Tolvaptan is indicated for the treatment of clinically significant hypervolemic and euvolemic hyponatremia including patients with heart failure, cirrhosis, Syndrome of Inappropriate Antidiuretic Hormone (SIADH), ADPKD (Autosomal Dominant Polycystic Kidney Disease)
How it works
Tolvaptan is a vasopressin 2 receptor antagonist which is used for short term treatment of severe hyponatremia in patients with heart failure, cirrhosis or syndrome of inappropriate secretion of antidiuretic hormone (SIADH). It has been used experimentally to prevention progression of disease in autosomal dominant polycystic kidney disease (ADPKD). Tolvaptan recently has been implicated in causing serum aminotransferase elevations as well as clinically apparent acute liver injury during long term use.
Indications
Tolvaptan is indicated for the treatment of clinically significant hypervolemic and euvolemic hyponatremia including patients with heart failure, cirrhosis, Syndrome of Inappropriate Antidiuretic Hormone (SIADH), ADPKD (Autosomal Dominant Polycystic Kidney Disease)
Dosage
The usual starting dose is 15 mg administered once daily. Increase the dose to 30 mg once daily, after at least 24 hours, to a maximum of 60 mg once daily, as needed to achieve the desired level of serum sodium. During initiation and titration, frequently monitor for changes in serum electrolytes and volume. Avoid fluid restriction during the first 24 hours of therapy. Patients should be advised that they can continue ingestion of fluid in response to thirst.
Side Effects
increased thirst or urination, dry mouth, loss of appetite, constipation, weakness, fruity breath odor, drowsiness, dry skin, nausea or vomiting.
Contraindication
Do not administer to patients requiring urgent intervention to raise serum sodium acutely
Do not use in patients who are unable to sense or to respond appropriately to thirst
Do not use in patients with hypovolemic hyponatremia
Do not use with strong CYP 3A inhibitors
Do not administer to patients who are anuric as no benefit is expected
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