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Case Reports
. 2015 Feb;8(1):47-51.
doi: 10.1007/s12328-014-0545-8. Epub 2014 Dec 5.

Re-response to tolvaptan after furosemide dose reduction in a patient with refractory ascites

Atsushi Goto  1 , Shuji Terai, Munetaka Nakamura, Masaharu Matsumoto, Isao Sakaida
Affiliations
Case Reports

Re-response to tolvaptan after furosemide dose reduction in a patient with refractory ascites

Atsushi Goto et al. Clin J Gastroenterol. 2015 Feb.

Abstract

Tolvaptan is a new drug used for treating ascites induced by liver cirrhosis, and it is covered by health insurance in Japan. In the present report, we describe the case of a 74-year-old man with type C liver cirrhosis and refractory ascites. He was receiving furosemide and spironolactone daily, but still required repeat puncture for ascites removal. Administration of tolvaptan (3.75 mg/day) was started in addition to his existing medications, and was subsequently increased to 7.5 mg/day. However, after 2 months, the ascites again exacerbated. Nevertheless, after we discontinued the administration of furosemide, the tolvaptan became effective. This may be because furosemide administration decreases urine osmolality, resulting in a non-response to tolvaptan.

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Figures

Fig. 1
Fig. 1
Plain abdominal computed tomography image. The hepatic lobes are atrophic with a blunt margin and irregularity on the surface. A moderate volume of ascites retention is also observed
Fig. 2
Fig. 2
The patient’s clinical course after the first admission
Fig. 3
Fig. 3
The patient’s clinical course after the second admission
See this image and copyright information in PMC

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