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Isaak J, Boesing M, Potasso L, Lenherr C, Luethi-Corridori G, Leuppi JD, Leuppi-Taegtmeyer AB. Diagnostic Workup and Outcome in Patients with Profound Hyponatremia. J Clin Med 2023; 12:jcm12103567. [PMID: 37240673 DOI: 10.3390/jcm12103567] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 04/19/2023] [Accepted: 05/14/2023] [Indexed: 05/28/2023] Open
Abstract
Hyponatremia is the most common electrolyte disorder. A proper diagnosis is important for its successful management, especially in profound hyponatremia. The European hyponatremia guidelines point at sodium and osmolality measurement in plasma and urine, and the clinical evaluation of volume status as the minimum diagnostic workup for the diagnosis of hyponatremia. We aimed to determine compliance with guidelines and to investigate possible associations with patient outcomes. In this retrospective study, we analysed the management of 263 patients hospitalised with profound hyponatremia at a Swiss teaching hospital between October 2019 and March 2021. We compared patients with a complete minimum diagnostic workup (D-Group) to patients without (N-Group). A minimum diagnostic workup was performed in 65.5% of patients and 13.7% did not receive any treatment for hyponatremia or an underlying cause. The twelve-month survival did not show statistically significant differences between the groups (HR 1.1, 95%-CI: 0.58-2.12, p-value 0.680). The chance of receiving treatment for hyponatremia was higher in the D-group vs. N-Group (91.9% vs. 75.8%, p-value < 0.001). A multivariate analysis showed significantly better survival for treated patients compared to not treated (HR 0.37, 95%-CI: 0.17-0.78, p-value 0.009). More efforts should be made to ensure treatment of profound hyponatremia in hospitalised patients.
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Affiliation(s)
- Johann Isaak
- University Centre of Internal Medicine, Cantonal Hospital Baselland, Rheinstrasse 26, 4410 Liestal, Switzerland
- Medical Faculty, University of Basel, Klingelbergstrasse 61, 4056 Basel, Switzerland
| | - Maria Boesing
- University Centre of Internal Medicine, Cantonal Hospital Baselland, Rheinstrasse 26, 4410 Liestal, Switzerland
- Medical Faculty, University of Basel, Klingelbergstrasse 61, 4056 Basel, Switzerland
| | - Laura Potasso
- University Centre of Internal Medicine, Cantonal Hospital Baselland, Rheinstrasse 26, 4410 Liestal, Switzerland
- Medical Faculty, University of Basel, Klingelbergstrasse 61, 4056 Basel, Switzerland
- Departments of Endocrinology, Diabetology and Metabolism, University Hospital Basel, Petersgraben 4, 4031 Basel, Switzerland
| | - Christoph Lenherr
- University Centre of Internal Medicine, Cantonal Hospital Baselland, Rheinstrasse 26, 4410 Liestal, Switzerland
- Department of Clinical Nephrology, Cantonal Hospital of Baselland, Rheinstrasse 26, 4410 Liestal, Switzerland
| | - Giorgia Luethi-Corridori
- University Centre of Internal Medicine, Cantonal Hospital Baselland, Rheinstrasse 26, 4410 Liestal, Switzerland
- Department of Clinical Nephrology, Cantonal Hospital of Baselland, Rheinstrasse 26, 4410 Liestal, Switzerland
| | - Joerg D Leuppi
- University Centre of Internal Medicine, Cantonal Hospital Baselland, Rheinstrasse 26, 4410 Liestal, Switzerland
- Medical Faculty, University of Basel, Klingelbergstrasse 61, 4056 Basel, Switzerland
| | - Anne B Leuppi-Taegtmeyer
- University Centre of Internal Medicine, Cantonal Hospital Baselland, Rheinstrasse 26, 4410 Liestal, Switzerland
- Medical Faculty, University of Basel, Klingelbergstrasse 61, 4056 Basel, Switzerland
- Department of Patient Safety, University Hospital Basel, Petersgraben 4, 4031 Basel, Switzerland
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Zhang Y, Lei X, Pan Y, Wu FX. Drug Repositioning with GraphSAGE and Clustering Constraints Based on Drug and Disease Networks. Front Pharmacol 2022; 13:872785. [PMID: 35620297 PMCID: PMC9127467 DOI: 10.3389/fphar.2022.872785] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Accepted: 04/11/2022] [Indexed: 11/29/2022] Open
Abstract
The understanding of therapeutic properties is important in drug repositioning and drug discovery. However, chemical or clinical trials are expensive and inefficient to characterize the therapeutic properties of drugs. Recently, artificial intelligence (AI)-assisted algorithms have received extensive attention for discovering the potential therapeutic properties of drugs and speeding up drug development. In this study, we propose a new method based on GraphSAGE and clustering constraints (DRGCC) to investigate the potential therapeutic properties of drugs for drug repositioning. First, the drug structure features and disease symptom features are extracted. Second, the drug–drug interaction network and disease similarity network are constructed according to the drug–gene and disease–gene relationships. Matrix factorization is adopted to extract the clustering features of networks. Then, all the features are fed to the GraphSAGE to predict new associations between existing drugs and diseases. Benchmark comparisons on two different datasets show that our method has reliable predictive performance and outperforms other six competing. We have also conducted case studies on existing drugs and diseases and aimed to predict drugs that may be effective for the novel coronavirus disease 2019 (COVID-19). Among the predicted anti-COVID-19 drug candidates, some drugs are being clinically studied by pharmacologists, and their binding sites to COVID-19-related protein receptors have been found via the molecular docking technology.
