Classifications: electrolytic & water balance agent; diuretic; vasopressin antagonist; Therapeutic:vasopressin antagonist; diuretic
Pregnancy Category: C
5 mg/mL solution for injection
Conivaptan is a vasopressin receptor (V2) antagonist that reduces the effect of vasopressin in the kidney, thus increasing
the excretion of free water into the renal collecting ducts.
Conivaptan increases urine output and decreases urine osmolality in patients with euvolemic hyponatremia, thus restoring
serum sodium balance.
Treatment of euvolemic hyponatremia (e.g., syndrome of inappropriate secretion of antidiuretic hormone, or SIADH) in hospitalized
Hypersensitivity to conivaptan; CHF; hyponatremia associated with hypovolemia; hypotension, syncope; intravenous use only;
concurrent administration of potent CYP3A4 inhibitors such as ketoconazole, itraconazole, ritonavir, etc.; pregnancy (category
C), lactation. Safety and efficacy in children not established.
Renal or hepatic function impairment.
Route & Dosage
Adult: IV 20 mg loading dose followed by 20 mg IV over 24 h. May repeat 20 mg/day dose for 13 d, or may titrate up to 40 mg/d
based on response. Total duration of infusion should not exceed 4 d.
PREPARE: IV Infusion: Use a filter needle when withdrawing a drug from an ampule. Loading dose infusion: Withdraw 4 mL (20 mg) from one ampule
and add to 100 mL of D5W. Gently invert the bag several times to mix. Initial maintenance infusion: Withdraw 4 mL (20 mg) from one ampule and add to 250 mL of D5W. Gently invert the bag several times to mix. Maximum maintenance dose infusion: Withdraw 8 mL (40 mg) from two ampules and add to 250 mL of D5W. Gently invert the bag several times to mix.
ADMINISTER: IV Infusion: Give via a large vein and change infusion site every 24 h. Loading dose: Give over 30 min. Maintenance dose: Give over 24 h. Frequently monitor the serum sodium level. A reduction in dose or discontinuation of infusion may be required
if the serum sodium rises too rapidly. Discontinue infusion immediately and notify physician of a rise in serum sodium >12
mEq/L/24 h. DO NOT resume infusion if serum sodium continues to rise. Infusion may be resumed ONLY if hyponatremia persists
or reoccurs and patient demonstrates no indication of neurologic impairment. If the serum sodium rises too slowly, the dose
may be titrated up to 40 mg over 24 h.
INCOMPATIBILITIES Solution/additive: Lactated Ringer's solution, sodium chloride 0.9%. Y-site: None listed.
Body as a Whole:
- Store vials at 25° C (77° F). Ampules should be stored in the original container and protected from light until
ready for use. After diluting with D5W, the solution should be used immediately, with infusion completed within 24 h of
Cannula-site reaction, infusion-site reaction,
pain, peripheral edema, pyrexia, thirst. CNS:
Confusional state, headache, insomnia
. CV: Atrial fibrillation,
hypertension, hypotension, orthostatic hypotension, phlebitis. GI: Constipation
, dry mouth, nausea, vomiting. Hematologic: Anemia
Dehydration, hyperglycemia, hypoglycemia
hypomagnesemia, hyponatremia. Respiratory: Pneumonia
. Skin: Erythema
. Special Senses:
Compounds that inhibit CYP3A4 (e.g., ketoconazole, itraconazole, clarithromycin, ritonavir, indinavir
) can increase conivaptan levels. Conivaptan can increase the levels of digoxin
and drugs that require CYP3A4 for metabolism
(e.g., midazolam, hmg coa reductase inhibitors
). Food: Grapefruit juice
may increase the level of conivaptan. Herbal: St. John's wort
may decrease the level of conivaptan.
99% protein bound. Metabolism:
Extensive hepatic metabolism
Primarily fecal elimination (83%) with minor renal
Assessment & Drug Effects
- Monitor infusion site for erythema, phlebitis, or other site reaction.
- Monitor vital signs and neurologic status frequently; report immediately S&S of hypernatremia (see Appendix F).
- Lab tests: Baseline and frequent serum sodium, serum potassium, and urine osmolality.
- Monitor digoxin blood levels with concurrent therapy and assess for S&S of digoxin toxicity.
- Monitor I&O closely. Effective treatment is accompanied by increased urine output, whereas decreasing urine output and oliguria
may indicate developing hypernatremia.
Patient & Family Education
- Report any of the following to a health care provider: pain at the infusion site, dizziness, confusion, palpitations, swelling
of hands or feet.