Review of Pharmacology - 9E (2015)

Kidney
Amiloride
It is the agent of choice for the treatment of Lithium induced DI.
VASOPRESSIN RECEPTOR ANTAGONISTS
• V 1
receptor antagonists may be useful when total peripheral resistance is increased
(e.g. CHF and hypertension) whereas V 2
antagonists may be useful for the
treatment of SIADH.
• Relcovaptan is selective V 1
antagonist whereas lixivaptan, mozavaptan and
tolvaptan are V 2
selective antagonists.
• Conivaptan is V 1a
/V 2
receptor antagonist used as an aquaretic (increase water
excretion without affecting electrolytes like sodium) in CHF.
• Conivaptan is administered by i.v. injection whereas lixivaptan and tolvaptan
can be given orally.
syndrome of inappropriate adh secretion (siadh)
ADH is secreted in response to hypovolumeia, in which case its secretion is appropriate.
However, if ADH is secreted in high quantities in the presence of euvolemia or
hypervolemia, it is called inappropriate secretion (siadh). The resultant water
retention can result in hyponatremia. Thus, SIADH is characterized by normovolemic or
hypervolemic hyponatremia.
• Fluid restriction is treatment of choice for SIADH.
• Hypertonic saline (3% NaCl) + loop diuretics (depending upon volume status) is
treatment of choice for severe symptomatic hyponatremia.
• Among drugs, tolvaptan (oral), conivaptan (i.v.) are preferred for long-term use.
• Alternatives are demeclocycline and lithium (not preferred now).
General Kidney Pharmacology
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