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Observational Study
. 2020 May;27(3):157-161.
doi: 10.1136/ejhpharm-2018-001664. Epub 2018 Nov 10.

Vasopressin antagonist efficacy and safety in volume-overloaded critically ill patients: a new therapeutic alternative

Jesús Ruiz-Ramos  1 , Paula Ramírez  2 , María Jesús Broch  2 , Mónica Gordon  2 , Esther Villarreal  2 , Armando Pinos  2 , Manuel Sosa  2 , Álvaro Castellanos-Ortega  2
Affiliations
Observational Study

Vasopressin antagonist efficacy and safety in volume-overloaded critically ill patients: a new therapeutic alternative

Jesús Ruiz-Ramos et al. Eur J Hosp Pharm. 2020 May.

Abstract

Objectives: To assess tolvaptan's efficacy and safety in critical care patients with volume overload.

Methods: Prospective observational study. Twenty-eight patients in the recovery phase from multiple organ failure and with volume overload refractory to conventional therapy treated with tolvaptan were included.

Results: Patients received an initial daily dose of 3.75 (n=1), 7.5 (n=8) and 15 (n=19) mg of tolvaptan. Median treatment duration was 2 days (range: 1 to 12). All patients presented an increase in 24 hours diuresis after the first dose (median increase from baseline (IQR)=1114 (285-1943) mL), with a median net daily fluid loss of 1007 mL (456-2380) mL after 24 hours. High diuretic efficacy (daily fluid loss higher than 0.5 L with tolvaptan first dose) was detected in 18 patients (64.3%). Initial hyponatraemia was present in 16 (57.1%) patients, while overly rapid correction with tolvaptan treatment occurred in two patients without clinical consequences. Two patients presented hypophosphataemia after treatment.

Conclusion: Tolvaptan is an effective therapeutic option in critically ill patients with volume overload refractory to conventional diuretics. Further studies are required to evaluate its safety profile and its effect on short-term outcomes and mortality.

Keywords: critical care; diuretics; edema; fluid balance; tolvaptan.

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Conflict of interest statement

Competing interests: PR and MJB have participated in training courses with funding from the laboratory Otsuka Pharmaceutical Europe.

Figures

Figure 1
Figure 1
Time-course of change in daily fluid balance (mL/24 hours). *:P<0.01 (Wilcoxon signed-rank test).
Figure 2
Figure 2
Time-course of changes in serum sodium levels (mEq/L). Values are shown as mean ±SD deviation.
See this image and copyright information in PMC

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