Tolvaptan for Volume Management in Heart Failure.
Pharmacotherapy. 2019 Feb 25;:
Authors: Gunderson EG, Lillyblad MP, Fine M, Vardeny O, Berei TJ
Volume management in acute decompensated and chronic heart failure remains a significant challenge. While there has been progress in development of mortality reducing neurohormonal regimens in the reduced ejection fraction population, there has yet to be a clinical trial demonstrating anything more than symptomatic relief or biomarker reduction with pharmacotherapeutic, volume-based interventions made in the acutely decompensated individual or those with evolving outpatient congestion. As the number of patients with heart failure continues to grow, in addition to heart failure related hospitalizations, identifying therapies that have the potential to more safely and efficaciously aid in diuresis is paramount to decreasing inpatient length of stay and preventing unnecessary admissions. More recently, there has been a significant amount of research dedicated to the use of vasopressin antagonists, specifically tolvaptan, as adjunctive therapy to loop and thiazide diuretics. Though these agents do not seem to have a pervasive role in fluid management in the acute decompensated and chronic heart failure populations, they are effective tools to have available for specific clinical situations. This review aims to summarize literature surrounding the use of tolvaptan for volume management in congestive heart failure, as well as offer practical guidance for utilization of this agent. This article is protected by copyright. All rights reserved.
PMID: 30802995 [PubMed - as supplied by publisher]