Intended for healthcare professionals


New drugs for hyponatraemia

BMJ 2010; 341 doi: (Published 15 November 2010) Cite this as: BMJ 2010;341:c6219
  1. Anjali Amin, specialist registrar, diabetes and endocrinology,
  2. Karim Meeran, professor of endocrinology
  1. 1Imperial Centre for Endocrinology, London W6 8RF, UK
  1. a.amin{at}

Evidence is lacking that they are better than cheaper standard treatment

Hyponatraemia is the most common electrolyte abnormality, especially in patients in hospital,1 and it is associated with substantial morbidity and mortality.2 The causes of hyponatraemia are often difficult to ascertain and may be multifactorial. Treatment varies according to the cause, severity of symptoms, and speed of onset. Tolvaptan, a vasopressin 2 receptor antagonist, has recently been licensed in the United Kingdom for the treatment of hyponatraemia secondary to the syndrome of inappropriate antidiuretic hormone secretion.


Arginine vasopressin, also known as antidiuretic hormone, regulates the renal clearance of free water. Raised concentrations of arginine vasopressin cause the kidneys to retain water, and disorders of its release and regulation cause an imbalance in total body water. Vasopressin 2 receptors are found mainly in the collecting ducts of the kidneys, where they control free water reabsorption. These receptors have been targeted by non-peptide vasopressin 2 receptor antagonists, which promote the excretion of water without loss of electrolytes. These agents were originally developed for the treatment of hyponatraemia as a result of heart failure, decompensated cirrhosis, and the syndrome of inappropriate antidiuretic hormone secretion.

Tolvaptan was licensed after completion of …

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