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Affiliation(s)
- Yuchen Zhang
- School of Computer Science, Shaanxi Normal University, Xi'an, China
| | - Xiujuan Lei
- School of Computer Science, Shaanxi Normal University, Xi'an, China
| | - Yi Pan
- Faculty of Computer Science and Control Engineering, Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China
| | - Fang-Xiang Wu
- Division of Biomedical Engineering, University of Saskatchewan, Saskatoon, SK, Canada
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Shakhsemampour B, Zojaji F, Amouzeshi A. Management of Persistent Hyponatremia after Off-Pump Coronary Artery Bypass Grafting: A Case Report. JOURNAL OF CLINICAL AND BASIC RESEARCH 2019. [DOI: 10.29252/jcbr.3.1.40] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
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Marbury T, Fox J, Kaelin B, Pavliv L. Pharmacokinetics of conivaptan use in patients with severe hepatic impairment. DRUG DESIGN DEVELOPMENT AND THERAPY 2017; 11:373-382. [PMID: 28243060 PMCID: PMC5315214 DOI: 10.2147/dddt.s125459] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Purpose Conivaptan is an intravenous dual V1A/V2 vasopressin antagonist approved for the treatment of euvolemic and hypervolemic hyponatremia. Earlier studies showed that patients with moderate liver disease could be safely treated with conivaptan by reducing the dose by 50%, whereas patients with mild hepatic impairment needed no dose adjustment. The objective of this Phase 1, open-label study was to assess the pharmacokinetics, protein binding, and safety of 48 h of conivaptan infusion in individuals with severe hepatic impairment. Patients and methods Eight subjects with severe hepatic impairment (Child–Pugh score 10–15) and nine subjects with normal liver function were enrolled. Intravenous conivaptan (20 mg) was given as a 30 min loading dose on Day 1 followed by two consecutive 20 mg continuous infusions over 24 h each. Subjects were monitored for adverse events and changes in clinical laboratory parameters. Plasma and urine pharmacokinetic samples were collected at defined times. Subjects were followed through Study Day 5. Results Hepatically impaired individuals exhibited higher concentrations of plasma conivaptan throughout the treatment period. Overall exposure, as measured by area under the plasma conivaptan concentration-time curve from time zero through infinity (AUCINF), was ~60% higher in impaired individuals compared to those with normal liver function. Terminal elimination half-life was slightly longer in impaired subjects (12 h) as compared to normal subjects (9 h), and clearance was 65% higher in subjects with normal liver function, while urinary excretion was higher in impaired individuals. Albumin levels directly, and alkaline phosphatase inversely, correlated with conivaptan clearance. Conclusion A 20 mg conivaptan loading dose given >30 min followed by two daily infusions of 20 mg each was well tolerated by patients with severe hepatic impairment as monitored by adverse events and clinical laboratory values. Based on pharmacokinetic data, however, a 50% reduction in the conivaptan dose is recommended for patients with severe liver impairment.
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Affiliation(s)
| | - Jerry Fox
- Department of Research and Development, Cumberland Pharmaceuticals, Inc., Nashville, TN, USA
| | - Byron Kaelin
- Department of Research and Development, Cumberland Pharmaceuticals, Inc., Nashville, TN, USA
| | - Leo Pavliv
- Department of Research and Development, Cumberland Pharmaceuticals, Inc., Nashville, TN, USA
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Gandhi S, McArthur E, Reiss JP, Mamdani MM, Hackam DG, Weir MA, Garg AX. Atypical antipsychotic medications and hyponatremia in older adults: a population-based cohort study. Can J Kidney Health Dis 2016; 3:21. [PMID: 27069639 PMCID: PMC4827184 DOI: 10.1186/s40697-016-0111-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2016] [Accepted: 03/24/2016] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND A number of case reports have suggested a possible association between atypical antipsychotic medications and hyponatremia. Currently, there are no reliable estimates of hyponatremia risk from atypical antipsychotic drugs. OBJECTIVE The objective of this study was to examine the 30-day risk of hospitalization with hyponatremia in older adults dispensed an atypical antipsychotic drug relative to no antipsychotic use. DESIGN The design of this study was a retrospective, population-based cohort study. SETTING The setting of this study was in Ontario, Canada, from 2003 to 2012. PATIENTS Adults 65 years or older with an identified psychiatric condition who were newly dispensed risperidone, olanzapine, or quetiapine in the community setting compared to adults with similar indicators of baseline health who were not dispensed such a prescription. MEASUREMENTS The primary outcome was the 30-day risk of hospitalization with hyponatremia. The tracer outcome (an outcome that is not expected to be influenced by the study drugs) was the 30-day risk of hospitalization with bowel obstruction. These outcomes were assessed using hospital diagnosis codes. METHODS Using health administrative data, we applied a propensity score technique to match antipsychotic users 1:1 to non-users of antipsychotic drugs (58,008 patients in each group). We used conditional logistic regression to compare outcomes among the matched users and non-users. RESULTS A total of 104 baseline characteristics were well-balanced between the two matched groups. Atypical antipsychotic use compared to non-use was associated with an increased risk of hospitalization with hyponatremia within 30 days (86/58,008 (0.15 %) versus 53/58,008 (0.09 %); relative risk 1.62 (95 % confidence interval (CI) 1.15 to 2.29); absolute risk increase 0.06 % (95 % CI 0.02 to 0.10)). The limited number of events precluded some additional analyses to confirm if the association was robust. Atypical antipsychotic use compared to non-use was not associated with hospitalization with bowel obstruction within 30 days (55/58,008 (0.09 %) versus 44/58,008 (0.08 %); relative risk 1.25 (95 % CI 0.84 to 1.86)). LIMITATIONS We could only study older adults within our data sources. CONCLUSIONS In this study, the use of an atypical antipsychotic was associated with a modest but statistically significant increase in the 30-day risk of a hospitalization with hyponatremia. The association was less pronounced than that described with other psychotropic drugs.
