초록
Background : Hyponatremia is the most common electrolyte disturbance in hospitalized patients and has been associated with increased morbidity and mortality. Tolvaptan, a vasopressin receptor antagonist, is increasingly used for the treatment of euvolemic and hypervolemic hyponatremia. The aim of this study was to evaluate the effectiveness and safety of tolvaptan for the management of hyponatremia. Methods : This study was a retrospective evaluation of 106 patients who received at least one dose of tolvaptan for hyponatremia at a single tertiary academic hospital between January 2014 and June 2015. The primary endpoint was the change in serum sodium concentration after tolvaptan administration within 24 hours, with secondary endpoints of overcorrection and adverse effects. Results : The mean initial dose of tolvaptan was 20.2±7.2 mg and the median duration of treatment was 15 days (range, 1-261 days). The maximal changes in sodium levels at 24 and 48 hours were 8.2± 4.7 mmol/L and 10.5±15.3 mmol/L, respectively. Of 99 patients in whom sodium concentrations were followed up, sodium overcorrection was observed in 26 (26.3%) patients, which was associated with concomitant use of an enzyme inhibitor (odds ratio [OR] = 4.80, 95% Cl: 1.27-18.15). However, sex, body mass index (BMI), serum albumin, a daily dose of tolvaptan, and concomitant use of hypertonic saline did not show any significant difference in overcorrection. The most commonly reported adverse effects were mild and related to aquaresis, such as polyuria, thirst, and constipation. However, severe adverse amioeffects such as hyperkalemia, hypotension, and one death related to osmotic demyelination were also reported. Conclusions : Tolvaptan is effective for treating hyponatremia. Nevertheless, the drug should be used cautiously due to serious adverse effects related to sodium overcorrection.
키워드
Tolvaptan, Hyponatremia, ADR (Adverse Drug Reaction), Overcorrection
참고문헌(20)
-
[학술지] Upadhyay A / 2006 / Incidence and prevalence of hyponatremia / Am J Med 119 (7 Suppl 1) : S30 ~ S35
-
[학술지] Miller M / 2006 / Hyponatremia and arginine vasopressin dysregulation: mechanisms, clinical consequences, and management / J Am Geriatr Soc 54 (2) : 345 ~ 353
-
[학술지] Schrier RW / 2006 / Tolvaptan, a selective oral vasopressin V2-receptor antagonist, for hyponatremia / N Engl J Med 355 (20) : 99 ~ 112
-
[학술지] Verbalis JG / 2013 / Diagnosis, evaluation, and treatment of hyponatremia: expert panel recommendations / Am J Med 126 (10 Suppl 1) : S1 ~ S42
-
[학술지] Corona G / 2015 / Hyponatremia improvement is associated with a reduced risk of mortality: evidence from a meta-analysis / PLoS One 10 (4) : e0124105
-
[학술지] Berl T / 2015 / Vasopressin antagonists / N Engl J Med 372 (23) : 2207 ~ 2216
-
[학술지] Umbrello M / 2016 / Tolvaptan for hyponatremia with preserved sodium pool in critically ill patients / Ann Intensive Care 6 (1) : 1
-
[학술지] Cyr PL / 2011 / Effect of serum sodium concentration and tolvaptan treatment on length of hospitalization in patients with heart failure / Am J Health Syst Pharm 68 (4) : 328 ~ 333
-
[인터넷자료] Food and Drug Administration / Samsca (tolvaptan): Drug Warning - Potential Risk of Liver Injury
-
[기타] / 2017 / Samsca (tolvaptan) package insert / Otsuka Pharmaceuticals Co
-
[학술지] Shoaf SE / 2012 / Effects of CYP3A4 inhibition and induction on the pharmacokinetics and pharmacodynamics of tolvaptan, a non-peptide AVP antagonist in healthy subjects / Br J Clin Pharmacol 73 (4) : 579 ~ 587
-
[인터넷자료] / Wolters Kluwer Clinical Drug Information, Inc
-
[학술지] Aditya S / 2012 / Vaptans: A new option in the management of hyponatremia / Int J Appl Basic Med Res 2 (2) : 77 ~ 83
-
[학술지] Rajan S / 2015 / Effectiveness of single dose conivaptan for correction of hyponatraemia in post-operative patients following major head and neck surgeries / Indian J Anaesth 59 (7) : 416 ~ 420
-
[학술지] Adhiyaman V / 2014 / Once-weekly tolvaptan for chronic symptomatic hyponatremia due to syndrome of inappropriate secretion of antidiuretic hormone / J Am Geriatr Soc 62 (7) : 1405 ~ 1406
-
[학술지] Tarhan NC / 2004 / Osmotic demyelination syndrome in endstage renal disease after recent hemodialysis: MRI of the brain / AJR Am J Roentgenol 182 (3) : 809 ~ 816
-
[학술지] Singh TD / 2014 / Central pontine and extrapontine myelinolysis: a systematic review / Eur J Neurol 21 (12) : 1443 ~ 1450
-
[학술지] Sterns RH / 1994 / Neurologic sequelae after treatment of severe hyponatremia: a multicenter perspective / J Am Soc Nephrol 4 (8) : 1522 ~ 1530
-
[학술지] Torres VE / 2012 / Tolvaptan in patients with autosomal dominant polycystic kidney disease / N Engl J Med 367 (25) : 2407 ~ 2418
-
[학술지] Liamis G / 2008 / A review of drug-induced hyponatremia / Am J Kidney Dis 52 (1) : 144 ~ 153