Lixivaptan for Hyponatremia—The Numbers Game

Borne, Ryan T.; Krantz, Mori J.

doi:10.1001/jama.2012.54515

Cited by 3 publications

(2 citation statements)

References 4 publications

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“…7,9 Still, it has been difficult to position vaptans in the therapeutic arsenal of chronic hyponatremia. 11,84,91,92 The United States guideline lists vaptans as one of the pharmacologic options, if fluid restriction has failed ( Table 2). 9 The European guideline did not recommend vaptans in moderate hyponatremia.…”

Section: Vaptansmentioning

confidence: 99%

Diagnosis and Treatment of Hyponatremia: Compilation of the Guidelines

Hoorn

Zietse

2017

JASN

291

330

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Hyponatremia is a common water balance disorder that often poses a diagnostic or therapeutic challenge. Therefore, guidelines were developed by professional organizations, one from within the United States (2013) and one from within Europe (2014). This review discusses the diagnosis and treatment of hyponatremia, comparing the two guidelines and highlighting recent developments. Diagnostically, the initial step is to differentiate hypotonic from nonhypotonic hyponatremia. Hypotonic hyponatremia is further differentiated on the basis of urine osmolality, urine sodium level, and volume status. Recently identified parameters, including fractional uric acid excretion and plasma copeptin concentration, may further improve the diagnostic approach. The treatment for hyponatremia is chosen on the basis of duration and symptoms. For acute or severely symptomatic hyponatremia, both guidelines adopted the approach of giving a bolus of hypertonic saline. Although fluid restriction remains the first-line treatment for most forms of chronic hyponatremia, therapy to increase renal free water excretion is often necessary. Vasopressin receptor antagonists, urea, and loop diuretics serve this purpose, but received different recommendations in the two guidelines. Such discrepancies may relate to different interpretations of the limited evidence or differences in guideline methodology. Nevertheless, the development of guidelines has been important in advancing this evolving field.

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Section: Vaptansmentioning

confidence: 99%

Diagnosis and Treatment of Hyponatremia: Compilation of the Guidelines

Hoorn

Zietse

2017

JASN

291

330

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“…Many have noted previously the lack of consensus on the appropriate use of these medications by the clinician 52,53. As noted in the overview section, hyponatremia appears to have broad deleterious effects, even in previously considered asymptomatic hyponatremia.…”

Section: Future Studiesmentioning

confidence: 99%

Lixivaptan – an evidence-based review of its clinical potential in the treatment of hyponatremia

Bowman¹,

Rosner²

2013

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Hyponatremia is the most common electrolyte abnormality seen in clinical practice. Most cases of euvolemic or hypervolemic hyponatremia involve arginine vasopressin (AVP). AVP leads to a concentrated urine and negative free water clearance. Given this primary role of AVP, antagonizing its effect through blockade of its receptor in the distal tubule is an attractive therapeutic target. Lixivaptan is a newer, non-peptide, vasopressin type 2 receptor antagonist. Recent studies have demonstrated efficacy. This review summarizes the clinical pharmacology and data for this new agent.

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