Use of tolvaptan vs. furosemide in older patients with heart failure

Huang, Weiling; Yang, Ying; Yang, Jun; Wang, H.‐b.; Xiong, Xiao‐Yi; Zhang, Y.‐f.

doi:10.1007/s00059-017-4563-4

Cited by 12 publications

(17 citation statements)

References 24 publications

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“…Xiong, et al 10) observed improvements in body weight and urine volume after tolvaptan therapy; however, serum creatinine levels significantly increased. On the contrary, Huang, et al 14) studied patients aged !65 years with acute heart failure and reported that tolvaptan significantly increased urine volume within 3 days of therapy and significantly decreased the rate of worsening of renal function. This discrepancy may be due to the difference in the dose of tolvaptan; four of the five studies included in the analysis of serum creatinine level by Xiong, et al 10) used a tolvaptan dose of at least 30 mg/day, whereas all six studies included in the analysis by Huang, et al 14) used a dose of 7.5-15 mg/day.…”

Section: Discussionmentioning

confidence: 99%

“…On the contrary, Huang, et al 14) studied patients aged !65 years with acute heart failure and reported that tolvaptan significantly increased urine volume within 3 days of therapy and significantly decreased the rate of worsening of renal function. This discrepancy may be due to the difference in the dose of tolvaptan; four of the five studies included in the analysis of serum creatinine level by Xiong, et al 10) used a tolvaptan dose of at least 30 mg/day, whereas all six studies included in the analysis by Huang, et al 14) used a dose of 7.5-15 mg/day. Under this dose, Huang, et al 14) concluded that tolvaptan reduced the worsening of renal function in older patients.…”

Section: Discussionmentioning

confidence: 99%

“…This discrepancy may be due to the difference in the dose of tolvaptan; four of the five studies included in the analysis of serum creatinine level by Xiong, et al 10) used a tolvaptan dose of at least 30 mg/day, whereas all six studies included in the analysis by Huang, et al 14) used a dose of 7.5-15 mg/day. Under this dose, Huang, et al 14) concluded that tolvaptan reduced the worsening of renal function in older patients.…”

Section: Discussionmentioning

confidence: 99%

“…Since 2015, meta-analyses of tolvaptan have been reported. [10][11][12][13][14] In recent years, several randomized controlled trials (RCTs) performed in actual clinical settings in Japan have also been reported, calling attention to the need for integrated analysis of differences between the doses of tolvaptan used in previous clinical studies in Europe and North America and the doses currently used in Japan. We performed a meta-analysis of RCTs in Europe, North America, and Japan.…”

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Effects of Tolvaptan on Volume Overload in Patients with Heart Failure

2018

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The present meta-analysis aimed to evaluate effects of tolvaptan on fluid retention in patients with heart failure who were non-responsive to conventional treatment and to assess differences between effects of low (! 15 mg/day) and high (> 15 mg/day) tolvaptan doses. Randomized controlled trials comparing add-on tolvaptan therapy and placebo or therapy with other diuretics in patients with heart failure were identified through a database search. The primary outcomes were changes in body weight and urine volume, and the secondary outcomes were changes in serum sodium and creatinine levels. In total, 14 reports were analyzed using a random effects model. Add-on tolvaptan was associated with increased urine volume [mean difference (MD), 1.44 L; 95% confidence interval (CI), 0.96 to 1.92], decreased body weight (MD, −0.99 kg; 95% CI, −1.24 to −0.74), and increased serum sodium levels (MD, 3.66 mEq/L; 95% CI, 3.43 to 3.88) within 2 days. Serum creatinine levels on day 7 were not different between the groups (MD, −0.03 mg/dL; 95% CI, −0.09 to 0.03). The high-dose group showed greater changes in urine volume, body weight, and serum sodium levels than the low-dose group. Serum creatinine levels slightly increased in the high-dose group (MD, 0.06; 95% CI, 0.04 to 0.08) and slightly decreased in the low-dose group (MD, −0.10; 95% CI, −0.19 to −0.01). Our findings suggest that add-on tolvaptan therapy for heart failure improves fluid retention in the early therapy phase. However, this drug should be properly used to avoid the worsening of renal function, which may occur at high doses.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

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Effects of Tolvaptan on Volume Overload in Patients with Heart Failure

2018

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“…1–3 It suppresses the synthesis and insertion of aquaporin-2 water channels into the luminal plasma membrane of collecting tubule principle cells, resulting in the restriction of water reabsorption in the hypertonic medulla without renal function deterioration. 1,4 Tolvaptan has a beneficial effect on patients in whom other diuretics, including loop diuretics, are ineffective; however, the US Food and Drug Administration (FDA) has issued a warning about the adverse effects of severe hypernatraemia and potentially fatal liver injury. 5…”

