Liver Injury in vasopressin receptor antagonists

Q: Which of the following Vasopressin receptor antagonists should be used with extreme caution in patients with liver pathology? 

 A) tolvaptan 
B) mozavaptan 
C) satavaptan 
D) lixivaptan 
E) conivaptan


Answer: A

FDA has safety warnings for tolvaptan. Liver function test (LFT) should be obtained on any patient who is getting tolvaptan. This concern was raised when 2.5  fold increase in liver enzymes was noted while tolvaptan was getting studied for its efficacy on the progression of kidney failure in polycystic kidney disease.

#hepatology
#pharmacology
#nephrology



References:

1. Higashihara E, Torres VE, Chapman AB, et al. Tolvaptan in autosomal dominant polycystic kidney disease: three years' experience. Clin J Am Soc Nephrol 2011; 6:2499. 

2. Torres VE, Chapman AB, Devuyst O, et al. Tolvaptan in patients with autosomal dominant polycystic kidney disease. N Engl J Med 2012; 367:2407. Samsca (tolvaptan): Drug Warning - Potential Risk of Liver Injury

3. https://www.fda.gov/Drugs/DrugSafety/ucm350062.htm