Conivaptan: a step forward in the treatment of hyponatremia?
Su Su Hline1, Phuong-Truc T Pham2, Phuong-Thu T Pham3, May H Aung1, Phuong-Mai T Pham4, Phuong-Chi T Pham1
1Olive View-UCLA Medical Center, Department of Medicine, Nephrology Division, Sylmar, CA, USA; 2Pennsylvania State Worthington Scranton, Dunmore, PA, USA; 3David Geffen School of Medicine at UCLA Medical Center, Los Angeles, CA, USA; 4Mather VA Medical Center, Mather, CA, USA
Abstract: Hyponatremia is one of the most common electrolyte abnormalities linked to adverse outcomes and increased mortality in hospitalized patients. While the differential diagnosis for hyponatremia is diverse, most cases stem from arginine vasopressin (AVP) dysregulation, where hypoosmolality fails to suppress AVP synthesis and release. The physiological effects of AVP are currently known to depend on its interaction with any of 3 receptor subtypes V1A, V2, and V1B. Activation of V2 by AVP is the key in renal water regulation and maintenance of total body volume and plasma tonicity. Despite the long-recognized problem with excess AVP in euvolemic and hypervolemic hyponatremia, traditional therapeutic options have relied on nonspecific and potentially problematic strategies. More recently, a new class of drugs, introduced as “aquaretics,” has gained great attention among clinicians because of its ability to correct hyponatremia via direct competitive inhibition of AVP at V2 receptors to induce renal electrolyte-free water excretion. In this paper, we aim to review available clinical data on the only FDA-approved aquaretic, dual V1A/V2 receptor antagonist conivaptan, discuss its clinical indications, efficacy, safety profile, and comment on its clinical limitations.
Keywords: conivaptan, hyponatremia, euvolemia, hypervolemia, AVP, AVP receptor antagonist
This work is published and licensed by Dove Medical Press Limited. The full terms of this license are available at https://www.dovepress.com/terms.php and incorporate the Creative Commons Attribution - Non Commercial (unported, v3.0) License. By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. For permission for commercial use of this work, please see paragraphs 4.2 and 5 of our Terms.Download Article [PDF]