Intravenous tolvaptan equally safe and effective as oral formulation in severe acute heart failure patients: Study

The study showed that in the acute phase of acute decompensated heart failure, IV tolvaptan is equally effective and as safe as oral TLV in real-world clinical settings. Additionally, intravenous TLV was used in more severe cases, however, may be equally effective.

ADHF, a condition characterized by sudden worsening of heart failure symptoms, often requires intensive treatment to relieve fluid retention and improve cardiac function. Tolvaptan, which works by increasing free water excretion without significantly altering electrolyte balance, has become a crucial tool in managing fluid overload in these patients. Intravenous tolvaptan is newly available, but its clinical reports are scarce.

To fill this knowledge gap, Tomoaki Okada, Department of Cardiology, Kagawa Prefectural Central Hospital, Kagawa, Japan, and colleagues aimed to investigate the efficacy and safety of intravenous versus oral tolvaptan in the acute phase of acute decompensated heart failure.

The comparative study included ADHF patients admitted to several tertiary care hospitals across the country. They were randomly assigned to receive either IV tolvaptan or oral tolvaptan within 24 hours after admission. Their safety and efficacy were analyzed during hospitalization.

The key findings were as follows:

• Efficacy: No differences were noted in total urine volume and change in body weight between the two groups.
• Safety: The incidence of hypernatremia and worsening renal function (WRF) did not differ between the groups.

The study's findings may help optimize treatment strategies for patients with ADHF, particularly in emergency and intensive care settings. By elucidating the comparative efficacy and safety profiles of IV versus oral tolvaptan, healthcare providers can make informed decisions regarding the suitable route of administration based on individual patient needs and clinical circumstances.

Reference:

Okada T, Takagi W, Miyoshi T, Oka A, Seiyama K, Ugawa S, Nosaka K, Doi M. Efficacy and safety of intravenous versus oral tolvaptan in the acute phase of acute decompensated heart failure. J Cardiol. 2024 Jun 23:S0914-5087(24)00125-4. doi: 10.1016/j.jjcc.2024.06.008. Epub ahead of print. PMID: 38917874.