ABSTRACT
To investigate the relationship between the exposure and efficacy of tolvaptan, we measured pharmacokinetics of total drug at 7 days after repeated doses of 3.75 mg/day tolvaptan in 16 patients with hepatic edema. Nine patients (56.3%) were responders, which were defined as those with body weight reduction of >1.5 kg/week. Serum albumin levels were significantly lower in responders than in non-responders (P = 0.031). However, the pharmacokinetics varied greatly among individuals and was not relevant to the clinical response.
Subject(s)
Antidiuretic Hormone Receptor Antagonists/pharmacokinetics , Antidiuretic Hormone Receptor Antagonists/therapeutic use , Ascites/drug therapy , Ascites/metabolism , Edema/drug therapy , Edema/metabolism , Liver Cirrhosis/drug therapy , Liver Cirrhosis/metabolism , Liver Diseases/drug therapy , Liver Diseases/metabolism , Tolvaptan/pharmacokinetics , Tolvaptan/therapeutic use , Adult , Aged , Aged, 80 and over , Antidiuretic Hormone Receptor Antagonists/blood , Ascites/complications , Edema/complications , Female , Humans , Liver Cirrhosis/complications , Liver Diseases/complications , Male , Middle Aged , Serum Albumin/metabolism , Tolvaptan/blood , Treatment OutcomeABSTRACT
AIM: The indocyanine green (ICG) finger-piece method (FPM), which allows measurement of the ICG concentration by mounting a light sensor onto a finger, is used to assess liver function. We compared the ICG FPM with the conventional ICG blood sampling method (BSM) in patients with liver disorders. METHODS: Ninety consecutive patients simultaneously underwent the ICG BSM and ICG FPM. After ICG administration, blood samples were collected at 5, 10, and 15 min for the ICG BSM. The ICG concentration was measured through the finger piece by an ICG clearance meter. RESULTS: Seventy-one patients (78.9%) had Child-Pugh class A liver disease, and 19 (21.1%) had class B or C. The FPM-measured ICG plasma disappearance rate was positively correlated with the BSM-measured values (r = 0.886, P < 0.001). Bland-Altman analysis showed good agreement between the two methods (mean difference, 0.012 ± 0.018). The FPM-measured ICG plasma disappearance rate was positively correlated with the BSM-measured values both in patients with Child-Pugh class A liver disease (r = 0.821, P < 0.001) and class B or C liver disease (r = 0.859, P < 0.001). CONCLUSION: The ICG FPM may be an alternative to the ICG BSM for liver function assessment.
