Would you recommend starting tolvaptan at 7.5 mg per day, which is half the typical starting dose, to reduce the risk of overcorrection in an inpatient with SIADH and a serum sodium level of 122 mEq/L?

If it is for SIADH, I always start with 7.5 mg.

See this, my fellow and I put together years ago.

Dosing in SIADH: A Tale of Two Tolvaptans

If it is for CHF, I would start with 15 mg as those patients are so pre-renal, their distal delivery is so impaired, and tolvaptan is limited by that. I haven't...

Yes, tolvaptan at 7.5 mg per day can be effective in treating SIADH with a decreased rate of overcorrection.

• Hanna et al., PMID 32734225

Yes, I would, depending on their risk factors. Osmotic demyelination is rare when the sodium is above 120 mEq/L, however, in the presence of risk factors (i.e., cirrhosis, malnutrition, hypokalemia), then I would be more cautious. I still do target a change closer to 8-10 mEq/L in 24 hours. If a pat...

Yes. It’s safe to use that way at 7.5 mg, and overcorrection is very rare. Dr. @Dr. First Last’s paper is very nice in explaining that.