The Medical Letter on Drugs and Therapeutics
Tolvaptan (Samsca) for Hyponatremia
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The FDA has approved the marketing of tolvaptan (Samsca – Otsuka), an oral vasopressin receptor antagonist, for treatment of hypervolemic or euvolemic hyponatremia due to congestive heart failure (CHF), cirrhosis or the syndrome of inappropriate antidiuretic hormone secretion (SIADH). A similar drug, conivaptan (Vaprisol) is already available for intravenous (IV) treatment of euvolemic hyponatremia in hospitalized patients.1 Tolvaptan was approved by the FDA for both inpatient and outpatient use, but it should be started in a hospital.

THE DISORDER — Hyponatremia is the most common electrolyte abnormality in hospitalized patients. The development of hypervolemic hyponatremia in patients with CHF or cirrhosis is associated with an increased risk of death. Even mild stable euvolemic hyponatremia due to SIADH has been associated with cognitive defects and gait disturbances. Overly rapid ... more      

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Title: Tolvaptan (Samsca) for Hyponatremia
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