Drug Interaction Report

Consumer information for this interaction is not currently available.

ADJUST DOSE: Coadministration with inhibitors of P-glycoprotein (P-gp) may increase the oral bioavailability of tolvaptan, which has been shown in vitro to be a substrate of the efflux transporter. Pharmacokinetic and clinical data are not available, however.

MANAGEMENT: Caution is advised if tolvaptan is prescribed in combination with P-glycoprotein inhibitors, especially potent ones such as amiodarone, cyclosporine, or quinidine. Serum sodium concentration and neurologic status should be closely monitored, and the tolvaptan dosage adjusted accordingly. Too rapid correction of hyponatremia increases the risk of osmotic demyelination syndrome, which is associated with dysarthria, mutism, dysphagia, lethargy, affective changes, spastic quadriparesis, seizures, coma, and death. Discontinuation or interruption of tolvaptan therapy should be considered in patients who develop too rapid a rise in serum sodium.

You should avoid drinking grapefruit juice during treatment with tolvaptan. Grapefruit juice can cause too much of the medication to be in the blood. Serious nervous system side effects such as difficulty swallowing, trouble speaking, muscle weakness, trouble controlling body movements, confusion, mood changes, seizures, and coma may occur. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.