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Heart Failure Patient With Hypervolemic Hyponatremia


Hypervolemic hyponatremia in an elderly patient with acute decompensated heart failure*

Why VAPRISOL was chosen for treatment

  • For this patient with hypervolemic hyponatremia resulting from CHF, IV furosemide failed to raise serum sodium to normal range
  • Treatment with VAPRISOL was initiated to provide aquaresis and a demonstrated increase in serum sodium

Initial Presentation

A 75-year-old woman was admitted to the hospital with hyponatremia secondary to acute decompensated congestive heart failure (CHF) of several days’ onset, primarily attributed to medication noncompliance. Her ejection fraction (EF) was 20%.

Medical History

  • Chronic ischemic cardiomyopathy


  • Lisinopril
  • Carvedilol
  • Furosemide
  • Aspirin
  • Pravastatin

Patient’s progression from admission to discharge

  Serum K+
Serum Na+
Admission 4.0 124 IV furosemide was started.
Day 3 4.0 126 A 20-mg loading dose of VAPRISOL was started followed by a continuous infusion of 20 mg/day because serum sodium remained below normal.
Day 4 130 A second 24-hour continuous infusion of VAPRISOL 20 mg/day was initiated.
Day 5 4.2 136 Serum sodium increased and infusion of VAPRISOL was discontinued. Patient was discharged to home on previous drug therapy and diuretics.

*VAPRISOL has not been shown to be effective for the treatment of the signs and symptoms of heart failure and is not approved for this indication. Safety data on use of VAPRISOL in these patients is limited. Consider other treatment options.

†In clinical studies of VAPRISOL, the adverse event profile in elderly patients was similar to that seen in the general population.1

REFERENCE: 1. Vaprisol® [Package Insert] Cumberland Pharmaceuticals Inc. Nashville, TN 2016

Indication: VAPRISOL is indicated to raise serum sodium in hospitalized patients with euvolemic and hypervolemic hyponatremia.
Important Limitations: VAPRISOL has not been shown to be effective for the treatment of the signs and symptoms of heart failure and is not approved for this indication. It has not been established that raising serum sodium with VAPRISOL provides a symptomatic benefit to patients.


VAPRISOL is contraindicated in patients with hypovolemic hyponatremia. The coadministration of VAPRISOL with potent CYP3A inhibitors, such as ketoconazole, itraconazole, clarithromycin, ritonavir, and indinavir, is contraindicated. In addition, no benefit can be expected in patients unable to make urine.

Hyponatremia associated with heart failure: Safety data on the use of VAPRISOL in these patients are limited. Consider other treatment options.
Overly rapid correction of serum sodium: Monitor serum sodium, volume and neurologic status and if the patient develops an undesirably rapid rate of rise of serum, VAPRISOL should be discontinued. If serum sodium concentration continues to rise, VAPRISOL should not be resumed. Serious neurologic sequelae, including osmotic demyelination syndrome, can result from over rapid correction of serum sodium. In susceptible patients, including those with severe malnutrition, alcoholism or advanced liver disease, slower rates of correction should be used.
Hypovolemia or Hypotension: For patients who develop hypovolemia or hypotension while receiving VAPRISOL, VAPRISOL should be discontinued, and volume status and vital signs should be monitored.
Infusion site reactions: Serious reactions have occurred. Administer through large veins and change infusion site every 24 hours.

The most common adverse reactions (incidence ≥10%) reported in clinical trials were infusion site reactions (including phlebitis), pyrexia, hypokalemia, headache and orthostatic hypotension.

Potent CYP3A inhibitors may increase the exposure of conivaptan and are contraindicated. Generally avoid CYP3A substrates. Exposure to coadministered digoxin may be increased and digoxin levels should be monitored.

Use in Patients with Hepatic Impairment
In patients with moderate to severe hepatic impairment, initiate VAPRISOL with a loading dose of 10 mg over 30 minutes followed by 10 mg/day as a continuous infusion for 2 to 4 days. If no rise in serum sodium, VAPRISOL may be titrated upward to 20 mg/day.