Cargando…

Role of tolvaptan in the management of hyponatremia in patients with lung and other cancers: current data and future perspectives

Hyponatremia is the most frequently observed electrolyte abnormality in clinical practice, and its frequency is almost double in hospitalized cancer patients. As a subset of cancer, hyponatremia is quite common in lung cancer patients, and it is often coupled with the diagnosis of syndrome of inappr...

Descripción completa

Detalles Bibliográficos
Autores principales: Thajudeen, Bijin, Salahudeen, Abdulla K
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Dove Medical Press 2016
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5001656/
https://www.ncbi.nlm.nih.gov/pubmed/27578998
http://dx.doi.org/10.2147/CMAR.S90169
_version_ 1782450460956819456
author Thajudeen, Bijin
Salahudeen, Abdulla K
author_facet Thajudeen, Bijin
Salahudeen, Abdulla K
author_sort Thajudeen, Bijin
collection PubMed
description Hyponatremia is the most frequently observed electrolyte abnormality in clinical practice, and its frequency is almost double in hospitalized cancer patients. As a subset of cancer, hyponatremia is quite common in lung cancer patients, and it is often coupled with the diagnosis of syndrome of inappropriate antidiuretic hormone secretion. The presence of hyponatremia is consequential in that its presence adversely affects cancer patients’ prognosis and outcomes. Limited data suggest that correcting hyponatremia in lung cancer patients can increase response to anticancer treatment, may help reduce length of hospital stay and cost, and reduce morbidity and mortality. The type of treatment for hyponatremia depends on several factors; the key factors are the duration and severity of neurological symptoms of hyponatremia and the status of extracellular volume. When hyponatremia is caused by syndrome of inappropriate antidiuretic hormone, hypertonic saline is indicated for acute symptomatic cases, whereas fluid restriction is recommended in chronic asymptomatic hyponatremia. The latter allows a slower rate of correction, thus avoiding the dreaded complication of osmotic demyelination syndrome. Fluid restriction is, however, insufficient or impractical, and often the use of pharmacological therapy such as antidiuretic hormone receptor antagonists becomes necessary. Availability of these antagonists as an effective treatment in the management of hyponatremia has been a major breakthrough, and furthermore, its clinical or investigational use in cancer-related hyponatremia may offer a potential opportunity to gain further insights into the prognostic impact of hyponatremia correction on cancer patients’ outcomes. Tolvaptan is a prototype of ADH receptor antagonists that acts at renal tubular levels to increase free water excretion without inducing major systemic electrolyte abnormalities such as hypokalemia or alkalosis. The aim of this paper is to provide a brief review while focusing on cancer hyponatremia; (1) of the epidemiology of hyponatremia and its pathophysiology and diagnostic approaches and (2) of the pharmacokinetics of tolvaptan and its clinical efficacy, safety, and compliance.
format Online
Article
Text
id pubmed-5001656
institution National Center for Biotechnology Information
language English
publishDate 2016
publisher Dove Medical Press
record_format MEDLINE/PubMed
spelling pubmed-50016562016-08-30 Role of tolvaptan in the management of hyponatremia in patients with lung and other cancers: current data and future perspectives Thajudeen, Bijin Salahudeen, Abdulla K Cancer Manag Res Review Hyponatremia is the most frequently observed electrolyte abnormality in clinical practice, and its frequency is almost double in hospitalized cancer patients. As a subset of cancer, hyponatremia is quite common in lung cancer patients, and it is often coupled with the diagnosis of syndrome of inappropriate antidiuretic hormone secretion. The presence of hyponatremia is consequential in that its presence adversely affects cancer patients’ prognosis and outcomes. Limited data suggest that correcting hyponatremia in lung cancer patients can increase response to anticancer treatment, may help reduce length of hospital stay and cost, and reduce morbidity and mortality. The type of treatment for hyponatremia depends on several factors; the key factors are the duration and severity of neurological symptoms of hyponatremia and the status of extracellular volume. When hyponatremia is caused by syndrome of inappropriate antidiuretic hormone, hypertonic saline is indicated for acute symptomatic cases, whereas fluid restriction is recommended in chronic asymptomatic hyponatremia. The latter allows a slower rate of correction, thus avoiding the dreaded complication of osmotic demyelination syndrome. Fluid restriction is, however, insufficient or impractical, and often the use of pharmacological therapy such as antidiuretic hormone receptor antagonists becomes necessary. Availability of these antagonists as an effective treatment in the management of hyponatremia has been a major breakthrough, and furthermore, its clinical or investigational use in cancer-related hyponatremia may offer a potential opportunity to gain further insights into the prognostic impact of hyponatremia correction on cancer patients’ outcomes. Tolvaptan is a prototype of ADH receptor antagonists that acts at renal tubular levels to increase free water excretion without inducing major systemic electrolyte abnormalities such as hypokalemia or alkalosis. The aim of this paper is to provide a brief review while focusing on cancer hyponatremia; (1) of the epidemiology of hyponatremia and its pathophysiology and diagnostic approaches and (2) of the pharmacokinetics of tolvaptan and its clinical efficacy, safety, and compliance. Dove Medical Press 2016-08-22 /pmc/articles/PMC5001656/ /pubmed/27578998 http://dx.doi.org/10.2147/CMAR.S90169 Text en © 2016 Thajudeen and Salahudeen. This work is published and licensed by Dove Medical Press Limited The full terms of this license are available at https://www.dovepress.com/terms.php and incorporate the Creative Commons Attribution – Non Commercial (unported, v3.0) License (http://creativecommons.org/licenses/by-nc/3.0/). By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed.
spellingShingle Review
Thajudeen, Bijin
Salahudeen, Abdulla K
Role of tolvaptan in the management of hyponatremia in patients with lung and other cancers: current data and future perspectives
title Role of tolvaptan in the management of hyponatremia in patients with lung and other cancers: current data and future perspectives
title_full Role of tolvaptan in the management of hyponatremia in patients with lung and other cancers: current data and future perspectives
title_fullStr Role of tolvaptan in the management of hyponatremia in patients with lung and other cancers: current data and future perspectives
title_full_unstemmed Role of tolvaptan in the management of hyponatremia in patients with lung and other cancers: current data and future perspectives
title_short Role of tolvaptan in the management of hyponatremia in patients with lung and other cancers: current data and future perspectives
title_sort role of tolvaptan in the management of hyponatremia in patients with lung and other cancers: current data and future perspectives
topic Review
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5001656/
https://www.ncbi.nlm.nih.gov/pubmed/27578998
http://dx.doi.org/10.2147/CMAR.S90169
work_keys_str_mv AT thajudeenbijin roleoftolvaptaninthemanagementofhyponatremiainpatientswithlungandothercancerscurrentdataandfutureperspectives
AT salahudeenabdullak roleoftolvaptaninthemanagementofhyponatremiainpatientswithlungandothercancerscurrentdataandfutureperspectives