New horizons in the pharmacologic approach to hyponatremia: the V2 receptor antagonists

This article provides an overview of the developing niche for vasopressin 2 receptor antagonists ("vaptans") in the management of hyponatremia in clinical practice. Specific areas of focus include the physiological and clinical rationale for use of this class of medications (including advantages over older and less specific therapeutic modalities), the practical limitations to the use of these new drugs (including issues of tolerability, toxicity, risk, and cost), and the unanswered question of the extent to which correcting hyponatremia will improve clinical outcomes.