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Affiliation(s)
- Sonja Gandhi
- Department of Epidemiology and Biostatistics, Western University, London, Ontario Canada ; Division of Nephrology, Department of Medicine, Western University, London, Ontario Canada
| | - Eric McArthur
- Division of Nephrology, Department of Medicine, Western University, London, Ontario Canada ; Institute for Clinical Evaluative Sciences, Toronto, Ontario Canada
| | - Jeffrey P Reiss
- Department of Psychiatry, Western University, London, Ontario Canada
| | - Muhammad M Mamdani
- Institute for Clinical Evaluative Sciences, Toronto, Ontario Canada ; Keenan Research Centre in the Li Ka Shing Knowledge Institute of St Michael's Hospital, Toronto, Ontario Canada
| | - Daniel G Hackam
- Institute for Clinical Evaluative Sciences, Toronto, Ontario Canada ; Division of Clinical Pharmacology, Department of Medicine, Western University, London, Ontario Canada
| | - Matthew A Weir
- Department of Epidemiology and Biostatistics, Western University, London, Ontario Canada ; Division of Nephrology, Department of Medicine, Western University, London, Ontario Canada
| | - Amit X Garg
- Department of Epidemiology and Biostatistics, Western University, London, Ontario Canada ; Division of Nephrology, Department of Medicine, Western University, London, Ontario Canada ; Institute for Clinical Evaluative Sciences, Toronto, Ontario Canada ; Institute for Clinical Evaluative Sciences, Room ELL-101, Westminster, London Health Sciences Centre, 800 Commissioners Road East, London, Ontario N6A 4G5 Canada
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Shanmugam E, Doss CRMP, George M, Jena A, Rajaram M, Ramaraj B, Anjaneyan K, Kanagesh B. Effect of tolvaptan on acute heart failure with hyponatremia--a randomized, double blind, controlled clinical trial. Indian Heart J 2015; 68 Suppl 1:S15-21. [PMID: 27056648 PMCID: PMC4824334 DOI: 10.1016/j.ihj.2015.07.006] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2014] [Revised: 05/20/2015] [Accepted: 07/07/2015] [Indexed: 12/23/2022] Open
Abstract
Objectives To assess the efficacy of tolvaptan in acute heart failure with hyponatremia using a randomized double-blinded placebo-controlled study design. Background Tolvaptan is a selective vasopressin receptor 2 antagonist. There are no published clinical trials on the utility of tolvaptan in acute heart failure with hyponatremia in the Indian population. Methods After screening and informed consent, 51 HF patients with hyponatremia were randomized using computer-generated randomization sequence to receive placebo or 15 mg of tolvaptan for 5 days along with conventional medical therapy. The patient's perception of dyspnea using Likert score and the plasma sodium was measured at baseline and for the next 4 days. Results There was a mean improvement in sodium concentration by 5 mEq/L (p = 0.001) in patients receiving tolvaptan, whereas no significant improvement was seen in the placebo group (p = 0.33). Significant improvement in Likert score was observed in both the groups (p = 0.001), even though there was no difference between both the groups. Dry mouth and thirst were the most commonly occurring adverse effects observed in both the groups. There were no significant hemodynamic changes with tolvaptan therapy. Conclusion Tolvaptan at a dose of 15 mg is effective in reversing hyponatremia in acute heart failure and may be a suitable option in these patients.
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Affiliation(s)
- Elangovan Shanmugam
- Department of Cardiology, SRM Medical College Hospital & Research Centre, Kattankulathur, Chennai, Tamil Nadu 603203, India
| | - C R Madhu Prabhu Doss
- Department of Cardiology, SRM Medical College Hospital & Research Centre, Kattankulathur, Chennai, Tamil Nadu 603203, India
| | - Melvin George
- Department of Cardiology, SRM Medical College Hospital & Research Centre, Kattankulathur, Chennai, Tamil Nadu 603203, India.
| | - Amrita Jena
- Department of Cardiology, SRM Medical College Hospital & Research Centre, Kattankulathur, Chennai, Tamil Nadu 603203, India
| | - Muthukumar Rajaram
- Department of Cardiology, SRM Medical College Hospital & Research Centre, Kattankulathur, Chennai, Tamil Nadu 603203, India
| | - Balaji Ramaraj
- Department of Community Medicine, SRM Medical College Hospital & Research Centre, Kattankulathur, Chennai, Tamil Nadu 603203, India
| | - Karthik Anjaneyan
- Department of Cardiology, SRM Medical College Hospital & Research Centre, Kattankulathur, Chennai, Tamil Nadu 603203, India
| | - B Kanagesh
- Department of Cardiology, SRM Medical College Hospital & Research Centre, Kattankulathur, Chennai, Tamil Nadu 603203, India
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Soiza RL, Talbot HSC. Management of hyponatraemia in older people: old threats and new opportunities. Ther Adv Drug Saf 2014; 2:9-17. [PMID: 25083198 DOI: 10.1177/2042098610394233] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Hyponatraemia is the commonest electrolyte abnormality seen in clinical practice, and is especially prevalent in frail, older people. However, the serious implications of hyponatraemia in this age group are seldom recognized by clinicians. Hyponatraemia is associated with osteoporosis, impaired balance, falls, hip fractures and cognitive dysfunction. Even mild, apparently asymptomatic hyponatraemia is associated with prolonged stays in hospital, institutionalization and increased risk of death. Emerging evidence of the potential benefits of improved treatment of hyponatraemia is slowly generating renewed clinical interest in this area. The development of specific vasopressin-2 receptor antagonists (vaptans) has the potential to revolutionize the management of hyponatraemia, in particular for the syndrome of inappropriate antidiuretic hormone. However, challenges remain for the attending physician. Diagnosing the cause or causes of hyponatraemia in older people is difficult, and incorrect diagnosis can lead to treatment that worsens the electrolyte imbalance. Established treatments are often poorly tolerated and patient outcomes remain poor, and the role of vaptans in the treatment of older people is unclear. This review summarizes the existing evidence base and highlights areas of controversy. It includes practical guidance for overcoming some common pitfalls in the management of the elderly patient with hyponatraemia.
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Affiliation(s)
- Roy L Soiza
- Department of Medicine for the Elderly, Woodend Hospital, Eday Road, Aberdeen AB15 6XS, UK
| | - Hannah S C Talbot
- School of Medicine and Dentistry, University of Aberdeen, Aberdeen, UK
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Synthesis and biological evaluation of substituted desloratadines as potent arginine vasopressin V2 receptor antagonists. Molecules 2014; 19:2694-706. [PMID: 24566331 PMCID: PMC6271649 DOI: 10.3390/molecules19022694] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2013] [Revised: 01/14/2014] [Accepted: 01/26/2014] [Indexed: 11/21/2022] Open
Abstract
Twenty-one non-peptide substituted desloratadine class compounds were synthesized as novel arginine vasopressin receptor antagonists from desloratadine via successive acylation, reduction and acylation reactions. Their structures were characterized by 1H-NMR and HRMS, their biological activity was evaluated by in vitro and in vivo studies. The in vitro binding assay and cAMP accumulation assay indicated that these compounds are potent selective V2 receptor antagonists. Among them compounds 1n, 1t and 1v exhibited both high affinity and promising selectivity for V2 receptors. The in vivo diuretic assay demonstrated that 1t presented remarkable diuretic activity. In conclusion, 1t is a potent novel AVP V2 receptor antagonist candidate.
