In:
Clinical Endocrinology, Wiley, Vol. 84, No. 4 ( 2016-04), p. 620-626
Abstract:
European guidelines do not recommend tolvaptan for treatment of syndrome of inappropriate antidiuretic hormone secretion ( SIADH ), principally owing to concerns about risk of overly rapid correction of hyponatraemia. This study evaluated the real‐life effectiveness and safety of tolvaptan. Design Consecutive case series. Patients Inpatients treated with tolvaptan for SIADH in 2 UK hospitals over a 3‐year period. Measurements The primary outcome measures were serum sodium ( sN a) correction at 24 and 48 h after tolvaptan therapy. Results This case series included 61 patients aged 74·4 ± 15·3 years with (mean ± SD ) sN a 119·9 ± 5·5 mmol/l. The mean sN a increase 24 h after tolvaptan initiation was 9 ± 3·9 mmol/l. Excessive correction of hyponatraemia was observed in 23% of patients with all these patients having baseline sN a 〈 125 mmol/l, but no cases of osmotic demyelination syndrome were recorded. At the end of tolvaptan therapy, sN a increase was 13·5 ± 5·9 mmol/l with 96·7% of patients having sN a increase ≥5 mmol/l in 48 h. There was a negative significant correlation ( P = 0·012) between baseline sN a and 24‐h change; for every 1 mmol/l reduction in baseline value, sN a increased by an additional 0·23 mmol/l (95% CI 0·05–0·41). Conclusions Tolvaptan is effective in correcting hyponatraemia. Without rigorous electrolyte monitoring, tolvaptan carries a significant risk of overly rapid sodium correction, especially in patients with starting sN a 〈 125 mmol/l. Tolvaptan should be used with great caution under close electrolyte monitoring.
Type of Medium:
Online Resource
ISSN:
0300-0664
,
1365-2265
DOI:
10.1111/cen.2016.84.issue-4
Language:
English
Publisher:
Wiley
Publication Date:
2016
detail.hit.zdb_id:
2004597-9
