Slow the progression of kidney function decline in adults at risk of rapidly progressing autosomal dominant polycystic kidney disease (ADPKD)
藥理
Vasopressin Antagonist
藥動學
Distribution: Vd ~3 L/kg Protein binding: >98% Metabolism: Almost exclusively via CYP3A4 (none are pharmacodynamically active) Bioavailability: 56% (range: 42% to 80%) Time to peak, plasma: 2 to 4 hours Excretion: Feces: 59% (19% as unchanged drug); Urine: 40% (<1% as unchanged drug) Half-life elimination: 3 hours
禁忌症
1. Hypersensitivity (eg, anaphylactic shock, generalized rash) to tolvaptan or any component of the formulation 2. Concurrent use with strong CYP3A inhibitors 3. Use in patients unable to sense or appropriately respond to thirst
懷孕分類
C Adverse events were observed in animal reproduction studies.
哺乳分類
Breastfeeding is not recommended by the manufacturer.
Initial: 60 mg/day in divided doses (given as 45 mg upon wakening and 15 mg 8 hours later)
Titrate: 90 mg/day in divided doses (given as 60 mg upon wakening and 30 mg 8 hours later) to 120 mg/day in divided doses (given as 90 mg upon wakening and 30 mg 8 hours later), at least 7 days between titrations
Maintain urine osmolality of <300 mOsm/kg if possible; If the maximum dose is not tolerated, administration of a lower dose with the goal of achieving urine osmolarity of 250 to 300 mOsm/kg is reasonable
小兒調整劑量
腎功能調整劑量
CrCl >10 mL/minute: No dosage adjustment necessary. CrCl <10 mL/minute: Use not recommended (has not been studied); contraindicated in anuria.
肝功能調整劑量
Permanently discontinue therapy :1. ALT or AST >3 times ULN; ALT or AST >5 times ULN for >2 weeks; ALT or AST >8 times ULN at any time 2. Persistent symptoms of hepatic injury 3. Total bilirubin >2 times ULN 4. INR >1.5
Interrupt therapy, promptly evaluate hepatic function within 48 to 72 hours: ALT or AST increased or signs/symptoms of hepatoxicity: Continue testing as necessary; if laboratory abnormalities stabilize or resolve, treatment may be reinitiated with increased monitoring