Goto Atsushi, Terai Shuji, Nakamura Munetaka, Matsumoto Masaharu, Sakaida Isao
Department of Gastroenterology and Hepatology, Hagi Civil Hospital, Tsubaki 3460-3, Hagi, Yamaguchi, 758-0061, Japan.
Clin J Gastroenterol. 2015 Feb;8(1):47-51. doi: 10.1007/s12328-014-0545-8. Epub 2014 Dec 5.
Tolvaptan is a new drug used for treating ascites induced by liver cirrhosis, and it is covered by health insurance in Japan. In the present report, we describe the case of a 74-year-old man with type C liver cirrhosis and refractory ascites. He was receiving furosemide and spironolactone daily, but still required repeat puncture for ascites removal. Administration of tolvaptan (3.75 mg/day) was started in addition to his existing medications, and was subsequently increased to 7.5 mg/day. However, after 2 months, the ascites again exacerbated. Nevertheless, after we discontinued the administration of furosemide, the tolvaptan became effective. This may be because furosemide administration decreases urine osmolality, resulting in a non-response to tolvaptan.
托伐普坦是一种用于治疗肝硬化引起的腹水的新药，在日本已被纳入医保。在本报告中，我们描述了一名74岁丙型肝硬化伴难治性腹水男性患者的病例。他每天接受呋塞米和螺内酯治疗，但仍需反复穿刺抽腹水。在其现有药物治疗基础上开始给予托伐普坦（3.75毫克/天），随后增加至7.5毫克/天。然而，2个月后，腹水再次加重。尽管如此，在我们停用呋塞米后，托伐普坦开始起效。这可能是因为使用呋塞米会降低尿渗透压，导致对托伐普坦无反应。
