Role of tolvaptan to treat acute heart failure

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Ratthaphon Chitthai
Bancha Satirapoj


Acute decompensated heart failure is a common condition that increases morbidity and cardiovascular mortality. Most patients often suffer from dyspnea. The main treatments are to treat precipitating causes of acute heart failure and to use diuretics to eliminate water and salt from the body. After a high dose of diuretic treatment for several patients, the signs and symptoms of acute heart failure cannot be improved and some side effects from hypokalemia, metabolic alkalosis, and worsening renal function develop. For those reasons, a new oral vasopressin receptor antagonist (VRA), i.e., tolvaptan, has been developed. It decreases the function of the aquaporin 2 channel at the distal collecting duct, inhibits reabsorption of water, and produces a clear aquaretic effect. Tolvaptan has been approved by the United States Food and Drug Administration to treat hypervolemic hyponatremia from heart failure and euvolemic hyponatremia from the syndrome of inappropriate antidiuretic hormone. Furthermore, several clinical studies show that tolvaptan improves congestive symptoms, promotes weight loss, increases urine output in patients with heart failure without affecting other electrolytes and maintains renal function.


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Chitthai, R., & Satirapoj, B. (2022). Role of tolvaptan to treat acute heart failure. Journal of the Nephrology Society of Thailand, 28(2), 4–16. Retrieved from
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