Antagonis Reseptor Arginine Vasopressin: Harapan Baru dalam Penanganan Hiponatremia pada Pasien Gagal Jantung - Saepudin, Saepudin (Indonesian Journal of Clinical Pharmacy, 2015)
Pasien gagal jantung merupakan salah satu kelompok pasien yang memiliki risiko tinggi mengalami hiponatremia. Selain masalah diagnosis, permasalahan terapi juga banyak dijumpai dalam penanganan hiponatremia. Di tengah minimnya hasil uji klinis terapi konvensional untuk penanganan hiponatremia, hasil uji klinis obat-obat golongan antagonis reseptor arginine vasopressin atau yang dikenal dengan golongan vaptan membawa harapan baru untuk penanganan hiponatremia pada pasien gagal jantung. Tulisan ini merupakan hasil telaah pustaka terhadap artikel-artikel hasil penelitian dan pengkajian yang relevan yang ditelusuri dengan menggunakan kata kunci heart failure, hyponatremia, argininevasopressin, arginine-vasopressin receptor antagonist dan vaptan. Hasil uji klinis golongan vaptan pada pasien gagal jantung menunjukkan bahwa obat-obat tersebut secara efektif meningkatkan kadar natrium dalam darah dengan efek samping ringan yang umumnya dapat ditoleransi. Berdasarkan hasil uji klinis, conivaptan dan tolvaptan disetujui oleh Food and Drug Administration di Amerika untuk digunakan dalam penanganan hiponatremia pada pasien gagal jantung. Namun, banyak pakar mengajukan pertanyaan kritis terhadap hasil uji klinis obat-obat golongan vaptan ini dan masih meragukan penggunaannya untuk penanganan hiponatremia. Tulisan ini mengulas secara ringkas tentang hiponatremia pada pasien gagal jantung dan peran hormon arginine vasopressin (AVP), aspek farmakologi dan hasil uji klinis beberapa obat golongan vaptan, serta beberapa pertanyaan yang masih tersisa dari hasil uji klinis obat-obat tersebut.Kata kunci: Antagonis arginine vasopressin, arginine vasopressin, gagal jantung, hiponatremia, vaptanArginine-Vasopressin Receptor Antagonists: A New Hope for Treatment of Hyponatremia in Patients with Heart FailureHyponatremia is an important problem in patients with heart failure. It has also been known as a predictor both of short and long-term clinical outcome of heart failure patients. While evidences of clinical efficacy and safety of conventional options for treatment of hyponatremia resulted from clinical trials are very limited, several clinical trials have been conducted to evaluate the efficacy and safety of arginine vasopressin antagonists or also known as vaptan group. This paper reviews hyponatremia in patients with heart failure and the important roles of arginine vasopressin in its development, pharmacological aspects and clinical trials outcomes of some vaptans and several questions emerged from those clinical trials. Relevant research papers, reviews, and website information have been searched and included in this review using keyword of heart failure, hyponatremia, arginine-vasopressin, arginine-vasopressin receptor antagonist and vaptan. Generally, clinical trials have highlighted the efficacy and safety of vaptan groups in the management of hypervolemic hyponatremia in patients with heart failure. ThoseÂ drugs can effectively increase serum sodium level with tolerable adverse reactions. Based on those clinical data two drugs of vaptan group, conivaptan and tolvaptan, have been approved by Food and Drug Administration in The United States to be used for the treatment of euvolemic and hypervolemic hyponatremia. However, many experts are still hesitant to recommend vaptans as treatment of choice for hyponatremia due to the lack of patients-focused outcomes measurements.Keywords: Arginine vasopressin antagonist, heart failure, hyponatremia, vaptan