<p><strong>Hypervolemic or euvolemic hyponatremia</strong>: The usual starting dose for Tolvaptan 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. Do not use for more than 30 days due to the risk of hepatotoxicity.<br />
<br />
<strong>Autosomal dominant polycystic kidney disease (ADPKD)</strong>:</p>

<ul>
	<li>Initially: 60 mg/day in divided doses (given as 45 mg upon wakening and 15 mg 8 hours later);</li>
	<li>Titrate per response and tolerability at intervals of at least 7 days between titrations to 90 mg/day in divided doses (given as 60 mg upon wakening and 30 mg 8 hours later) followed by 120 mg/day in divided doses (given as 90 mg upon wakening and 30 mg 8 hours later).</li>
	<li>Maintain urine osmolality of &lt;300 mOsm/kg if possible; if the maximum dose is not tolerated, administration of a lower dose with the goal of achieving urine osmolality of 250 to 300 mOsm/kg is reasonable.</li>
</ul>