Department of Pharmacy, Banner Good Samaritan Medical Center, Phoenix, AZ.
Ann Pharmacother. 2013 Sep;47(9):1194-200. doi: 10.1177/1060028013503126.
To review the literature evaluating the clinical safety and efficacy of conivaptan in the management of hyponatremia in a neurologic and neuro-surgical adult patient population.
A literature search was conducted using MEDLINE, EMBASE, PubMed, and the Cochrane Central Register of Controlled Trials (1966-May 2013). Search limits were English, human, and adult using the terms vasopressin receptor antagonist, conivaptan, tolvaptan, lixivaptan, neurology, neurological disorder, neurosurgery, neurointensive care, and neurocritical care.
All case reports, case series, and clinical trials investigating the use of conivaptan in neurosurgical patients were included.
Seven reports were identified using conivaptan as monotherapy or adjunctive treatment for hyponatremia in a neurosurgical patient population. One study was a prospective, randomized, controlled trial, while 6 reports were case reports or case series. The prospective randomized trial found a significant increase in serum sodium concentration over baseline with a conivaptan 20-mg intravenous bolus dose followed by a 20-mg/day continuous infusion for 24 hours compared to "usual care" at 6 hours (7.0 ± 1.7 vs -0.6 ± 2.1 mEq/L, respectively; p = 0.008) and 36 hours (8.0 ± 5.6 vs -1.7 ± 2.1 mEq/L, respectively; p = 0.05) after treatment. One case series found that the mean serum sodium remained significantly increased from baseline up to 72 hours (5.12 ± 4.0 mEq/L; p < 0.001) after a single conivaptan 20-mg intravenous bolus dose. All reports demonstrated clinical effectiveness of conivaptan in significantly increasing serum sodium concentrations following administration compared to baseline. However, the clinical significance of this finding remains debatable since some of these patients remained hyponatremic.
Overall, conivaptan is a promising and well-tolerated agent for the management of hyponatremia in neurologic and neurosurgical patients. However, its use should be limited to patients in whom conventional therapies fail or as adjunctive therapy.
综述评估在神经和神经外科成年患者人群中应用盐酸考尼伐坦治疗低钠血症的临床安全性和疗效的文献。
使用 MEDLINE、EMBASE、PubMed 和 Cochrane 对照试验中心注册库（1966 年 5 月至 2013 年）进行文献检索。检索限定为英文、人类和成人，使用术语血管加压素受体拮抗剂、盐酸考尼伐坦、托伐普坦、利伐普坦、神经病学、神经障碍、神经外科学、神经重症监护和神经危重症监护。
所有病例报告、病例系列和临床试验均纳入了对神经外科患者应用盐酸考尼伐坦的研究。
通过盐酸考尼伐坦单药或联合治疗神经外科患者低钠血症，共鉴定出 7 项研究。其中一项研究为前瞻性、随机、对照试验，而其余 6 项为病例报告或病例系列。前瞻性随机试验发现，与“常规治疗”相比，在 6 小时（分别为 7.0 ± 1.7 对-0.6 ± 2.1 mEq/L；p = 0.008）和 36 小时（分别为 8.0 ± 5.6 对-1.7 ± 2.1 mEq/L；p = 0.05）时，用 20 mg 盐酸考尼伐坦静脉推注 1 次后，血清钠浓度较基线明显升高。1 项病例系列研究发现，单次给予 20 mg 盐酸考尼伐坦静脉推注后，平均血清钠浓度直至 72 小时（5.12 ± 4.0 mEq/L；p < 0.001）仍明显高于基线。所有报告均表明与基线相比，在给予盐酸考尼伐坦后，血清钠浓度显著升高，提示其临床疗效确切。然而，由于部分患者仍存在低钠血症，该发现的临床意义仍存在争议。
总的来说，盐酸考尼伐坦是治疗神经和神经外科患者低钠血症的一种有前途且耐受性良好的药物。但是，应将其使用限制在常规治疗失败或作为辅助治疗的患者。
