Case Report|Articles in Press

Initial clinical experience of intravenous tolvaptan sodium phosphate in patients with congestive heart failure

Published:January 06, 2023DOI:


      Tolvaptan sodium phosphate (Samtas®; Otsuka Pharmaceutical, Tokyo, Japan) is a newly available intravenous aquaretic diuretic (commercially available from May 2022), which acts as an arginine vasopressin V2 receptor antagonist. Thus far, optimal patient selection as well as safety and efficacy in real-world practice remain unknown. We experienced two patients with congestive heart failure treated with tolvaptan sodium phosphate. In one patient with right-sided heart failure, oral tolvaptan was converted to intravenous tolvaptan sodium phosphate, and another one with right and left-sided heart failure and impaired swallowing function received intravenous tolvaptan sodium phosphate on a de novo basis. Following the initiation of tolvaptan sodium phosphate, their congestive symptoms ameliorated immediately without any complications. Tolvaptan sodium phosphate may be safe and effective in real-world practice, although further studies are warranted to establish optimal patient selection and clinical management.

      Learning objective

      We report here an initial experience of newly-introduced intravenous tolvaptan sodium phosphate in real-world practice. The novel medication might be particularly suitable for those with severe thirst, congestive gut edema, or requiring rapid amelioration of systemic/pulmonary congestion, although further accumulating experiences are warranted to establish optimal therapeutic strategy.


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        • Tsutsui H.
        • Isobe M.
        • Ito H.
        • Ito H.
        • Okumura K.
        • Ono M.
        • Kitakaze M.
        • Kinugawa K.
        • Kihara Y.
        • Goto Y.
        • Komuro I.
        • Saiki Y.
        • Saito Y.
        • Sakata Y.
        • Sato N.
        • et al.
        JCS 2017/JHFS 2017 guideline on diagnosis and treatment of acute and chronic heart failure - digest version.
        Circ J. 2019; 83: 2084-2184
        • McDonagh T.A.
        • Metra M.
        • Adamo M.
        • Gardner R.S.
        • Baumbach A.
        • Böhm M.
        • Burri H.
        • Butler J.
        • Čelutkienė J.
        • Chioncel O.
        • Cleland J.G.F.
        • Coats A.J.S.
        • Crespo-Leiro M.G.
        • Farmakis D.
        • Gilard M.
        • et al.
        2021 ESC guidelines for the diagnosis and treatment of acute and chronic heart failure.
        Eur Heart J. 2021; 42: 3599-3726
        • Gupta R.
        • Testani J.
        • Collins S.
        Diuretic resistance in heart failure.
        Curr Heart Fail Rep. 2019; 16: 57-66
        • Kinugawa K.
        • Sato N.
        • Inomata T.
        • Yasuda M.
        • Shimakawa T.
        • Fukuta Y.
        Real-world effectiveness and tolerability of tolvaptan in patients with heart failure - final results of the samsca post-marketing surveillance in heart failure (SMILE) study.
        Circ J. 2019; 83: 1520-1527
        • Kuragaichi T.
        • Sato Y.
        Temporal trends of a vasopressin V2 receptor antagonist in heart failure using a nationwide database in Japan.
        ESC Heart Fail. 2021; 8: 527-528
        • Sato N.
        • Uno S.
        • Yamasaki Y.
        • Hirano T.
        • Kim S.
        Pharmacokinetics, pharmacodynamics, efficacy, and safety of OPC-61815, a prodrug of tolvaptan for intravenous administration, in patients with congestive heart failure - a phase II, multicenter, double-blind, randomized, active-controlled trial.
        Circ J. 2022; 86: 699-708
        • Sato N.
        • Uno S.
        • Kurita Y.
        • Kim S.
        • OPTION-HF Investigators
        Efficacy and safety of intravenous OPC-61815 compared with oral tolvaptan in patients with congestive heart failure.
        ESC Heart Fail. 2022; 9: 3275-3286
        • Kinugawa K.
        • Nakata E.
        • Hirano T.
        • Kim S.
        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) - a phase III, multicenter, open-label trial.
        Circ J. 2022; 86: 1068-1078
        • Imamura T.
        • Kinugawa K.
        • Shiga T.
        • Kato N.
        • Muraoka H.
        • Minatsuki S.
        • Inaba T.
        • Maki H.
        • Hatano M.
        • Yao A.
        • Kyo S.
        • Nagai R.
        Novel criteria of urine osmolality effectively predict response to tolvaptan in decompensated heart failure patients–association between non-responders and chronic kidney disease.
        Circ J. 2013; 77: 397-404
        • Imamura T.
        • Kinugawa K.
        Urine aquaporin-2: a promising marker of response to the arginine vasopressin type-2 antagonist, tolvaptan in patients with congestive heart failure.
        Int J Mol Sci. 2016; 17: 105