title: Re-response to tolvaptan after furosemide dose reduction in a patient with refractory ascites.
abstract: Tolvaptan is a new drug used for treating ascites induced by liver cirrhosis, and it is covered by health insurance in Japan. In the present report, we describe the case of a 74-year-old man with type C liver cirrhosis and refractory ascites. He was receiving furosemide and spironolactone daily, but still required repeat puncture for ascites removal. Administration of tolvaptan (3.75 mg/day) was started in addition to his existing medications, and was subsequently increased to 7.5 mg/day. However, after 2 months, the ascites again exacerbated. Nevertheless, after we discontinued the administration of furosemide, the tolvaptan became effective. This may be because furosemide administration decreases urine osmolality, resulting in a non-response to tolvaptan.
authors.affiliation: Department of Gastroenterology and Hepatology, Hagi Civil Hospital, Tsubaki 3460-3, Hagi, Yamaguchi, 758-0061, Japan.
authors.forename: Atsushi
authors.initials: A
authors.lastname: Goto
authors.forename: Shuji
authors.initials: S
authors.lastname: Terai
authors.forename: Munetaka
authors.initials: M
authors.lastname: Nakamura
authors.forename: Masaharu
authors.initials: M
authors.lastname: Matsumoto
authors.forename: Isao
authors.initials: I
authors.lastname: Sakaida
mesh_terms: D065092:Antidiuretic Hormone Receptor Antagonists / Q000627:therapeutic use*; D001201:Ascites / Q000188:drug therapy* / Q000209:etiology; D001552:Benzazepines / Q000627:therapeutic use*; D004232:Diuretics / Q000008:administration & dosage*; D004334:Drug Administration Schedule; D004359:Drug Therapy, Combination; D005665:Furosemide / Q000008:administration & dosage*; D006801:Humans; D008103:Liver Cirrhosis / Q000150:complications; D008297:Male; D013148:Spironolactone / Q000008:administration & dosage; D000077602:Tolvaptan
chemical_list: D065092:Antidiuretic Hormone Receptor Antagonists; D001552:Benzazepines; D004232:Diuretics; D000077602:Tolvaptan; D013148:Spironolactone; D005665:Furosemide