Section: Introductionmentioning

confidence: 99%

Validated liquid chromatography coupled to tandem mass spectrometry method for simultaneous quantitation of tolvaptan and its five major metabolites in human plasma

et al. 2019

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Background Tolvaptan is converted to major metabolites including three monohydroxylates (DM-4110, DM-4111 and DM-4119), an oxidate (MOP-21826) and a carboxylate (DM-4103) in humans. This study developed a simultaneous quantitative method for tolvaptan and its five major metabolites in human plasma using liquid chromatography coupled to tandem mass spectrometry. Methods Deproteinized plasma specimens using acetonitrile were separated using a 3- μm particle size octadecylsilyl column with 250 mm length and a simple linear gradient program at a flow rate of 0.3 mL/min with a total run time of 15 min. This method was applied to the determination of plasma samples collected from 20 heart failure patients treated with 3.75–15 mg tolvaptan. Results No interfering peak was found in drug-free plasma specimens. The calibration curves of tolvaptan, DM-4110, DM-4111, DM-4119, MOP-21826 and DM-4103 were linear over the concentration ranges of 3.125–1000, 0.3125–100, 1.25–400, 0.625–200, 0.125–40 and 31.25–10,000 ng/mL, respectively. Their pretreatment recovery rates and matrix factors were 94.1–113.9% and 86.9–108.0%, respectively. The intra- and inter-day accuracies and imprecisions were 91.6–106.5% and 0.9–10.9%, respectively, for all analytes. The plasma concentration ranges of tolvaptan, DM-4110, DM-4111, DM-4119, MOP-21826 and DM-4103 were 9.37–280, 1.91–16.3, 3.43–88.9, 1.43–10.4, 0.160–1.01 and 40.2–1471 ng/mL, respectively, in heart failure patients. Conclusions This validated method with acceptable analytical performance can be utilized for evaluating the pharmacokinetics of oral tolvaptan, including the determination of its major metabolites, in heart failure patients.

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Efficacy and safety of tolvaptan in chronic heart failure

Oya

Sato

Maezawa

et al. 2022

Pharmacy Practice and Res

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Background: The efficacy and safety of tolvaptan (TLV) in patients with chronic heart failure (CHF) are unclear. Aim: The aim of this study was to evaluate the efficacy and safety of tolvaptan (TLV) versus conventional therapy, primarily furosemide (FRM). In addition, the effect of the nutritional status on the efficacy of TLV was evaluated. Method: This retrospective study included patients with CHF who were hospitalised and treated between March 2015 and February 2019, including 51 patients in the FRM group and 63 patients in the TLV group. Result: Weight loss did not differ between the FRM and TLV groups (−2.1 AE 2.1 kg vs −1.5 AE 3.5 kg, p = 0.250). After 7 days, the change in the estimated glomerular filtration rate was significantly smaller in the FRM group (56.5 AE 22.2 vs 51.9 AE 20.0 mL/min/ 1.73 m 2 , p = 0.002). There was no significant difference in serum sodium (Na) levels between days 0 and 7 in the FRM group (138.8 AE 5.2 vs 139.2 AE 3.9 mEq/L, p = 0.487). However, the serum Na level was significantly increased in the TLV group (138.4 AE 5.0 mEq/L vs 139.4 AE 4.0 mEq/L, p = 0.047). There was no significant correlation between weight loss due to diuresis and the objective prognostic nutritional index in either group. Conclusion:In hyponatremic patients with CHF, TLV may be more effective than FRM in slowing the course of renal damage and elevating serum Na levels; however, nutritional indices may not be necessary to consider while administering TLV.

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Use of tolvaptan vs. furosemide in older patients with heart failure

Abstract: In older patients, tolvaptan relieves WRF, reduces the hospitalization period, and increases urine volume without significant effects on blood pressure. However, surprisingly, the use of tolvaptan did not influence 6‑month all-cause mortality.

Cited by 12 publications

References 24 publications

Effects of Tolvaptan on Volume Overload in Patients with Heart Failure

Effects of Tolvaptan on Volume Overload in Patients with Heart Failure

Validated liquid chromatography coupled to tandem mass spectrometry method for simultaneous quantitation of tolvaptan and its five major metabolites in human plasma

Efficacy and safety of tolvaptan in chronic heart failure

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