Endocrine Unit, Center for Research, Transfer and High Education on Chronic, Inflammatory, Degenerative and Neoplastic Disorders for the Development of Novel Therapies, Department of Experimental and Clinical Biomedical Sciences, University of Florence, 50139 Florence, Italy.
J Clin Endocrinol Metab. 2013 Apr;98(4):1321-32. doi: 10.1210/jc.2012-4082. Epub 2013 Feb 11.
Hyponatremia is the most common electrolyte disorder encountered in clinical practice and represents a clinical, social, and economic burden. Conventional treatments of hyponatremia present some pitfalls, such as suboptimal efficacy, risk of overly rapid correction, and adverse effects. Vasopressin receptor antagonists, known as vaptans, represent a new and interesting class of drugs for the treatment of the euvolemic and hypervolemic forms of hyponatremia.
This review is based on a PubMed search with the following terms: "vaptans," "vasopressin receptor antagonists," "tolvaptan," "conivaptan," "vasopressin receptor antagonists and SIADH," "vasopressin receptor antagonists and congestive heart failure," "vasopressin receptor antagonists and cirrhosis," and "vasopressin receptor antagonists and polycystic kidney disease."
Overall, the studies reported in this review indicate that vaptans effectively correct hyponatremia in euvolemic and hypervolemic patients. In the latter group, vaptans generally had favorable effects on fluid balance also. To date two vaptans, ie, conivaptan and tolvaptan, have been marketed in the United States for the treatment of euvolemic and hypervolemic hyponatremia, whereas tolvaptan has been marketed in Europe with the limitation of euvolemic hyponatremia. Although these drugs have a good safety profile, caution should be used, and treatment should be initiated in a hospital setting in order to closely monitor patients and avoid overly rapid correction or overcorrection.
Vaptans can be considered a new effective tool for the treatment of euvolemic and hypervolemic hyponatremia. Nevertheless, more comparative research of vaptans vs other therapies on clinical grounds is needed to more accurately assess the value of these drugs in the treatment of hyponatremia.
低钠血症是临床实践中最常见的电解质紊乱，代表了一种临床、社会和经济负担。低钠血症的传统治疗方法存在一些缺陷，例如疗效不佳、过快纠正的风险以及不良反应。血管加压素受体拮抗剂，即所谓的血管加压素受体拮抗剂，是治疗等容性和高容量性低钠血症的一种新的、有趣的药物类别。
这篇综述是基于对以下术语的 PubMed 搜索：“血管加压素受体拮抗剂”、“vasopressin 受体拮抗剂”、“tolvaptan”、“conivaptan”、“vasopressin 受体拮抗剂和 SIADH”、“vasopressin 受体拮抗剂和充血性心力衰竭”、“vasopressin 受体拮抗剂和肝硬化”以及“vasopressin 受体拮抗剂和多囊肾病”。
总的来说，本综述中报告的研究表明，血管加压素受体拮抗剂可有效纠正等容性和高容量性低钠血症患者的低钠血症。在后一组中，血管加压素受体拮抗剂通常对液体平衡也有有利影响。迄今为止，两种血管加压素受体拮抗剂，即 conivaptan 和 tolvaptan，已在美国上市用于治疗等容性和高容量性低钠血症，而 tolvaptan 已在欧洲上市，仅限于治疗等容性低钠血症。尽管这些药物具有良好的安全性，但应谨慎使用，并应在医院环境中开始治疗，以便密切监测患者并避免过快纠正或过度纠正。
血管加压素受体拮抗剂可被视为治疗等容性和高容量性低钠血症的一种新的有效工具。然而，需要更多基于临床的血管加压素受体拮抗剂与其他治疗方法的比较研究，以更准确地评估这些药物在低钠血症治疗中的价值。