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Okita K, Kawazoe S, Hasebe C, Kajimura K, Kaneko A, Okada M, Sakaida I. Dose-finding trial of tolvaptan in liver cirrhosis patients with hepatic edema: A randomized, double-blind, placebo-controlled trial. Hepatol Res 2014; 44:83-91. [PMID: 23530991 DOI: 10.1111/hepr.12099] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2013] [Revised: 02/14/2013] [Accepted: 02/17/2013] [Indexed: 01/07/2023]
Abstract
AIM Liver cirrhosis represents the end stage of any chronic liver disease, and it is associated with hepatic edema such as ascites. Many patients with ascites do not respond to diuretic therapy or require administration of diuretics at high doses that can cause adverse events. This 7-day, multicenter, double-blind trial of tolvaptan was designed to determine the optimal dose of tolvaptan for producing the intended pharmacological effect in hepatic edema. METHODS Liver cirrhosis patients with inadequate diuretic response despite having received a conventional diuretic therapy were enrolled in the trial. Participants were stratified randomly to four groups receiving tolvaptan at 7.5, 15 or 30 mg/day, or placebo as an add-on to conventional diuretics once daily for 7 days. Changes in bodyweight and abdominal circumference were analyzed. Serum sodium concentrations were measured. Safety assessment was performed. RESULTS Tolvaptan at 7.5-30 mg/day reduced bodyweight and abdominal circumference compared with placebo. Serum sodium concentrations remained within the normal range in all tolvaptan groups. Serious adverse events were not observed, and most common adverse event was thirst. Tolvaptan at 7.5 mg/day showed the maximum change in bodyweight and abdominal circumference together with preferable tolerability. CONCLUSION Tolvaptan at 7.5 mg/day was considered the optimal dose in liver cirrhosis patients with hepatic edema who showed inadequate response to conventional diuretics.
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Affiliation(s)
- Kiwamu Okita
- Social Insurance Alliance Shimonoseki Kohsei Hospital, Yamaguchi, Japan
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Malabu UH, Porter D, Vangaveti VN, Kazi M, Kennedy RL. Prevalence of hyponatremia in acute medical admissions in tropical Asia Pacific Australia. ASIAN PAC J TROP MED 2014; 7:40-3. [DOI: 10.1016/s1995-7645(13)60189-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2013] [Revised: 11/10/2013] [Accepted: 12/13/2013] [Indexed: 11/27/2022] Open
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Pharmacokinetics of intravenous conivaptan in subjects with hepatic or renal impairment. Clin Pharmacokinet 2013; 52:385-95. [PMID: 23456393 DOI: 10.1007/s40262-013-0047-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
BACKGROUND Conivaptan is a non-peptide dual antagonist of vasopressin V1A and V2 receptors that is approved in the United States as an intravenous formulation for the treatment of euvolemic and hypervolemic hyponatremia in hospitalized patients. The pharmacokinetics of intravenous conivaptan had not been studied in patients with hepatic or renal impairment. OBJECTIVE The objective of this study was to assess the pharmacokinetics and tolerability of intravenous conivaptan in subjects with mild or moderate hepatic or renal impairment compared with subjects with normal function. STUDY DESIGN These studies were phase I, open-label pharmacokinetic studies conducted at two sites in the US. PATIENTS Men and non-pregnant women 30-70 years of age were allocated to the mild (Child-Pugh classification score of 5-6) or moderate (Child-Pugh classification score of 7-9) hepatically impaired groups (n = 8-9 per group) based on their liver function assessed at screening. For the renal study, men and non-pregnant women between 18 and 70 years of age were assigned to renal function groups (n = 8-9 per group) based on estimated glomerular filtration rate (eGFR) assessed at screening. Normal renal function was defined as an eGFR >80 ml/min, mild renal impairment as 50-80 ml/min, and moderate renal impairment as 30-49 ml/min. Subjects with normal hepatic or renal function were selected to match the race, sex, age, and body mass index of subjects enrolled in the impaired groups. INTERVENTION Subjects were administered a 20-mg/30-min intravenous loading dose of conivaptan on day 1, followed by a 20-mg/23.5-h continuous conivaptan infusion. On day 2, immediately following the end of the day 1 infusion, a 20-mg/24-h continuous conivaptan infusion was administered. MAIN OUTCOME MEASURE Primary pharmacokinetic parameters estimated were the area under the plasma conivaptan concentration-time curve from time 0 to infinity (AUC∞), plasma conivaptan concentrations at the end of the 20-mg loading dose (C LD), and plasma conivaptan concentrations at the end of the second day 20-mg/24-h continuous infusion (C 48). RESULTS For each of C LD, C 48, and AUC∞, the mean values were similar for subjects with mild hepatic impairment and subjects with normal hepatic function. Subjects with moderate hepatic impairment had a 73 % higher C 48 and an 80 % higher AUC∞ compared with subjects with normal hepatic function. There were no clinically relevant changes in conivaptan exposure in the mild and moderate renal impairment groups compared with subjects with normal renal function. Intravenous conivaptan was generally well tolerated in subjects with mild or moderate hepatic or renal impairment. Infusion-site reaction was the most commonly reported adverse event. CONCLUSION Overall exposure to conivaptan increased in subjects with moderate hepatic impairment compared with subjects with normal hepatic function. Therefore, in patients with moderate hepatic impairment, conivaptan should be initiated with a loading dose of 10 mg over 30 min followed by 10 mg per day as a continuous infusion for 2-4 days, which is half the approved dose. No dose adjustment is necessary in patients with mild or moderate renal impairment and in patients with mild hepatic impairment.
