /V 2 ) (14). Two of these are currently available on the market: In the United States, conivaptan is approved for intravenous use in euvolemic and hypervolemic hyponatremia (15,16), and oral tolvaptan is approved for euvolemic and hypervolemic hyponatremia (17,18). Tolvaptan is approved in the European Union only for SIADH.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Efficacy and Tolerance of Urea Compared with Vaptans for Long-Term Treatment of Patients with SIADH

Soupart

Coffernils²,

Couturier

et al. 2012

Clinical Journal of the American Society of Nephrology

130

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SummaryBackground and objectives Vaptans (vasopressin V 2 -receptor antagonists) are a new approach for the treatment of hyponatremia. However, their indications remain to be determined, and their benefit compared with that of the usual treatments for the syndrome of inappropriate antidiuretic hormone secretion (SIADH) have not been evaluated. This prospective, long-term study compared the efficacy, tolerability, and safety of two oral vaptans with those of oral urea in patients with SIADH.Design, setting, participants, & measurements Patients with chronic SIADH of various origins were treated first with vaptans for 1 year. After an 8-day holiday period, they received oral urea for an additional 1-year follow-up. Serum sodium was measured every 2 months, and drug doses were adjusted accordingly.Results Thirteen participants were initially included in the study (serum sodium, 12563 mEq/L); 12 completed the 2-year treatment period. Treatment with vaptans (satavaptan, 5-50 mg/d, n=10; tolvaptan, 30-60 mg/day, n=2) increased natremia (serum sodium, 13563 mEq/L) during the 1-year vaptan period without escape. Hyponatremia recurred in the 12 participants when vaptans were stopped (holiday period). Urea improved the natremia with the same efficacy (serum sodium, 13562 mEq/L) as vaptans during the 1-year urea treatment period. One participant treated with tolvaptan withdrew from the study early because of excessive thirst. Another patient receiving urea developed hypernatremia without complications.Conclusions Urea has efficacy similar to that of vaptans for treatment of chronic SIADH. Tolerance is generally good for both agents.

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Section: Discussionmentioning

confidence: 88%

Section: Introductionmentioning

confidence: 99%

Efficacy and Tolerance of Urea Compared with Vaptans for Long-Term Treatment of Patients with SIADH

Soupart

Coffernils²,

Couturier

et al. 2012

Clinical Journal of the American Society of Nephrology

130

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“…73,74 In addition, other studies such as Okita and associates have suggested a dose-dependent improvement in ascites, lower extremity edema and tolerance to diuretics with tolvaptan, but further research is needed to confirm these findings. 60,61,76,79,80 Conivaptan, approved for only 4 days of intravenous use in the hospital, for euvolemic and hypervolemic hyponatremia, 81 has limited data on its safety and efficacy. [82][83][84] In general, conivaptan was well tolerated with the most common adverse reaction being infusion-site reactions.…”

Section: Clinical Associationsmentioning

confidence: 99%

Hyponatremia: Clinical Associations, Prognosis, and Treatment in Cirrhosis

Sharma²,

Saab³

2012

Exp Clin Transplant

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Hyponatremia has long been associated with worsened clinical outcomes in patients with cirrhosis and those awaiting liver transplant. However, in the last several years, new modalities of therapy, particularly aquaretics known as "vaptans," and comprehensive prognostic models have been increasingly studied in the hopes of bolstering serum sodium levels and altering liver transplant candidate status. To examine the most recent, comprehensive, and pertinent data, a systematic review of both prospective and retrospective studies available on MEDLINE was completed, which provided information detailing clinical associations, treatment, and prognoses seen in those with hyponatremia in cirrhosis. Clinical associations with hyponatremia in cirrhosis including hepatorenal syndrome and hepatic encephalopathy were identified. For hyponatremia in those awaiting liver transplant, tolvaptan is an effective agent in temporarily normalizing serum sodium levels with minimal risk of osmotic demyelination. Prognostic models incorporating serum sodium levels were better able to predict urgency and need for transplant; yet the benefits and posttransplant effects of redefining a liver allocation score have yet to be established. Key words: Hyponatremia, Cirrhosis, Outcomes IntroductionHyponatremia is a common electrolyte disturbance in patients with advanced liver disease. [1][2][3][4] In the setting of cirrhosis, hyponatremia can be classified as either hypovolemic hyponatremia, which occurs in the setting of overtreatment with diuretics or excessive losses from the gastrointestinal tract, or hypervolemic hyponatremia, which results in decreased effective circulating volume from increased arterial from splanchnic vasodilatation leading to excessive secretion of arginine vasopressin. 1,5,6 Hyponatremia can occur both before and after liver transplant. Pretransplant, it is associated with several clinical manifestations of decompensation, 4,7,8 and the degree of hyponatremia may increase the accuracy of the model for end-stage liver disease (MELD) score to predict survival. [8][9][10][11] Treatment of hyponatremia has not been demonstrated to improve survival in patients with advanced liver disease, and rapid correction can lead to life-threatening neurologic complications. 12,13 This systematic review focuses on the prevalence, clinical associations, treatment, and prognosis of hypervolemic hyponatremia in patients with liver disease. An algorithm will be developed to guide management based on best available data. Methods Search strategy and identification of studiesWe searched database MEDLINE for all studies on hyponatremia in the setting of cirrhosis as related to clinical implications, prognosis, and treatment. We used combinations of the key words: "hyponatremia," "sodium," "liver cirrhosis," "prevalence," "incidence," "intensive care units," "hepatorenal syndrome," "ascites," "central pontine myelinolysis," "therapeutics," "prognosis," and "liver Experimental and Clinical Transplantation (2013) 1: 3-11Christine Yu et a...

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“…Recently a single-center study conducted by Velez et al assessed retrospectively the effect of intravenous conivaptan as an aquaretic in 18 patients with SIADH [78].…”

Section: Siadhmentioning

confidence: 99%

Arginine vasopressin (AVP) and treatment with arginine vasopressin receptor antagonists (vaptans) in congestive heart failure, liver cirrhosis and syndrome of inappropriate antidiuretic hormone secretion (SIADH)

Gassanov

Semmo

et al. 2011

Eur J Clin Pharmacol

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Arginine vasopressin (AVP) is the major physiological regulator of renal water excretion and blood volume. The AVP pathways of V 1a R-mediated vasoconstriction and V 2 R-induced water retention represent a potentially attractive target for therapy of edematous diseases.Experimental and clinical evidence suggests beneficial effects of AVP receptor antagonists by increasing free water excretion and serum sodium levels. This review provides an update on the therapeutic implication of newly developed AVP receptor antagonists in respective disorders such as chronic heart failure, liver cirrhosis and syndrome of inappropriate antidiuretic hormone secretion.3

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Intravenous conivaptan for the treatment of hyponatraemia caused by the syndrome of inappropriate secretion of antidiuretic hormone in hospitalized patients: a single-centre experience

Cited by 65 publications

References 41 publications

Efficacy and Tolerance of Urea Compared with Vaptans for Long-Term Treatment of Patients with SIADH

Efficacy and Tolerance of Urea Compared with Vaptans for Long-Term Treatment of Patients with SIADH

Hyponatremia: Clinical Associations, Prognosis, and Treatment in Cirrhosis

Arginine vasopressin (AVP) and treatment with arginine vasopressin receptor antagonists (vaptans) in congestive heart failure, liver cirrhosis and syndrome of inappropriate antidiuretic hormone secretion (SIADH)

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