Tolvaptan Use to Treat SIADH in a Child

Köksoy, Adem Yasin; Kurtul, Meltem; Ozsahin, Aslı Kantar; Çaycı, Fatma Şemsa; Tayfun, Meltem; Bayrakçı, Umut Selda

doi:10.5863/1551-6776-23.6.494

Cited by 8 publications

(18 citation statements)

References 18 publications

(19 reference statements)

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“…Higashi et al (22) reported the case series of 34 pediatric patients given tolvaptan for congestive heart failure, six of whom experienced thirst and dry mouth, and one patient had a mild increase in liver enzymes. However, in all the reported cases tolvaptan was well-tolerated and is considered to be a safe treatment (21)(22)(23)(24)(25)(26)(27)(28).…”

Section: Discussionmentioning

confidence: 91%

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Case Report: Long-Term Tolvaptan Treatment in a Child With SIADH and Suprasellar Arachnoid Cyst

et al. 2021

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Suprasellar arachnoid cysts represent a rare occurrence in the pediatric population and usually cause symptoms related to mass effect and can occasionally cause endocrine dysfunctions. The association between SAC and the syndrome of inappropriate antidiuretic hormone (SIADH) in the pediatric population has rarely been described previously. In most cases, SIADH is temporary and resolves by treating the underlying cause. The first-line treatment consists of fluid restriction in asymptomatic children. Oral urea and demeclocycline are other effective treatment options. Vaptans are a new class of medication for the management of SIADH. These agents are a nonpeptide vasopressin V2 receptor antagonist that selectively antagonizes the antidiuretic effect of AVP, resulting in excretion of diluted urine or “aquaresis.” Their efficacy has been shown in adult patients with euvolemic or hypervolemic hyponatremia. However, evidence is lacking in pediatric patients with SIADH. We report the case of a 9-year-old female child with a SAC, who underwent endoscopic fenestration at the age of 2 years. After surgery she developed chronic hyponatremia due to SIADH. Hyponatremia was refractory to treatment with fluid restriction, oral sodium, and urea. In order to normalize serum sodium levels, tolvaptan treatment was started on a compassionate-use basis; 24–48 h later serum sodium levels returned to normal. To date, tolvaptan has been used regularly for 6 years with no side effects occurring during the treatment period. This is the first case of a child with chronic SIADH secondary to SAC successfully treated with tolvaptan. Further studies are needed to demonstrate its usefulness on a broader case series.

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Section: Discussionmentioning

confidence: 91%

“…Recently there have been a few reports on the use of tolvaptan as treatment for SIADH in infancy; but to date, experience is limited. In Table 2B, we have summarized the characteristics of the seven cases described in the literature (25)(26)(27)(28)(29).…”

Section: Discussionmentioning

confidence: 99%

Case Report: Long-Term Tolvaptan Treatment in a Child With SIADH and Suprasellar Arachnoid Cyst

et al. 2021

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“…The literature search process is summarized in Figure 1. For the final analysis, we retained 26 reports published since 2008 9,11–35 : ten from Asia (Japan, n = 7; Turkey, n = 3), eight from Europe (United Kingdom, n = 3; Germany, n = 2; France, n = 1; Italy, n = 1; Spain, n = 1) and eight from the United States. The included articles described 226 patients.…”

Section: Resultsmentioning

confidence: 99%

Vaptans for oedematous and hyponatraemic disorders in childhood: A systematic literature review

Piffer

Bianchetti

Leoni-Foglia

et al. 2022

Brit J Clinical Pharma

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Aims The aim of this study was to systematically review the use of vaptans (nonpeptide vasopressin receptor antagonists) in children. Methods Through a database search (Web of Science, the National Library of Medicine, Excerpta Medica), we identified case series and case reports and extracted clinical and laboratory data. Results Twenty‐six articles, published since 2008, reported on 226 patients. Among 115 children with hyponatraemic (n = 63) and oedematous disorders (n = 52), a 48 hour course of tolvaptan with an initial dose of 0.38 ± 0.27 mg/kg was administered in 106 cases, while intravenous conivaptan was reported in nine cases. An increase (P < .02) in urine output was shown in both oedematous (from 3.2 ± 2.0 to 5.3 ± 6.7 mL/kg/day) and hyponatraemic (from 3.0 ± 1.5 to 4.4 ± 2.3 mL/kg/day) patients. In these latter, sodium increased from 125 ± 6 to 133 ± 6 mmol/L (P < .0001). The increase in sodium level correlated with its basal value, but not with the administered vaptan dose. Among 111 children undergoing cardiac surgery, after tolvaptan 0.21 ± 0.01 mg/kg/day, mostly combined with conventional diuretics, an increase in diuresis by 41 ± 4% was seen within 24 hours (P < .0001). Similarly, a single add‐on dose of tolvaptan 0.45 mg/kg allowed a reduced additional intravenous furosemide administration (0.26 ± 0.23 vs 0.62 ± 0.48 mg/kg, P < .005). Side effects were rarely reported, and included excessive thirst and xerostomia in seven, skin rash in one and elevated aminotransferases in one patient(s). Conclusion Vaptans appear to be safe for oedematous and hyponatraemic disorders also in children. Although they increase diuresis and natraemia, no superiority to traditional diuretics and sodium supplements has been demonstrated. Reported side effects are rare and non‐serious.

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“…Reports of tolvaptan use for SIADH in children are limited [ 6 , 7 , 8 , 9 , 10 , 11 ]. The reported pediatric patients are summarized in Table 2 .…”

Section: Discussionmentioning

confidence: 99%

Regulation of Serum Sodium Levels during Chemotherapy Using Selective Arginine Vasopressin V2-Receptor Antagonist Tolvaptan in a Four-Year-Old Girl with a Suprasellar Germ Cell Tumor

et al. 2021

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There are limited reports on the use of tolvaptan for syndrome of inappropriate antidiuretic hormone secretion (SIADH) in children. Managing serum sodium levels in SIADH patients during chemotherapy is often difficult because of the need for massive fluid infusions. We report the course of the use of tolvaptan for the treatment of hyponatremia during chemotherapy in a four-year-old girl with a suprasellar germ cell tumor. The patient was a Japanese girl who presented with left ptosis with a mass in the pituitary gland and cavernous sinus. She was diagnosed with an intermediate-grade germ cell tumor and was treated with carboplatin and etoposide combination chemotherapy. She developed hyponatremia due to SIADH caused by intravenous infusion therapy before chemotherapy. Subsequently, tolvaptan (3.25 mg; 0.20 mg/kg/dose) was administered orally to control serum sodium levels. After 4 h of administration, a marked increase in urine volume of up to 15 mL/kg/h was observed, and serum sodium level increased from 126 to 138 mEq/L after 10 h of tolvaptan administration, followed by a decrease in urine volume. The use of tolvaptan in pediatric patients with SIADH who require intravenous hydration during chemotherapy can be useful for the management of serum sodium balance.

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Tolvaptan Use to Treat SIADH in a Child

Cited by 8 publications

References 18 publications

Case Report: Long-Term Tolvaptan Treatment in a Child With SIADH and Suprasellar Arachnoid Cyst

Case Report: Long-Term Tolvaptan Treatment in a Child With SIADH and Suprasellar Arachnoid Cyst

Vaptans for oedematous and hyponatraemic disorders in childhood: A systematic literature review

Regulation of Serum Sodium Levels during Chemotherapy Using Selective Arginine Vasopressin V2-Receptor Antagonist Tolvaptan in a Four-Year-Old Girl with a Suprasellar Germ Cell Tumor

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