medicina59巻12号

2022年11月発行

特集 避けて通れない心不全診療—総合内科力・循環器力を鍛えよう！ 急性心不全

トルバプタンの使い方を教えてください

著者： 宮原大輔¹ 北井豪¹

所属機関： ¹国立循環器病研究センター心臓血管内科

ページ範囲：P.2158 - P.2163

Point
◎トルバプタンはバソプレシンV₂受容体を介して水利尿を促す薬剤であり，浸透圧勾配により組織浮腫の改善が期待できる．
◎トルバプタンは，ループ利尿薬抵抗性の症例，腎機能障害例，血行動態が不安定な症例などへの効果が期待される．
◎静注薬として使用が可能になったサムタス^®に関しては，今後本邦からのエビデンス創出が期待される．

参考文献

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3）Koji T, et al：Differences in pharmacological property between combined therapy of the vasopressin V2-receptor antagonist tolvaptan plus furosemide and monotherapy of furosemide in patients with hospitalized heart failure. J Cardiol 76：499-505, 2020

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5）Konstam MA, et al：Effects of oral tolvaptan in patients hospitalized for worsening heart failure；The EVEREST outcome trial. JAMA 297：1319-1331, 2007

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8）Heidenreich PA：2022 AHA/ACC/HFSA Guideline for the management of heart failure；A report of the American College of Cardiology/American Heart Association Joint Committee on clinical practice guidelines. Circulation 145：e895-e1032, 2022

9）Theresa AM, et al：2021 ESC guidelines for the diagnosis and treatment of acute and chronic heart failure；Developed by the task force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology（ESC）with the special contribution of the Heart Failure Association（HFA）of the ESC. Eur Heart J 42：3599-3726, 2021

10）Inomata T, et al：Effects of additive tolvaptan vs. increased furosemide on heart failure with diuretics resistance and renal impairment；Results from the K-STAR study. Circ J 82：159-167, 2017

11）Matsue Y, et al：Clinical effectiveness of tolvaptan in patients with acute heart failure and renal dysfunction. J Card Fail 22：423-432, 2016.

12）Matsuzaki M, et al：Efficacy and safety of tolvaptan in heart failure patients with volume overload despite the standard treatment with conventional diuretics；A phase Ⅲ, randomized, double-blind, placebo-controlled study（QUEST study）. Cardiovasc Drugs Ther 25 Suppl 1：S33-45, 2011

13）Boorsma EM, et al：Renal compression in heart failure；The renal tamponade hypothesis. J Am Coll Cardiol HF 10：175-183, 2022

14）Shiraishi Y, et al：Time-sensitive approach in the management of acute heart failure. ESC Heart Failure 8：204-221, 2021

15）Imamura T, et al：Tolvaptan prolongs blockage of the vasopressin type Ⅱ receptor over 24 hours in responders with stage D heart failure. Int Heart J 57：41-46, 2016

16）Kinugawa K, et al：Tolerability of the intravenously administered tolvaptan prodrug, OPC-61815, in patients with congestive heart failure who have difficulty with, or are incapable of, oral intake（TRITON-HF）. Circ J 86：1068-1078, 2022