Adult Dosing
Euvolemic and hypervolemic hyponatremia (conivaptan)
- Start 20 mg loading dose IV for 30 min, followed by 20 mg/day IV as a continuous infusion for 24 hrs x 1-3 days
- Titrate the dose to 40 mg/day as a continuous infusion, if serum sodium is not rising at desired rate
- Max dose: 40 mg/day
Note: Total duration after loading dose should not exceed 4 days
Euvolemic and hypervolemic hyponatremia (conivaptan in 5% dextrose in plastic container)
- Initial 20 mg/100 mL loading dose IV for 30 min, followed by 20 mg/100 mL/day IV as a continuous infusion for 24 hrs x 1-3 days
Pediatric Dosing
- Safety and effectiveness in pediatric population have not been established
[Outline]
Renal Dose Adjustment (Based on CrCl)
- >60 mL/min: No dose adjustment
- Moderate renal impairment (30-60 mL/min): Start 10 mg loading dose IV for 30 min followed by a continuous infusion of 10 mg over 24 hours x 2-4 days. Titrate the dose to 20 mg for 24 hours as a continuous infusion, if serum sodium is not rising at desired rate
- Severe renal impairment: Contraindicated
Hepatic Dose Adjustment
- Hepatic impairment (Child-Pugh Class A-C): Start 10 mg loading dose IV for 30 min followed by a continuous infusion of 10 mg over 24 hours x 2-4 days. Titrate the dose to 20 mg for 24 hours as a continuous infusion if serum sodium is not rising at desired rate
- Safety in hypervolemic hyponatremia patients with underlying heart failure has not been established. Conivaptan should be used to raise serum sodium in such patients only after consideration of other treatment options
- Rapid increase in serum sodium (more than 12 mEq/L per 24 h) may result in osmotic demyelination syndrome causing dysarthria, mutism, dysphagia, lethargy, affective changes, spastic quadriparesis, seizures, coma or death. In such susceptible patients, use slower rates of correction
- Monitor serum sodium concentration and neurologic status during therapy. Discontinue the therapy if patient develops an overly rapid rate of rise of serum sodium
- Do not resume conivaptan if serum sodium continues to rise. May resume conivaptan at a reduced dose if hyponatremia persists or recurs after initial discontinuation of conivaptan and patient has had no evidence of neurologic sequelae
- Avoid concomitant use of conivaptan with drugs eliminated primarily by CYP3A-mediated metabolism
- Co-administration of digoxin with oral conivaptan may lead to increase in digoxin level, monitor digoxin levels
- Adjust the dose in patients with moderate hepatic impairment
- Contraindicated in patient with severe renal impairment
- Administer conivaptan only via large veins following proper dilution. Rotate injection sites every 24 hrs
- Monitor serum sodium, vital signs, volume status, and neurologic status during conivaptan administration. Frequently assess administration site for reactions
Cautions: Use cautiously in
- Renal impairment
- Hepatic impairment
- Alcoholism
- Malnutrition
Pregnancy Category:C
Breastfeeding: Safety unknown. Manufacturer recommends discontinuation of nursing or discontinuation of drug, taking into account the importance of the drug to the mother.
US Trade Name(s)
- Vaprisol
- Vaprisol in 5% dextrose in plastic container
US Availability
Vaprisol
Vaprisol in 5% dextrose in plastic container
Canadian Trade Name(s)
Canadian Availability
UK Trade Name(s)
UK Availability
Australian Trade Name(s)
Australian Availability
[Outline]
