Novel therapeutic strategy using tolvaptan for cirrhotic ascites

Therapeutic strategy for cirrhotic ascites in Japan has changed drastically since the drug was approved in 2013. Tolvaptan, an oral arginine vasopressin (AVP) V2 receptor antagonist, has been used as a new diuretic for ascites in combination with conventional diuretics. Tolvaptan has an indication in Japan for the treatment of fluid retention in patients with hepatic cirrhosis, experiencing difficulties or inadequacy with conventional diuretic treatments. Although the deterioration of renal function is frequently observed with conventional diuretic therapy, renal dysfunction has shown to be related with poor prognosis. Appropriate combination diuretic therapy using tolvaptan and conventional diuretics may offer the possibility to control ascites without deterioration of renal function. Further investigation will be necessary.