Skip to main content

Table 1 Indications for Tolvaptan Initiation

From: In-patient Tolvaptan use in SIADH: care audit, therapy observation and outcome analysis

Tolvaptan – Initial usage policy
ᅟ1) Confirm SIADH (See Fig. 1a) AND
ᅟ2) Na <125 despite 48 h fluid restriction at 750 ml/24 h or
ᅟ3) Na <125 and falling despite 24 h fluid restriction @ 750 ml/24 h or
ᅟ4) Symptoms/risks associated with 2) or 3) awaiting for Chemotherapy
At initiation of Tolvaptan
ᅟ1) Stop fluid restriction (allow patient to drink when thirsty)
ᅟ1) Monitor Na levels 6hrly for 36 h then 12hrly
ᅟ1) Review Tolvaptan use at 3, 6 and 9 days
ᅟ1) If Na rises by >6 at 6 h, >8 mmol/L in 12 h, >12 mmol/L in 24 h or >18 in 48 h OR if Na >126, STOP Tolvaptan and continue to monitor Na 12hrly for 36 h – Consider 5% Dextrose.
  1. Ensure free water intake. Avoid Tolvaptan if oral intake is inadequate/unsafe
  2. Ensure details are kept for each patient in which Tolvaptan is used according to attached proforma
  3. Where SIADH is associated with recurrent severe hyponatraemia Na <125 there may be a case to extend prescription to the outpatient setting, but this should be made as an individual case to the F&M chair