UCL Discovery
UCL home » Library Services » Electronic resources » UCL Discovery

Tolvaptan for the treatment of the syndrome of inappropriate antidiuresis (SIAD)

Tzoulis, P; Kaltsas, G; Baldeweg, SE; Bouloux, PM; Grossman, AB; (2023) Tolvaptan for the treatment of the syndrome of inappropriate antidiuresis (SIAD). Therapeutic Advances in Endocrinology and Metabolism , 14 pp. 1-17. 10.1177/20420188231173327. Green open access

[thumbnail of tzoulis-et-al-2023-tolvaptan-for-the-treatment-of-the-syndrome-of-inappropriate-antidiuresis-siad.pdf]
Preview
PDF
tzoulis-et-al-2023-tolvaptan-for-the-treatment-of-the-syndrome-of-inappropriate-antidiuresis-siad.pdf - Published Version

Download (273kB) | Preview

Abstract

The syndrome of inappropriate antidiuresis (SIAD), the commonest cause of hyponatraemia, is associated with significant morbidity and mortality. Tolvaptan, an oral vasopressin V2-receptor antagonist, leads through aquaresis to an increase in serum sodium concentration and is the only medication licenced in Europe for the treatment of euvolaemic hyponatraemia. Randomised controlled trials have shown that tolvaptan is highly efficacious in correcting SIAD-related hyponatraemia. Real-world data have confirmed the marked efficacy of tolvaptan, but they have also reported a high risk of overly rapid sodium increase in patients with a very low baseline serum sodium. The lower the baseline serum sodium, the higher the tolvaptan-induced correction rate occurs. Therefore, a lower starting tolvaptan dose of 7.5 mg has been evaluated in small cohort studies, demonstrating its efficacy, but it still remains unclear as to whether it can reduce the risk of overcorrection. Most international guidelines, except for the European ones, recommend tolvaptan as second-line treatment for SIAD after fluid restriction. However, the risk of unduly rapid sodium correction in combination with its high cost have limited its routine use. Prospective controlled studies are warranted to evaluate whether tolvaptan-related sodium increase can improve patient-related clinical outcomes, such as mortality and length of hospital stay in the acute setting or neurocognitive symptoms and quality of life in the chronic setting. In addition, the potential role of a low tolvaptan starting dose needs to be further explored. Until then, tolvaptan should mainly be used as second-line treatment for SIAD, especially when there is a clinical need for prompt restoration of normonatraemia. Tolvaptan should be used with specialist input according to a structured clinical pathway, including rigorous monitoring of electrolyte and fluid balance and, if needed, implementation of appropriate measures to prevent, or when necessary reverse, overly rapid hyponatraemia correction.

Type: Article
Title: Tolvaptan for the treatment of the syndrome of inappropriate antidiuresis (SIAD)
Location: United States
Open access status: An open access version is available from UCL Discovery
DOI: 10.1177/20420188231173327
Publisher version: https://doi.org/10.1177/204201882311733
Language: English
Additional information: This article is distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 License (https://creativecommons.org/licenses/by-nc/4.0/) which permits non-commercial use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access pages (https://us.sagepub.com/en-us/nam/open-access-at-sage).
Keywords: SIAD, hyponatraemia, sodium, tolvaptan, vaptans
UCL classification: UCL
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences > Div of Medicine
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences > Div of Medicine > Experimental and Translational Medicine
URI: https://discovery.ucl.ac.uk/id/eprint/10171418
Downloads since deposit
10Downloads
Download activity - last month
Download activity - last 12 months
Downloads by country - last 12 months

Archive Staff Only

View Item View Item