skip to main content

Tolvaptan Hepatotoxicity ADPKD — ESENeph MCQ

Instant feedback + full explanation. One question, done properly.

ModeratePolycystic Kidney DiseaseTolvaptan Hepatotoxicity ADPKDESENeph

A 50-year-old man with ADPKD has been on Tolvaptan for 2 years. His eGFR has declined from 50 to 45 mL/min/1.73m2. His ALT is 120 U/L (3x upper limit of normal, previously normal). What action is required?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: C — Immediately stop Tolvaptan and investigate hepatotoxicity; do not rechallenge if confirmed drug-related

Tolvaptan carries a risk of clinically significant hepatotoxicity (elevated ALT/AST, rarely liver failure). NICE TA877 and the Tolvaptan SPC mandate regular LFT monitoring (monthly for 18 months, then 3-monthly). If ALT rises to >3x ULN, Tolvaptan must be stopped immediately and the patient investigated. Rechallenge is not recommended if hepatotoxicity is confirmed as drug-related. The mechanism involves idiosyncratic hepatocellular injury.

Reference: NICE TA877 2022 – Tolvaptan for ADPKD; Tolvaptan (Jynarque) SPC