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Karaca P, Desailloud R. [Hormonal dysnatremia]. ANNALES D'ENDOCRINOLOGIE 2013; 74 Suppl 1:S42-S51. [PMID: 24356291 DOI: 10.1016/s0003-4266(13)70020-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Because of antidiuretic hormone (ADH) disorder on production or function we can observe dysnatremia. In the absence of production by posterior pituitary, central diabetes insipidus (DI) occurs with hypernatremia. There are hereditary autosomal dominant, autosomal recessive or X- linked forms. When ADH is secreted but there is an alteration on his receptor AVPR2, it is a nephrogenic diabetes insipidus in acquired or hereditary form. We can make difference on AVP levels and/or on desmopressine response which is negative in nephrogenic forms. Hyponatremia occurs when there is an excess of ADH production: it is a euvolemic hypoosmolar hyponatremia. The most frequent etiology is SIADH (syndrome of inappropriate secretion of ADH), a diagnostic of exclusion which is made after eliminating corticotropin deficiency and hypothyroidism. In case of brain injury the differential diagnosis of cerebral salt wasting (CSW) syndrome has to be discussed, because its treatment is perfusion of isotonic saline whereas in SIADH, the treatment consists in administration of hypertonic saline if hyponatremia is acute and/or severe. If not, fluid restriction demeclocycline or vaptans (antagonists of V2 receptors) can be used in some European countries. Four types of SIADH exist; 10 % of cases represent not SIADH but SIAD (syndrome of inappropriate antidiuresis) due to a constitutive activation of vasopressin receptor that produces water excess. c 2013 Published by Elsevier Masson SAS.
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Affiliation(s)
- P Karaca
- Service d'endocrinologie, Maladies métaboliques et nutrition, CHU d'Amiens, place Victor-Pauchet, 80054 Amiens, France.
| | - R Desailloud
- Service d'endocrinologie, Maladies métaboliques et nutrition, CHU d'Amiens, place Victor-Pauchet, 80054 Amiens, France
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Sakaida I, Yanase M, Kobayashi Y, Yasutake T, Okada M, Okita K. The pharmacokinetics and pharmacodynamics of tolvaptan in patients with liver cirrhosis with insufficient response to conventional diuretics: a multicentre, double-blind, parallel-group, phase III study. J Int Med Res 2013; 40:2381-93. [PMID: 23321196 DOI: 10.1177/030006051204000637] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVES This study investigated the pharmacokinetic and pharmacodynamic profile of tolvaptan, and verified its efficacy and safety in patients with liver cirrhosis-associated ascites, with insufficient response to conventional diuretic treatment. METHODS This multicentre, double-blind, parallel-group study allocated patients with cirrhosis to receive either 3.75 or 7.5 mg/day tolvaptan orally, once daily, for 7 days. Pharmacokinetic, pharmacodynamic and efficacy variables were measured. RESULTS Tolvaptan was shown to have high plasma concentrations, and prolonged duration of maximum concentration and half life, in these patients with impaired hepatic function. Tolvaptan resulted in dose-dependent decreases in body weight and ascites volume, and increases in urine output. There were no effects on urinary or serum electrolytes. Tolvaptan was well tolerated, with a good safety profile. CONCLUSIONS Tolvaptan at 3.75 mg/day exerts some effects due to the pharmacokinetic profile in patients with liver cirrhosis. Tolvaptan at 7.5 mg/day is a clinically useful option for treating patients who do not respond well to conventional diuretics.
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Affiliation(s)
- I Sakaida
- Department of Gastroenterology and Hepatology, Yamaguchi University Graduate School of Medicine, Ube, Yamaguchi, Japan.
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Sakaida I, Yamashita S, Kobayashi T, Komatsu M, Sakai T, Komorizono Y, Okada M, Okita K. Efficacy and safety of a 14-day administration of tolvaptan in the treatment of patients with ascites in hepatic oedema. J Int Med Res 2013; 41:835-47. [PMID: 23685892 DOI: 10.1177/0300060513480089] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
OBJECTIVE To investigate the efficacy and safety of 14 days' orally administered tolvaptan as adjunctive treatment for hepatic oedema in Japanese liver cirrhosis patients with insufficient response to conventional diuretics, with the option to increase dose in those who did not respond initially. METHODS This multicentre, single-arm, phase 3 study allocated patients with liver cirrhosis and persistent ascites to 7-day treatment with 7.5 mg/day tolvaptan followed by an additional 7 days' treatment. Responders at day 7 (achieving ≥ 1 kg body-weight reduction) continued on 7.5 mg/day tolvaptan; nonresponders (<1 kg body-weight reduction) received 15 mg/day tolvaptan. Conventional diuretic treatment continued throughout. The primary endpoint was change in body weight from baseline, as a marker of ascites volume. RESULTS A total of 51 patients received 7.5 mg/day tolvaptan for 7 days, which caused a significant reduction in mean body weight (55% response rate). During the second 7-day treatment period, 30 patients received 7.5 mg/day tolvaptan and 13 patients received tolvaptan 15 mg/day: response rates were 43% and 23%, respectively. Two serious adverse events were observed. Serum sodium was within normal range. CONCLUSIONS Tolvaptan therapy for 14 days (with possible dose increase as necessary), in combination with conventional diuretics, effectively reduced body weight in patients with hepatic oedema.
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Affiliation(s)
- Isao Sakaida
- Department of Gastroenterology and Hepatology, Yamaguchi University Graduate School of Medicine, Yamaguchi, Japan.
