Tolvaptan-induced Liver Injury: Who is at Risk? A Case Report and Literature Review.
Muhammad Y Khan1, Muhammad Shabbir Rawala2, Maryam Siddiqui1
1Internal Medicine, Unitypoint Health, Rock Island, USA.
Cureus
|August 15, 2019
Summary
Tolvaptan, used for Syndrome of Inappropriate Antidiuretic Hormone (SIADH), can cause rare liver injury. This case highlights the need for caution with tolvaptan in elderly patients due to potential hepatotoxicity.
Area of Science:
- Internal Medicine
- Clinical Pharmacology
- Hepatology
Background:
- Hyponatremia is a frequent hospital condition, with SIADH being a primary cause.
- Tolvaptan is a vasopressin receptor antagonist approved for treating SIADH.
Observation:
- A case study involving an elderly female patient with hyponatremia.
- The patient developed cholestatic liver injury after receiving two 15mg doses of tolvaptan.
Findings:
- Elevated total bilirubin and alkaline phosphatase levels were observed post-tolvaptan administration.
- The patient's liver enzymes improved after discontinuing tolvaptan, suggesting drug-induced hepatotoxicity.
Implications:
- This case underscores the potential for tolvaptan to cause idiosyncratic hepatotoxicity, even at low doses.
- Cautious use of tolvaptan is recommended in elderly patients, particularly those with SIADH, due to the risk of liver injury.
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