Tolvaptan, hyponatremia, and heart failure

Abstract

Tolvaptan is the first FDA-approved oral V2 receptor antagonist for the treatment of euvolemic and hypervolemic hyponatremia, in patients with conditions associated with free water excess such as heart failure, cirrhosis, and the syndrome of inappropriate antidiuretic hormone secretion. Tolvaptan inhibits the binding of arginine vasopressin to the V2 receptors on the collecting ducts of the kidneys resulting in aquaresis, the electrolytes sparing excretion of water. This article reviews the accumulated experience with tolvaptan and all the major clinical trials that were conducted to study its safety and efficacy and concludes by summarizing clinicians’ views of its current application in clinical practice.

Severe Symptomatic Hyponatremia Secondary to Escitalopram-Induced SIADH: A Case Report with Literature Review

“…Demeclocycline has been used previously which lead to acute kidney injury and hence its use has been limited. Vaptans, a selective V2 receptor antagonist (Tolvaptan and Conivaptan) can be safely used for treatment of SIADH in carefully monitored patients [ 17 , 18 ]. High cost and overcorrection remain a potential risk for vaptans [ 18 ].…”

Efficacy of vaptans for correction of postoperative hyponatremia: A comparison between single intravenous bolus conivaptan vs oral tolvaptan

“…The common side effects of tolvaptan are thirst, dry mouth, lethargy, constipation, polyuria, and hyperglycemia. [ 15 ] It is commonly used to treat hypervolemic or euvolemic hyponatremia associated with congestive heart failure, hepatic cirrhosis, SIADH, and autosomal-dominant polycystic kidney disease. [ 16 17 18 19 ]…”

Efficacy of oral tolvaptan versus 3% hypertonic saline for correction of hyponatraemia in post-operative patients

“…The most common adverse reactions are thirst, dry mouth, lethargy, constipation, polyuria and hyperglycaemia. [ 22 ]…”