AdultHyponatremia Initially 15 mg once daily, may be increased to 30 mg once daily after at least 24 hr. Max: 60 mg once daily. Adjunct treatment of vol overload in heart failure 15 mg once daily in combination w/ other diuretics eg, loop diuretics, thiazides, aldosterone antagonists. Elderly, patient w/ serum Na <125 mEq/L, undesirable rapid plasma vol decrease or serum Na conc >140 mEq/L Initially 7.5 mg daily.
View Samsca overdosage for action to be taken in the event of an overdose.
Administration
May be taken with or without food: Take in the morning. Swallow whole w/ water.
Contraindications
Hypersensitivity. Autosomal dominant polycystic kidney disease. Urgent need to raise serum Na acutely. Inability to sense or appropriately respond to thirst. Hypovolemic hyponatremia. Hypernatremia. Anuria. Concomitant use w/ strong CYP3A inhibitors.
Initiate & re-initiate therapy in hospital to evaluate therapeutic response. Discontinue use if serum Na rises too rapidly (>12 mEq/L/24 hr); serum Na level increases above normal range; patients w/ symptoms indicating liver injury; osmotic demyelination syndrome; dehydration & hypovolemia. Secure urinary output for patients w/ partial urinary outflow obstruction. May induce thromboembolism for patients w/ serious CAD or cerebrovascular disease & elderly patients. Monitor serum Na level after initiation & when co-administered w/ diuretics. Assess serum Na conc & neurologic status during & after titration. Monitor serum K level after initiation in patients w/ serum K >5 mEq/L & patients receiving drugs increasing serum K level. Monitor fluid intake, urine vol, occurrence of thirst & dehydration. Limit duration of therapy to 30 days for hyponatremia treatment. Perform LFTs prior to initiation & frequently at least for 1st 2 wk of treatment for vol overload in heart failure. Perform blood testing for hepatic transaminases & bilirubin prior to initiation & continuing mthly for 18 mth at regular intervals thereafter for long-term use >30 days. Avoid fluid restriction during 1st 24 hr of treatment. Not to be used w/ strong CYP3A inhibitors. Avoid use w/ moderate CYP3A inhibitors. Not recommended in concomitant use w/ hypertonic saline. May need to increase dose if co-administered w/ CYP3A inducers & reduce dose in concomitant use w/ P-gp inhibitors. May affect ability to drive & use machines. Avoid use in patients w/ underlying hepatic disease. Not recommended in patients w/ CrCl <10 mL/min. Pregnancy & lactation. Ped. Elderly.
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