Observations regarding the use of the aquaretic agent conivaptan for treatment of hyponatremia

Abstract

The treatment of hyponatremia, especially euvolemic and hypervolemic hyponatremia, has changed with the development of drugs which function as vasopressin receptor antagonists. These agents increase solute-free water excretion by the kidney resulting in an aquaresis. Conivaptan, a vasopressin receptor antagonist, has recently been approved by the FDA in the United States for use in the therapy of both euvolemic and hypervolemic hyponatremia. This report summarizes one center's experience with ten patients treated with this new drug. The patients had euvolemic hyponatremia with serum sodium levels less than 128 mEq/l. The same protocol was used in all patients with the conivaptan being given as a 20-mg intravenous loading dose followed by a 20-mg continuous 24-h infusion. Review of the data revealed that six of the ten patients had an excellent response to the therapy, with serum sodium increasing by a mean of 8.5+/-0.8 mEq/l (increases ranged from 7 to 12 mEq/l over 24 h). No significant changes in serum potassium levels or mean arterial pressures were noted. Two of the ten patients experienced a decrease in urine osmolality without a significant increase in serum sodium. Two other patients had only slight decreases in urine osmolality, and no significant increase in serum sodium levels. The data reveal that conivaptan is useful in the management of significant hyponatremia. There were no significant untoward effects, with the exception of one patient whose blood pressure decreased during the conivaptan infusion and who responded to cessation of the infusion and saline replacement therapy. This new class of drugs holds great promise for the treatment of dilutional hyponatremic disorders.

Efficacy of conivaptan and hypertonic (3%) saline in treating hyponatremia due to syndrome of inappropriate antidiuretic hormone in a tertiary Intensive Care Unit

“…Our findings resembled those of other studies,[13142122] where there were no reports of neurological damage despite rapid correction.…”

“…The magnitude of increase in serum sodium levels is a bit higher in our study compared to previous studies[72122] though the rate of correction is still within the recommended treatment guidelines for hyponatremia. [2] The faster correction of sodium in our study could be possibly due to the presence of a more elderly population and low baseline serum sodium levels.…”

“…Metzger et al . [21] observed that responders had lower mean serum sodium compared to nonresponders.…”

Hyponatremia associated with large-bone fracture in elderly patients

“…The occurrence of hyponatremia with an SSRI is generally thought to result from the development of a SIADH-like syndrome and has been demonstrated to be improved following the use of vasopressin blocking drugs [21]. Vasopressin blocking drugs have been associated with water diuresis in a variety of clinical syndromes such as SIADH and congestive heart failure [10,22].…”

Current Trends in Prevalence and Etiologic Factors Responsible for Hyponatremia in Hospitalized Patients

“…Studies have demonstrated changes in mentation and mobility in hyponatremic patients [17] and changes in bone structure and susceptibility to fracture have also been reported [18,19]. Interest in hyponatremia has been further stimulated by the recent development of specific vasopressin receptor blocking agents which can facilitate an increase in serum sodium levels in patients with clinically significant low levels [20][21][22][23].…”