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Haring B, Pettinger M, Bea JW, Wactawski-Wende J, Carnahan RM, Ockene JK, Wyler von Ballmoos M, Wallace RB, Wassertheil-Smoller S. Laxative use and incident falls, fractures and change in bone mineral density in postmenopausal women: results from the Women's Health Initiative. BMC Geriatr 2013; 13:38. [PMID: 23635086 PMCID: PMC3645973 DOI: 10.1186/1471-2318-13-38] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2012] [Accepted: 04/22/2013] [Indexed: 12/20/2022] Open
Abstract
Background Laxatives are among the most widely used over-the-counter medications in the United States but studies examining their potential hazardous side effects are sparse. Associations between laxative use and risk for fractures and change in bone mineral density [BMD] have not previously been investigated. Methods This prospective analysis included 161,808 postmenopausal women (8907 users and 151,497 nonusers of laxatives) enrolled in the WHI Observational Study and Clinical Trials. Women were recruited from October 1, 1993, to December 31, 1998, at 40 clinical centers in the United States and were eligible if they were 50 to 79 years old and were postmenopausal at the time of enrollment. Medication inventories were obtained during in-person interviews at baseline and at the 3-year follow-up visit on everyone. Data on self-reported falls (≥2), fractures (hip and total fractures) were used. BMD was determined at baseline and year 3 at 3 of the 40 clinical centers of the WHI. Results Age-adjusted rates of hip fractures and total fractures, but not for falls were similar between laxative users and non-users regardless of duration of laxative use. The multivariate-adjusted hazard ratios for any laxative use were 1.06 (95% confidence interval [CI], 1.03-1.10) for falls, 1.02 (95% CI, 0.85-1.22) for hip fractures and 1.01 (95% CI, 0.96-1.07) for total fractures. The BMD levels did not statistically differ between laxative users and nonusers at any skeletal site after 3-years intake. Conclusion These findings support a modest association between laxative use and increase in the risk of falls but not for fractures. Its use did not decrease bone mineral density levels in postmenopausal women. Maintaining physical functioning, and providing adequate treatment of comorbidities that predispose individuals for falls should be considered as first measures to avoid potential negative consequences associated with laxative use.
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Affiliation(s)
- Bernhard Haring
- Department of Internal Medicine I, Comprehensive Heart Failure Center, University of Würzburg, Oberdürrbacher Strasse 6, Würzburg 97080, Germany.
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Abstract
Hyponatremia (serum sodium <135 mEq/L) is the most common electrolyte disorder. The severity of symptoms is related to how rapidly the condition develops and the degree of cerebral edema that results from the low serum level of sodium. Hypertonic saline and the new vasopressin receptor antagonists are highly effective treatments for severe symptomatic hyponatremia, yet they can result in severe neurological complications if sodium levels are restored too quickly. Hyponatremia is classified as hypovolemic, euvolemic, and hypervolemic. Treatments include administration of high-risk medications and fluid restriction to restore fluid and electrolyte balance and relieve cerebral effects. Nursing care to ensure safe outcomes involves multidisciplinary collaboration, close monitoring of serum sodium levels and intake and output, and assessment for neurological changes.
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Thompson C, Hoorn EJ. Hyponatraemia: an overview of frequency, clinical presentation and complications. Best Pract Res Clin Endocrinol Metab 2012; 26 Suppl 1:S1-6. [PMID: 22469246 DOI: 10.1016/s1521-690x(12)00019-x] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Hyponatraemia (defined as a serum sodium concentration <136 mmol/L) is the most frequently encountered electrolyte disturbance in clinical practice. It is classified according to volume status (hypovolaemia, hypervolaemia or euvolaemia), reflecting the relative proportions of water and sodium within the body. The syndrome of inappropriate secretion of antidiuretic hormone (SIADH) is the most common cause of euvolaemic hyponatraemia. Although hyponatraemia is associated with poor prognosis and increased length of hospital stay, it is often poorly managed and sometimes underdiagnosed and undertreated. This article provides an overview of the frequency, pathophysiology and complications associated with this common clinical condition.
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Affiliation(s)
- Chris Thompson
- Academic Department of Endocrinology, Beaumont Hospital and RCSI Medical School, Beaumont Road, Dublin 9, Ireland.
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Perioperative management of a parturient with hyponatraemia due to carbamazepine therapy. Int J Obstet Anesth 2012; 21:93-7. [DOI: 10.1016/j.ijoa.2011.10.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2011] [Revised: 10/20/2011] [Accepted: 10/20/2011] [Indexed: 11/19/2022]
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Daily variance of urinary excretion of AQP2 determined by sandwich ELISA method. Clin Exp Nephrol 2011; 16:406-10. [PMID: 22160633 DOI: 10.1007/s10157-011-0574-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2011] [Accepted: 11/24/2011] [Indexed: 10/14/2022]
Abstract
BACKGROUND Urinary excretion of aquaporin 2 (AQP2) is a useful marker of kidney collecting duct function. A specific and convenient method to measure AQP2 in human urine would help to treat water balance disorders. It is unknown whether urinary excretion of AQP2 shows any daily variance. METHODS A sandwich enzyme-linked immunosorbent assay (ELISA) method for AQP2 was established using two different kinds of antibodies, and its sensitivity and specificity were examined. Daily variance of urinary excretion of AQP2 and responses to acute water load were examined. RESULTS The established ELISA specifically detected urine AQP2 with high sensitivity (detected as low as 0.34 pmol/mL). Urinary excretion of AQP2 did not show daily variance between 9 a.m. and 9 p.m. in healthy subjects. CONCLUSIONS The developed ELISA method using two different antibodies is convenient and highly sensitive, and could be useful in clinical practice. Urinary excretion of AQP2 is relatively constant from morning to night, and spot urine sampling at any time during this time period does not affect the results.
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Gargani L, Schmidt PH, Gheorghiade M. Tolvaptan for the treatment of hyponatremia secondary to the syndrome of inappropriate antidiuretic hormone secretion. Expert Rev Cardiovasc Ther 2011; 9:1505-13. [PMID: 22103869 DOI: 10.1586/erc.11.163] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Hyponatremia is prevalent in hospitalized patients and predicts a poor prognosis. The syndrome of inappropriate secretion of antidiuretic hormone (SIADH) is perceived as one of the most frequent causes of hyponatremia. Traditionally, chronic hyponatremia has been treated with fluid restriction and demeclocycline. However, these treatment options have been unsatisfactory due to problems with treatment compliance and/or safety concerns. In recent years, several vasopressin-receptor antagonists, the vaptans, were introduced into clinical practice. One of these vaptans - tolvaptan - is an oral vasopressin V2-receptor antagonist that induces free water excretion without increasing sodium excretion. Few studies have assessed the role of vaptans in treating hyponatremia in a population with only SIADH. Current data shows that vaptans may safely correct mild or moderate hyponatremia in patients with SIADH. However, further clinical trials are needed to determine the optimal dosing, proper monitoring and adequate precautions for the use of vaptans in this patient population.
