Tolvaptan
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Thirst, hepatotoxicity and creatine kinase elevation: 2 case reports In a case series, a 41-year-old man developed thirst, hepatotoxicity and creatine kinase (CK) elevation, and a 43-year-old man developed CK elevation during treatment with tolvaptan for autosomal dominant polycystic kidney disease (ADPKD) [not all durations of treatments to reactions onsets and outcomes stated]. Case 1: A 41-year-old man was diagnosed with familial ADPKD at the age of 34. He had a history of hypertension and cysts in the kidney and liver. Thereafter, due to the rapidly progressive ADPKD, he was started on oral tolvaptan 45mg in the morning and 15mg in the evening (45-0-15). He tolerated the tolvaptan treatment well except for the development of thirst. Twenty days after the initiation of treatment, blood tests evaluated the development of tolvaptan-associated hepatotoxicity and CK elevation. Additionally, an elevation in lactate dehydrogenase (LDH) was noted without any clinical symptoms. The cause of CK elevation was not found and his tolvaptan treatment was discontinued. Four weeks later, his CK and LDH levels recovered to normal and he felt better than before. Case 2: A 43-year-old man was diagnosed with familial ADPKD at the age of 34. He had numerous cysts in kidneys and had kidneys bigger than normal. He showed normal laboratory tests without liver cysts. On 4 May 2019, due to the rapidly progressive ADPKD, he was started on oral tolvaptan 45mg in the morning and 15mg in the evening (45-0-15). After the completion of 17 doses of treatment, blood tests evaluated the development of 5–6 fold elevation in CK levels. Additionally, moderate elevation in LDH was noted without any clinical symptoms. Therefore, his tolvaptan treatment was discontinued. Six weeks later, his CK and LDH levels recovered to normal. Agraz-Pamplona I, et al. Case report: tolvaptan-associated creatine kinase elevation in two patients with autosomal dominant polycystic kidney disease (ADPKD). European 803504470 Journal of Clinical Pharmacology 76: 1473-1475, No. 10, Oct 2020. Available from: URL: http://doi.org/10.1007/s00228-020-02906-z
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Reactions 3 Oct 2020 No. 1824
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