Tolvaptan (patient information)

# Why is this medication prescribed?
Tolvaptan is used to increase low levels of sodium in the blood in people who have heart failure (condition in which the heart cannot pump enough blood to all parts of the body), syndrome of inappropriate antidiuretic hormone (SIADH; condition in which the body produces too much of a certain natural substance that causes the body to retain water) or other conditions. Tolvaptan is in a class of medications called vasopressin V2 receptor antagonists. It works by increasing the amount of water released from the body as urine. Removing fluid from the body helps to increase the level of sodium in the blood.

# How should this medicine be used?
Tolvaptan comes as a tablet to take by mouth. It is usually taken once a day with or without food for no longer than 30 days. At the beginning of your treatment, you will be given tolvaptan at a regularly scheduled time in the hospital. If you are told to take tolvaptan at home after you are discharged, you should take it at around the same time every day. Follow the directions on your prescription label carefully, and ask your doctor or pharmacist to explain any part you do not understand. Take tolvaptan exactly as directed. Do not take more or less of it or take it more often than prescribed by your doctor.
Your doctor will probably start you on a low dose of tolvaptan and gradually increase your dose, not more often than once every 24 hours.
Talk to your doctor about what you should do after you stop taking tolvaptan. You will probably need to limit the amount of fluid you drink, and your doctor will monitor you carefully during this time.

# Other uses for this medicine
This medication may be prescribed for other uses; ask your doctor or pharmacist for more information.

# What special precautions should I follow?
Before taking tolvaptan,
- tell your doctor and pharmacist if you are allergic to tolvaptan, any other medications, or any of the ingredients in tolvaptan tablets. Ask your pharmacist or check the Medication Guide for a list of the ingredients.
- tell your doctor if you are taking certain antifungals such as ketoconazole (Nizoral) or itraconazole (Sporanox); clarithromycin (Biaxin); certain medications for HIV such as indinavir (Crixivan), nelfinavir (Viracept), ritonavir (Norvir), or saquinavir (Invirase); nefazodone; or telithromycin (Ketek). Your doctor may tell you not to take tolvaptan if you are taking one or more of these medications.
- tell your doctor and pharmacist what other prescription and nonprescription medications, vitamins, and nutritional supplements you are taking or plan to take. Be sure to mention any of the following: angiotensin-converting enzyme (ACE) inhibitors such as benazepril (Lotensin), captopril (Capoten), enalapril (Vasotec), fosinopril (Monopril), lisinopril (Prinivil, Zestril), moexipril (Univasc), perindopril, (Aceon), quinapril (Accupril), ramipril (Altace), and trandolapril (Mavik); angiotensin II receptor blockers such as candesartan (Atacand), eprosartan (Teveten), irbesartan (Avapro), losartan (Cozaar), olmesartan (Benicar), telmisartan (Micardis), and valsartan (Diovan); aprepitant (Emend); barbiturates such as phenobarbital; carbamazepine (Equetro, Tegretol); cyclosporine (Gengraf, Neoral, Sandimmune); digoxin (Lanoxin); diltiazem (Cardizem, Dilacor, Tiazac); diuretics (water pills); erythromycin (E.E.S., E-Mycin, Erythrocin); fluconazole (Diflucan); phenytoin (Dilantin); potassium supplements; rifabutin (Mycobutin); rifampin (Rimactane, Rifadin); rifapentine (Priftin); and verapamil (Calan, Covera, Isoptin,Verelan). Your doctor may need to change the doses of your medications or monitor you carefully for side effects. Many other medications may also interact with tolvaptan, so be sure to tell your doctor about all the medications you are taking, even those that do not appear on this list.
- tell your doctor what herbal products you are taking or plan to take, especially St John's wort.
- tell your doctor if you have kidney disease and do not produce urine, if you have severe vomiting or diarrhea, or if you have lost a lot of fluid from your body and feel dizzy or faint. Your doctor will probably tell you not to take tolvaptan. Your doctor will also probably not prescribe tolvaptan if your sodium level must be increased very quickly.
- tell your doctor if you have or have ever had a high level of potassium in your blood.
- tell your doctor if you are pregnant, plan to become pregnant, or are breast-feeding. If you become pregnant while taking tolvaptan, call your doctor.

# What special dietary instructions should I follow?
Do not eat grapefruit or drink grapefruit juice while taking this medication.

# What should I do if I forget a dose?
Take the missed dose as soon as you remember it. However, if it is almost time for the next dose, skip the missed dose and continue your regular dosing schedule. Do not take a double dose to make up for a missed one.

# What side effects can this medication cause?
Tolvaptan may cause side effects. Tell your doctor if any of these symptoms are severe or do not go away:
- thirst
- dry mouth
- frequent, excessive urination
- constipation
Some side effects can be serious. If you experience any of these symptoms or those listed in the IMPORTANT WARNING section, call your doctor immediately:
- loss of appetite
- nausea
- vomiting
- fever
- feeling unwell
- unusual tiredness or weakness
- itching
- yellowing of the skin or eyes
- dark urine
- pain in the upper right part of the stomach
- diarrhea
- inability to drink normally
- dizziness
- faintness
- vomit that is bloody or looks like coffee grounds
- bloody or black and tarry stools
Tolvaptan may cause other side effects. Call your doctor if you have any unusual problems while taking this medication.
If you experience a serious side effect, you or your doctor may send a report to the Food and Drug Administration's (FDA) MedWatch Adverse Event Reporting program online  or by phone .

# What should I know about storage and disposal of this medication?
Keep this medication in the container it came in, tightly closed, and out of reach of children. Store it at room temperature and away from excess heat and moisture (not in the bathroom). Throw away any medication that is outdated or no longer needed. Talk to your pharmacist about the proper disposal of your medication.
In case of emergency/overdose
In case of overdose, call your local poison control center at 1-800-222-1222. If the victim has collapsed or is not breathing, call local emergency services at 911.
Symptoms of overdose may include:
- excessive urination
- excessive thirst
- dizziness
- faintness

# What other information should I know?
Keep all appointments with your doctor and the laboratory. Your doctor may order certain lab tests to check your body's response to tolvaptan.
Do not let anyone else take your medication. Ask your pharmacist any questions you have about refilling your prescription.
It is important for you to keep a written list of all of the prescription and nonprescription (over-the-counter) medicines you are taking, as well as any products such as vitamins, minerals, or other dietary supplements. You should bring this list with you each time you visit a doctor or if you are admitted to a hospital. It is also important information to carry with you in case of emergencies.
Brand names
Samsca