Tolvaptan for the Syndrome of Inappropriate Secretion of Antidiuretic Hormone: Is the Dose Too High?

What could be more logical than treating hyponatremia caused by the syndrome of inappropriate antidiuretic hormone secretion (SIADH) with an inhibitor of antidiuretic hormone? After many years of searching for this magic bullet, 2 vasopressin antagonists (vaptans), tolvaptan and conivaptan, became available for use in the United States.1 However, a decade after their approval by the US Food and Drug Administration, they are still used infrequently in hospitalized patients.

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