Drug interactions -summary

CYP3A4 inhibitors eg clarithromycin, indinavir, itraconazole, ketoconazole,ritonavir- + Conivinaptan
coadministration of convinaptan and these agents is contraindicated

Convinaptan +  CYP3A4  substrates eg. amlodipine, atorvastatin, convastatin, midazolam ,
simavastain-
convinaptan is a potent inhibitor and may increase plasma concentration of coadministred drugs
that are primarily metabolized by CYP3A4

Conivaptan + Digoxin-
coadministration of convinaptan and digoxin resulted in 30% redution in clearance and a
79% increase in digoxin Cmax and AUC values respy.

Euvolemic and hypervolemic hypernatremia

Cardiovascular-      atrial fibrilation 2%     ECG ST segment depression 5%  
                                 hypertension  NOS  8%           hypotension  NOS 8%
                                orthostatic hypotension   13%

CNS -                     headache  7%  insominia  5%

GI-                          constipation   8%  nausea  3%        post-procedural diarrhea  5%
                               thirst   3%              vomiting  5%

Local-                   infusion site phebitis     51%     infusion reaction  22%  

Metabolic/nutrional -     hypokalemia    22%       hypomagnesimia   5%   hyponatremia  8%

Respiratory -             pharyngeal pain     5%   pneumonia  5%

Miscellaneous-        Anemia NOS  5%   peripheral edema  3%   pruritus  5%   pyrexia 11%
                                 urinary tract infection NOS   5%
                  

Coadministration with potent CYP3A4 eg ketoconazole, clarithromycin,ritonavir

Special Precaution-
Congestive heart failure- conivaptan is not indicated for treatment of patients with congestive
heart failure. Only use convinaptan for treatment of hyponatremia  in patients with underlying
heart failure when the expected clinical benifit of raising serum sodium outweighs  increased
risk of adverse reactions for heart patients

Rapid correction of serum sodium- ostmotic demyelination syndrome has been reported following
rapid correction of low serum concentration
 
Renal  function impairment- excercise caution when administering convinaptan to patients
with renal function impairment

Hepatic function impairment- excercise caution when administering convinaptan to patients
 with  renal function impairment

Pregnancy- appraise patients of the potential hazard to the fetus.

Lactation- excercise caution when convinaptan is administred to breast feeding woman.

Children- safety and efficacy of convinaptan in children have not been studied

Monitoring- patients receiving convinaptan must have frequent monitoring  of serum sodium,
 neurologic status. 

Indication-

Euvolemic and hypervolemic hypernatremia

Dosage-
The loading dose should be followed by conivaptan 20mg administred as a continuous IV infusion
throughout the 24- hour period.
Following the day of treatment convinaptan to be administred for an additional 1 to 3 days
in a continuous infusion of 20mg/day

1. This medicine may cause light headedness, or fainting. Advice patients not                         to drive, operate  machinery, or do anything else that could be dangerous until                           they know how  they  react to  this medicine.

2. This medicine may cause harm to the fetus, If the patient may be pregnant,                       discuss the benefits the  risks of using this medicine during pregnancy.

3. It is not known whether this medicine is found in the breast milk. Advice                          patients to check with  their health care provider if they are or will be                                        breast-feeding while using this medicine and to discuss any possible risks                             to the baby. 

Pregnancy-
Appraise patients of the potential hazard to the fetus.

Lactation-
Excercise caution when convinaptan is administred to breast feeding woman.

Children-
Safety and efficacy of convinaptan in children have not been studied