Tolvaptan Use for Syndrome of Inappropriate of Antidiuretic Hormone.pptx

Tolvaptan Use for SIADH

1. Ade Wijaya , MD August 2024 Tolvaptan Use for Syndrome of Inappropriate Secretion of Antidiuretic Hormone (SIADH)

2. SIADH D isorder in which vasopressin is inappropriately released beyond the physiological regulatory mechanism, due to various underlying diseases Cuesta M, Garrahy A, Thompson CJ (2016) SIAD: practi ‐ cal recommendations for diagnosis and management. J Endocrinol Invest 39: 991–1001. Peri A, Giuliani C (2014) Management of euvolemic hyponatremia attributed to SIADH in the hospital setting. Minerva Endocrinol 39: 33–41. Verbalis JG, Goldsmith SR, Greenberg A, Schrier RW, Sterns RH (2007) Hyponatremia treatment guidelines 2007: expert panel recommendations. Am J Med 120: S1– S21.

3. SIADH Diagnostic Criteria Mentrasti G, Scortichini L, Torniai M, Giampieri R, Morgese F, Rinaldi S, Berardi R. Syndrome of inappropriate antidiuretic hormone secretion (SIADH): optimal management. Therapeutics and clinical risk management. 2020 Jul 24:663-72.

4. Management of SIADH Elimination of the cause Fluid restriction Vasopressin receptor antagonists Aim of therapy: - Correct the low sodium levels - Improve the CNS-related symptoms - Prevent cerebral edema Cuesta M, Garrahy A, Thompson CJ (2016) SIAD: practi ‐ cal recommendations for diagnosis and management. J Endocrinol Invest 39: 991–1001. Spasovski G, Vanholder R, Allolio B, Annane D, Ball S, et al. (2014) Clinical practice guideline on diagnosis and treatment of hyponatraemia . Eur J Endocrinol 170: G1– G47.

5. Tolvaptan Mechanism of action: oral vasopressin receptor antagonist with a high affinity for the V2 receptor and has been shown to promote aquaresis resulting in the increased excretion of free water FDA approved for SIADH and heart failure Dose: starting dose 7.5 – 15 mg / day once daily, titrate up to 60 mg / day once daily Schrier RW, Gross P, Gheorghiade M, Berl T, Verbalis JG, et al. (2006) Tolvaptan , a selective oral vasopressin V2-receptor antagonist, for hyponatremia . N Engl J Med 355: 2099–2112. Yamamura Y, Nakamura S, Itoh S, Hirano T, Onogawa T, et al. (1998) OPC-41061, a highly potent human vasopres ‐ sin V2-receptor antagonist: pharmacological profile and aquaretic effect by single and multiple oral dosing in rats. J Pharmacol Exp Ther 287: 860–867. Cuesta M, Garrahy A, Thompson CJ (2016) SIAD: practi ‐ cal recommendations for diagnosis and management. J Endocrinol Invest 39: 991–1001.

6. Tolvaptan Efficacy Arima H, Goto K, Motozawa T, Mouri M, Watanabe R, Hirano T, Ishikawa SE. Open-label, multicenter, dose-titration study to determine the efficacy and safety of tolvaptan in Japanese patients with hyponatremia secondary to syndrome of inappropriate secretion of antidiuretic hormone. Endocrine Journal. 2021;68(1):17-29.

7. Tolvaptan Adverse Effects Arima H, Goto K, Motozawa T, Mouri M, Watanabe R, Hirano T, Ishikawa SE. Open-label, multicenter, dose-titration study to determine the efficacy and safety of tolvaptan in Japanese patients with hyponatremia secondary to syndrome of inappropriate secretion of antidiuretic hormone. Endocrine Journal. 2021;68(1):17-29.

8. Summary Oral tolvaptan effectively corrects hyponatremia in SIADH No significant safety concerns were identified

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