title: Tolvaptan for the treatment of hyponatremia and hypervolemia in patients with congestive heart failure.
abstract: Patients with heart failure often show increased arginine vasopressin secretion and enhanced sympathetic and renin-angiotensin-aldosterone activation, which accelerate renal water reabsorption, causing water retention and volume overload. Tolvaptan is an orally active antagonist of arginine vasopressin type 2 receptors in the collecting duct of the kidney that inhibits water reabsorption without substantially affecting the electrolyte balance. Tolvaptan in combination with conventional diuretics improves fluid retention and congestive symptoms in patients with heart failure and volume overload, with minimal effects on hemodynamics and serum potassium. Tolvaptan slightly increases serum sodium concentrations, generally within the normal range. Although it does not seem to affect long-term mortality, tolvaptan does improve short-term water retention and congestive symptoms in heart failure patients with volume overload despite the use of conventional diuretics, and is approved for this indication in Japan.
authors: Osaka Medical Center for Cancer & Cardiovascular Diseases, 1-3-3 Nakamichi, Higashinari-ku, Osaka 537-8511, Japan. hori-ma@mc.pref.osaka.jp
authors: Masatsugu
authors: M
authors: Hori
mesh_terms: D065092:Antidiuretic Hormone Receptor Antagonists; D001127:Arginine Vasopressin / Q000378:metabolism; D001552:Benzazepines / Q000493:pharmacokinetics / Q000494:pharmacology / Q000627:therapeutic use*; D001810:Blood Volume / Q000187:drug effects* / Q000502:physiology; D004305:Dose-Response Relationship, Drug; D006333:Heart Failure / Q000150:complications / Q000503:physiopathology; D006706:Homeostasis; D006801:Humans; D007010:Hyponatremia / Q000150:complications / Q000188:drug therapy*; D007668:Kidney / Q000503:physiopathology; D012964:Sodium / Q000378:metabolism; D000077602:Tolvaptan; D016896:Treatment Outcome
chemical_list: D065092:Antidiuretic Hormone Receptor Antagonists; D001552:Benzazepines; D001127:Arginine Vasopressin; D000077602:Tolvaptan; D012964:Sodium