SAMSCA(tolvaptan) is indicated for the treatment of clinically significant hypervolemic and euvolemic hyponatremia (low blood serum sodium <125 mEq/L or less marked hyponatremia that is symptomatic and has resisted correction with fluid restriction), including patients with heart failure, cirrhosis, and Syndrome of Inappropriate Antidiuretic Hormone (SIADH). The latter condition occurs with lung cancer, especially small lung cancer, and less commonly other cancer or in associations with certain chemotherapy drugs that are used to treat cancer, such as cisplatin.
SAMSCA should be initiated and re-initiated in patients only in a hospital where serum sodium can be monitored closely. This allows observing for side effects and to titrate to an appropriate dose. The FDA aproved Prescribing information says: “The usual starting dose for SAMSCA is 15 mg administered once daily without regard to meals. Increase the dose to 30 mg once daily, after at least 24 hours, to a maximum of 60 mg once daily, as needed to achieve the desired level of serum sodium. ”
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