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Affiliation(s)
- Luna Gargani
- Institute of Clinical Physiology, National Council of Research of Pisa, Pisa, Italy
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22
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Dunn RL, Smith WJ, Stratton MA. Trimethoprim-Sulfamethoxazole-Induced Hyponatremia. ACTA ACUST UNITED AC 2011; 26:342-9. [DOI: 10.4140/tcp.n.2011.342] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Abstract
The non-peptide vasopressin antagonists (VPA), called vaptans, were developed in the 1990s to antagonize both the pressor and antidiuretic effects of vasopressin. There are three subtypes of VPA receptors: V1a, V1b and V2. V1a receptors are widely distributed in the body, mainly the blood vessels and myocardium. The V1b receptors are located mainly in the anterior pituitary gland and play a role in ACTH release. V2 receptors are located in the collecting tubular renal cells. Both V1a and V1b receptors act through the intracellular phosphoinositol signalling pathway, Ca(++) being the second messenger. V2 receptors work through AMPc generation, which promotes aquaporin 2 (AQP2) trafficking and allows water to enter the cell. The vaptans act competitively at the AVP receptor. The most important are mozavaptan, lixivaptan, satavaptan and tolvaptan, all of which are selective V2 antagonists and are administered through the oral route. In contrast, conivaptan is a dual V1 and V2 antagonist administered through the endovenous route. The main characteristics of vaptans are their effect on free water elimination without affecting electrolyte excretion. There are several studies on the effects of these drugs in hypervolemic hyponatremia (heart failure, hepatic cirrhosis) as well as in normovolemic hyponatremia (inappropriate secretion of ADH [SIADH]). Current studies show that the vaptans are effective and well tolerated, although knowledge of these drugs remains limited. There are no studies of the use of vaptans in severe hyponatremia. Osmotic demyelination syndrome due to excessively rapid correction of hyponatremia has not been described.
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Affiliation(s)
- Carles Villabona
- Servicio de Endocrinología y Nutrición, Hospital Universitario de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
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Hidalgo-Mora JJ, Vila-Vives JM, Fernández Navarro JA, López-Prats MJ, Martín López E, Perales Marín A. Syndrome of inappropriate antidiuretic hormone secretion after cesarean section complicated with hemorrhage. J Perinat Med 2011; 39:213-4. [PMID: 21241204 DOI: 10.1515/jpm.2010.143] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Brain Natriuretic Peptide Concentrations After Aneurysmal Subarachnoid Hemorrhage: Relationship with Hypovolemia and Hyponatremia. Neurocrit Care 2011; 14:176-81. [DOI: 10.1007/s12028-011-9504-0] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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Katsarou A, Singh S. Hyponatraemia associated rhabdomyolysis following water intoxication. BMJ Case Rep 2010; 2010:2010/sep08_1/bcr0220102720. [PMID: 22778200 DOI: 10.1136/bcr.02.2010.2720] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
A young man with bipolar disorder was admitted in a coma. Cerebral oedema secondary to severe hyponatraemia was implicated. This was due to self-induced water intoxication. He developed rhabdomyolysis, a massive creatine kinase (out of proportion to longstanding antipsychotic medication) and acute renal failure. In the intensive care unit, hyponatraemia was corrected, and following appropriate fluid resuscitation, with forced alkaline diuresis, the rhabdomyolysis and renal function normalised, averting renal support. While a full recovery ensued, the persisting risk factors for hyponatraemia, that is polydipsia, and its association with rhabdomyolysis, increased the chances of a recurrence. Closely supervised regulation of his water intake, and monitoring of antipsychotic efficacy (for biochemical homeostatsis) are essential for secondary prevention. Rhabdomyolysis is a rare complication of hyponatraemia. When associated with psychogenic polydipsia, the acute and chronic management are challenging. Vaptans, which are aquaretics, that preferentially prevent renal tubular water reabsorption, may be beneficial in this situation.
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Affiliation(s)
- Alexia Katsarou
- Department of Medicine, Central Middlesex Hospital, London, UK
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Bulloch MN, Pinner NA. Tolvaptan: a vasopressin antagonist for the management of euvolemic and hypervolemic hyponatremia. Expert Rev Clin Pharmacol 2010; 3:601-12. [PMID: 22111741 DOI: 10.1586/ecp.10.45] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Tolvaptan is a new vasopressin antagonist developed for the treatment of hypervolemic or euvolemic hyponatremia. It has greater affinity for the V(2) receptor than native vasopressin or any other vasopressin antagonist. Blockade of the V(2) receptor induces solute-free water excretion without affecting normal electrolyte excretion. The pharmacokinetics and pharmacodynamics of tolvaptan are suitable for once-daily dosing. Throughout all phases of clinical studies, it was shown to be safe for short- and long-term use. Tolvaptan effectively increases serum sodium levels in patients with heart failure, cirrhosis and syndrome of inappropriate secretion of antidiuretic hormone. In patients hospitalized owing to heart failure, tolvaptan decreased bodyweight, increased urine output and improved dyspnea compared with placebo. However, tolvaptan has not proven to be beneficial for the long-term management of heart failure. Currently, tolvaptan is the only oral agent in its class available in the USA and Europe.
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Rozen-Zvi B, Yahav D, Gheorghiade M, Korzets A, Leibovici L, Gafter U. Vasopressin Receptor Antagonists for the Treatment of Hyponatremia: Systematic Review and Meta-analysis. Am J Kidney Dis 2010; 56:325-37. [DOI: 10.1053/j.ajkd.2010.01.013] [Citation(s) in RCA: 73] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2009] [Accepted: 01/04/2010] [Indexed: 11/11/2022]
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30
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Salerno F, Cazzaniga M, Accordino S. May vaptans contribute to the treatment of refractory ascites? J Hepatol 2010; 53:225-7. [PMID: 20546963 DOI: 10.1016/j.jhep.2010.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2010] [Accepted: 04/23/2010] [Indexed: 12/04/2022]
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Brugioni L, Dareggi D, Ognibene C, Gozzi C, Amorotti E, Zandomeneghi R. SIADH e iponatriemie al Policlinico di Modena nel periodo gennaio 2006 - settembre 2008. ITALIAN JOURNAL OF MEDICINE 2010. [DOI: 10.1016/j.itjm.2010.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Abstract
Hyponatremia is a common problem in patients with advanced cirrhosis. Hyponatremia in cirrhosis includes two distinct types: hypovolemic hyponatremia, and hypervolemic or dilutional hyponatremia. The former is characterized by low blood sodium, low blood volume, dehydration and prerenal renal dysfunction, not accompanied by edema and ascites, while the latter is characterized by insufficient circulatory volume and dilutional hyponatremia, accompanied by edema and ascites. Hyponatremia is closely related to various complications of cirrhosis and to early mortality after liver transplantation. Vaptans, a class of selective non-peptide arginine vasopressin (AVP) receptor antagonists, act by antagonizing specifically the effects of AVP V2 receptor located in the renal collecting tubules to inhibit water reabsorption without affecting electrolytes excretion. Vaptans has been evaluated by several clinical trials for their role in the management of hyponatremia. The short-term treatment with vaptans is associated with a marked increase in renal solute-free water excretion and improvement of hyponatremia with no apparent adverse reactions. The discovery of vaptans is considered a new milestone in the management of hyponatremia in cirrhosis.
