Therapeutic Options in Managing Hyponatremia: Focus on Arginine Vasopressin Receptor Antagonists

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To describe the available and emerging treatment options for acute and chronic hyponatremia, including the efficacy, safety, and recommendations regarding appropriate use, monitoring, and treatment individualization.


Arginine vasopressin (AVP) receptor antagonists provide an opportunity to address some of the unmet medical needs of patients with hyponatremia. Traditional therapies, including diuretics, fluid restriction, and saline infusions, have variable effects, potential toxicities, and issues with patient adherence. Furthermore, these therapies are not specific to the underlying pathophysiology causing the hyponatremia. The recently approved AVP receptor antagonists target the underlying abnormal release of AVP that is very likely at the core of the physiology.


Management of hyponatremia requires balancing the benefits of therapeutic intervention for the restoration of normal serum sodium against the potential risks. The data available indicate that this new class of medications, the AVP receptor antagonists, can favorably affect serum sodium and clinical outcomes in patients with hypervolemic and euvolemic hyponatremia.

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