Efficacy and Safety of Low-Dose Tolvaptan (7.5 mg) in the Treatment of Inpatient Hyponatremia: A Retrospective Study
Authors' conclusion
In our view, tolvaptan can be initiated with a 7.5 mg dose, accompanied by Na + monitoring at 12 and 24 hours. If a second dose is necessary, 7.5 mg is comparably effective to a 15 mg dose, depending on the initial response. Further monitoring should include Na + concentration at around 24 hours after the second dose.
Study context
- Population
- Inpatients with hyponatremia secondary to SIADH treated with an initial tolvaptan 7.5 mg dose, single academic hospital in London
- Participants
- 181 inpatients
- Exposure
- Initial tolvaptan 7.5 mg dose; second dose 7.5 vs 15 mg
- Outcome
- Na+ increase and frequency of over-correction (increment ≥10 mmol/L) after initial 7.5 mg dose
- Follow-up
- Initial 8 or 24 hours
Methodological detailssingle-centre
- Single-centre
Main finding
As reported in the abstract
Na+ increase after initial 7.5 mg dose · 4-12 hours
Mean Na+ increase (P < .0001)
4.54 ± 3.70 mmol/L
Increase exceeding 10 mmol/L
8.7%
Mean Na+ increase at 18-30 hours (P < .0001)
6.15 ± 3.51 mmol/L
Over-correcting at 18-30 hours
19.4%
Observational data: associations, not effects.
Further findings
| Outcome | P value |
|---|---|
| Na+ increment after second doseNo significant difference | P = 0.532 |
Over-correction by pre-dose Na+ ≤127 mmol/L
- OR for over-correction with pre-dose Na+ ≤127 mmol/L
- 13.64 (95% CI 1.80-102.95)
Safety
- Cases of osmotic demyelination syndrome
- 0
Original publication
Efficacy and Safety of Low-Dose Tolvaptan (7.5 mg) in the Treatment of Inpatient Hyponatremia: A Retrospective Study. Endocr Pract. Published 27 December 2024. doi:10.
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