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Initiate and Reinitiate in a Hospital and Monitor Serum Sodium: Samsca should be initiated and reinitiated in patients only in a hospital where serum sodium can be monitored closely.
Too rapid correction of hyponatremia (eg, >12 mEq/L/24 hrs) can cause osmotic demyelination resulting in dysarthria, mutism, dysphagia, lethargy, affective changes, spastic quadriparesis, seizures, coma and death. In susceptible patients including those with severe malnutrition, alcoholism or advanced liver disease, slower rates of correction may be advisable.
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