Efficacy of vaptans for correction of postoperative hyponatremia: A comparison between single intravenous bolus conivaptan vs oral tolvaptan

Rajan, Sunil; Tosh, Pulak; Kadapamannil, Dilesh; Srikumar, Soumya; Paul, Jerry; Kumar, Lakshmi

doi:10.4103/joacp.joacp_263_17

Cited by 6 publications

(3 citation statements)

References 26 publications

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“…This increase was about 8.030±0.6507 mEq/l and 12.33±0.6489 mEq/l for 3% hypertonic saline and about 5.111±0.6616 mEq/l and 10.11±0.6230 mEq/l for tolvaptan, after 24 hours and 48 hours, respectively. 18 Duration of hospital stay was compared between moderate hyponatremia and profound hyponatremia and median duration of stay was found to be 7 days in both the groups and was not statistically significant (p<0.063 by Man Whitney U test). In one study it was shown that oral tolvaptan and 3% hypertonic saline were equally effective in correcting hyponatraemia at 48 hours, but serum sodium levels were higher at 72 hours after oral tolvaptan.…”

Section: Discussionmentioning

confidence: 86%

Clinical and biochemical profile of hyponatremia and the role of vaptans in comparison to other standard modalities of therapy

Ahmed,

Khan,

Umakanth

et al. 2023

Int J Res Med Sci

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Background: This study, conducted from August 2014 to August 2015, investigated hyponatremia in 228 in-hospital patients, aiming to discern its clinical and biochemical features and compare the efficacy of vaptans against standard treatments. The null hypothesis assumed no significant disparity in outcomes, while the alternate hypothesis posited otherwise. Methods: Using an open-label, non-blinded, observational, prospective comparative design, we assessed 228 hyponatremia patients. We scrutinized their clinical and biochemical profiles and made comparisons between moderate and profound hyponatremia cases, along with different treatment approaches. Results: Our findings revealed that patients aged 61-80, primarily females, dominated the cohort. Moderate hyponatremia occurred in 56.6% of cases, with severe hyponatremia in 43.4%. Common symptoms included drowsiness, nausea, and vomiting. Euvolemic hyponatremia was predominantly due to SIADH, while heart failure led to most hypervolemic cases. Various treatments were employed, with fluid restriction and normal saline being common. Tolvaptan and 1.6% hypertonic saline significantly increased serum sodium levels at 24 and 48 hours. Hospital stay duration didn’t significantly differ, and no osmotic demyelination cases emerged. Mortality stood at 10.5%, notably higher in profound hyponatremia cases. Conclusions: This study provides insights into hyponatremia’s clinical and biochemical aspects and compares vaptans to standard treatments. Tolvaptan and hypertonic saline displayed promise in raising serum sodium levels. Nevertheless, further research is warranted to validate these findings and explore additional factors impacting hyponatremia treatment outcomes.

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Section: Discussionmentioning

confidence: 86%

Clinical and biochemical profile of hyponatremia and the role of vaptans in comparison to other standard modalities of therapy

Ahmed,

Khan,

Umakanth

et al. 2023

Int J Res Med Sci

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“…Tolvaptan is a clinically approved V2R antagonist, successfully used in hyponatremia treatment [34]. However, in the ischemic stroke mouse model, Tolvaptan and other selective V2R antagonists, apart from the established aquaretic effect, did not produce the neuroprotective effects displayed by V1aR antagonists [134,179,180].…”

Section: Targeting Arginine Vasopressin Receptors In the Acute Phase ...mentioning

confidence: 99%

“…Another clinical implication in understanding AVP stroke pathology in stroke settings is using AVP receptor antagonists as an add-on or complementary target to mitigate AVP-induced edema and BBB disruption [26][27][28][29][30][31][32][33]. AVP receptor antagonists have been FDA-approved for hyponatremia, and hence are readily available for repurposing [34,35].…”

Section: Introductionmentioning

confidence: 99%

The Role of Arginine-Vasopressin in Stroke and the Potential Use of Arginine-Vasopressin Type 1 Receptor Antagonists in Stroke Therapy: A Narrative Review

Chojnowski

Opiełka

Gozdalski

et al. 2023

IJMS

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Stroke is a life-threatening condition in which accurate diagnoses and timely treatment are critical for successful neurological recovery. The current acute treatment strategies, particularly non-invasive interventions, are limited, thus urging the need for novel therapeutical targets. Arginine vasopressin (AVP) receptor antagonists are emerging as potential targets to treat edema formation and subsequent elevation in intracranial pressure, both significant causes of mortality in acute stroke. Here, we summarize the current knowledge on the mechanisms leading to AVP hyperexcretion in acute stroke and the subsequent secondary neuropathological responses. Furthermore, we discuss the work supporting the predictive value of measuring copeptin, a surrogate marker of AVP in stroke patients, followed by a review of the experimental evidence suggesting AVP receptor antagonists in stroke therapy. As we highlight throughout the narrative, critical gaps in the literature exist and indicate the need for further research to understand better AVP mechanisms in stroke. Likewise, there are advantages and limitations in using copeptin as a prognostic tool, and the translation of findings from experimental animal models to clinical settings has its challenges. Still, monitoring AVP levels and using AVP receptor antagonists as an add-on therapeutic intervention are potential promises in clinical applications to alleviate stroke neurological consequences.

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Effects of YM087 and VPA985 on the T237M mutant receptor functionality in nephrogenic diabetes insipidus

Avcu,

Erdem Tuncdemir,

Saglar Ozer

2024

Turkish Journal of Biochemistry

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Objectives Mutations detected in the AVPR2 gene (arginine vasopressin type 2 receptor) are known to cause nephrogenic diabetes insipidus (NDI). Several pharmacological chaperones (PCs) target misfolded AVPR2 proteins and rescue them from the quality control system of the cell. In this study, we investigated the effect of YM087 and VPA985, which are PCs, on T273M-AVPR2 mutant that are known to cause NDI. Methods The total and cell surface expressions of T273M in COS-1 cells were measured by sandwich ELISA and flow cytometry after the cells were treated with YM087 and VPA985 separately. In addition, the cAMP accumulation assay was performed. Results It was observed that VPA985 treatment significantly increased the cell surface expression and slightly increased the maximum cAMP response of T273M. Both YM087 and VPA985 decreased the ligand concentrations which were responsible for making half of the maximum response of the T273M mutant receptor. Conclusions PCs have different potential effects on different AVPR2 mutants. Therefore, studying the effectiveness of PCs in rescuing AVPR2 mutants and making them functional again may contribute to the development of new therapeutic strategies.

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Efficacy of vaptans for correction of postoperative hyponatremia: A comparison between single intravenous bolus conivaptan vs oral tolvaptan

Cited by 6 publications

References 26 publications

Clinical and biochemical profile of hyponatremia and the role of vaptans in comparison to other standard modalities of therapy

Clinical and biochemical profile of hyponatremia and the role of vaptans in comparison to other standard modalities of therapy

The Role of Arginine-Vasopressin in Stroke and the Potential Use of Arginine-Vasopressin Type 1 Receptor Antagonists in Stroke Therapy: A Narrative Review

Effects of YM087 and VPA985 on the T237M mutant receptor functionality in nephrogenic diabetes insipidus

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