Vaptans: A new option in the management of hyponatremia

Abstract

Arginine vasopressin (AVP) plays an important role in water and sodium homeostasis. It acts via three receptor subtypes—V1a, V1b, and V2—distributed widely throughout the body. Vaptans are nonpeptide vasopressin receptor antagonists (VRA). By property of aquaresis, VRAs offer a novel therapy of water retention. Conivaptan is a V1a/V2 nonselective VRA approved for euvolemic and hypervolemic hyponatremia. Tolvaptan is the first oral VRA. Other potential uses of this new class of drugs include congestive heart failure (CHF), cirrhosis of liver, syndrome of inappropriate secretion of antidiuretic hormone, polycystic kidney disease, and so on. These novel drugs score over diuretics as they are not associated with electrolyte abnormalities. Though much remains to be elucidated before the VRAs are applied clinically, the future holds much promise.

Hiponatremias en el paciente neurocrítico: enfoque terapéutico basado en la evidencia actual

“…Dado que los vaptanos corrigen la hiponatremia promoviendo la eliminación de agua libre, es importante evaluar el volumen de sangre del paciente y evitar su uso en aquellos con hiponatremia hipovolémica. Por lo tanto, son fármacos que podrían estar indicados en pacientes neurocríticos con hiponatremia, sin embargo, por el momento su uso debería estar limitado a enfermos en los cuales la terapia convencional fracasa, o como tratamiento coadyuvante 52 .…”

Role of vaptans in the management of hydroelectrolytic imbalance in liver cirrhosis

“…The actions of AVP are mediated by three receptor subtypes: V1a, V1b and V2, all of them being G proteincoupled receptors and classified by their location [26] . V1a receptors are present on vascular smooth muscle cells, myocardium, platelets, and hepatocytes, and mediate vasoconstriction, platelet aggregation, and glycogenolysis [25,27,28] .…”

Efficiency of Single Dose of Tolvaptan Treatment During the Triphasic Episode After Surgery for Craniopharyngioma

“…In more severe forms that also show neurological symptoms, administration of hyperosmolar saline combined with furosemide may be required. Additionally, underlying etiology should be treated if possible (3,5,(6)(7)(8)(9)(10). However, these treatments may be inadequate for some patients with SIADH.…”