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Hyponatremia is the most common electrolyte disorder in general practice and is associated with increased hospital mortality and prolonged length of stay. The most frequent cause of hyponatremia is the syndrome of inappropriate antidiuretic hormone (SIADH), accounting for 35 to 46% of all cases of hyponatremia. Currently, V2 receptor antagonists, especially tolvaptan, have been increasingly used to manage patients with SIADH. Evidence has shown efficacy and safety profiles. In 2009, tolvaptan was approved by the US Food and Drug Administration to treat euvolemic and hypervolemic hyponatremia and was approved by the European Medicines Agency treatment of hyponatremia from SIADH. therefore, tolvaptan has been commonly and widely used for to treat SIADH. The results from 11 studies have shown efficacy and safety profiles of tolvaptan in treating patients with SIADH. Tolvaptan has also demonstrated efficacy among patients with cancer and patients after pituitary surgery. The recommended starting dose is 15 mg daily, and may be increased to a maximum dose of 60 mg daily. Patients with SIADH and high risk of overcorrection, such as those with baseline serum sodium less than 121-125 mmol/L, blood urea nitrogen less than 10 mg/dL, low body weight or low body mass index, should be initiated with a half dose (7.5 mg daily). In terms of safety, the most common adverse events comprise dry mouth and thirst. Serious adverse events include severe vomiting, hepatitis (1 case) and arrhythmia (1 case). Overcorrection has increased, ranging from 3.2-43.8%. However, neither osmotic demyelination syndrome (ODS) nor death event from tolvaptan has been reported.
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