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Holt NF, Haspel KL. Vasopressin: A Review of Therapeutic Applications. J Cardiothorac Vasc Anesth 2010; 24:330-47. [DOI: 10.1053/j.jvca.2009.09.006] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2009] [Indexed: 01/03/2023]
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35
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Emet M, Caner I, Cakir M, Aslan S, Cakir Z. Lightning injury may cause abrupt cerebral salt wasting syndrome. Am J Emerg Med 2010; 28:640.e1-3. [PMID: 20579567 DOI: 10.1016/j.ajem.2009.07.010] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2009] [Accepted: 07/11/2009] [Indexed: 10/19/2022] Open
Affiliation(s)
- Mucahit Emet
- Department of Emergency Medicine, Ataturk University, Erzurum 25200, Turkey
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36
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Favory R, Salgado DR, Vincent JL. Investigational vasopressin receptor modulators in the pipeline. Expert Opin Investig Drugs 2010; 18:1119-31. [PMID: 19589090 DOI: 10.1517/13543780903066764] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The vasopressin system is complex and interacts with the central nervous, cardiovascular, renal, and hematological systems. Vasopressin plays an important role in the control of blood osmolarity and vascular tone, but is also involved in many other physiological events, which are mediated mainly via three types of vasopressin receptor: V1R, V2R, and V3R. V1R primarily mediate the vascular, and V2R the aquaretic, effects of vasopressin. Vasopressin may also interact with other receptors, like adrenergic and angiotensin-II receptors, or with distinct biological pathways, including those of nitric oxide and the K(ATP) channel. There are numerous clinical situations where vasopressin receptor modulators (agonists or antagonists) could be used. Currently, vasopressin and terlipressin are most commonly used to stimulate V1R in vasodilatory shock and cardiac arrest, while desmopressin, a synthetic analogue of vasopressin, acts on V2R; but new molecules are becoming available in the treatment of inappropriate antidiuretic hormone (ADH) secretion.
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Affiliation(s)
- Raphaël Favory
- Université Libre de Bruxelles, Erasme Hospital, Department of Intensive Care, Brussels, Belgium
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Ku E, Nobakht N, Campese VM. Lixivaptan: a novel vasopressin receptor antagonist. Expert Opin Investig Drugs 2010; 18:657-62. [PMID: 19379124 DOI: 10.1517/13543780902889760] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Arginine vasopressin, also known as antidiuretic hormone, is a neuropeptide that functions in the maintenance of body water homeostasis. Inappropriate secretion of vasopressin has been implicated in the pathophysiology of multiple diseases, including polycystic kidney disease, syndrome of inappropriate antidiuretic hormone (SIADH) secretion, and the hyponatremia commonly associated with cirrhosis and congestive heart failure. Vasopressin receptor antagonists are novel agents that block the physiologic actions of vasopressin. Lixivaptan is a vasopressin receptor antagonist with high V2 receptor affinity and is now undergoing Phase III clinical trials. Studies so far have demonstrated that lixivaptan is efficacious in the correction of hyponatremia in SIADH, heart failure and liver cirrhosis with ascites, and few adverse effects have been noted. Thus, lixivaptan remains a promising therapeutic modality for the treatment of multiple diseases and prevention of the associated morbidity and mortality associated with hyponatremia.
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Affiliation(s)
- Elaine Ku
- University of Southern California, Keck School of Medicine, Los Angeles, CA, USA
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Zietse R, van der Lubbe N, Hoorn EJ. Current and future treatment options in SIADH. NDT Plus 2009; 2:iii12-iii19. [PMID: 19881932 PMCID: PMC2762827 DOI: 10.1093/ndtplus/sfp154] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2009] [Accepted: 09/29/2009] [Indexed: 01/17/2023] Open
Abstract
The treatment of hyponatraemia due to SIADH is not always as straightforward as it seems. Although acute treatment with hypertonic saline and chronic treatment with fluid restriction are well established, both approaches have severe limitations. These limitations are not readily overcome by addition of furosemide, demeclocycline, lithium or urea to the therapy. In theory, vasopressin-receptor antagonists would provide a more effective method to treat hyponatraemia, by virtue of their ability to selectively increase solute-free water excretion by the kidneys (aquaresis). In this review we explore the limitations of the current treatment of SIADH and describe emerging therapies for the treatment of SIADH-induced hyponatraemia.
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Affiliation(s)
- Robert Zietse
- Department of Internal Medicine, Erasmus Medical Center, Rotterdam , The Netherlands
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Bergum D, Lonnée H, Hakli TF. Oxytocin infusion: acute hyponatraemia, seizures and coma. Acta Anaesthesiol Scand 2009; 53:826-7. [PMID: 19397503 DOI: 10.1111/j.1399-6576.2009.01964.x] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Hyponatremia is not uncommon, serious cases can cause dangerous complications as seizures, brain damage and even death. We present a case of a young mother with post partum hemorrhage and some of the serious complications.
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Affiliation(s)
- D Bergum
- Department of Anaesthesia and Intensive Care, St. Olavs Hospital, Trondheim, Norway.
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Margetić B, Aukst-Margetić B. Treatment of hyponatremia--a complex problem in psychiatric practice. Intern Med 2008; 47:2197; author reply 2199. [PMID: 19075553 DOI: 10.2169/internalmedicine.47.1377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
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