Vasopressin receptor antagonists in the management of acute heart failure

Vasopressin is a potent vasoconstrictor and plays a significant role in the regulation of volume homeostasis. Several non-peptide vasopressin receptor antagonists (vaptans) have emerged as promising drugs in the management of acute heart failure. Results of early trials with tolvaptan (selective vasopressin subtype 2 receptor antagonist) and conivaptan (dual vasopressin subtypes 1a and 2 receptor antagonist) have demonstrated improvement in the fluid status, osmotic balance and haemodynamic profile in patients with heart failure presenting with signs and symptoms of decompensation. Nevertheless, their comparative long-term safety and efficacy remains to be determined in large-scale clinical trials.