Q. Can Tolsama be used to correct sodium levels?

Answered by
Dr. Mohammed Parvez
and medically reviewed by iCliniq medical review team.
This is a premium question & answer published on Dec 21, 2017 and last reviewed on: Jun 06, 2022

Hello doctor,

My mother suffers from low sodium levels. Although she tries to maintain them through a sodium-rich diet, she loses the levels when she is affected by any ailment. One doctor suggested her to use Tolsama on alternate days and monitor the serum electrolytes to check the levels and stop when they are in good range. I need a second opinion.



Welcome to

I need more information to know the main diagnosis. I would like to know why is she having low sodium levels.

As per the suggestion for Tolsama (Tolvaptan) by your physician, I assume the diagnosis to be SIADH (syndrome of inappropriate antidiuretic hormone secretion).

The first line of treatment in SIADH are

  • To stop all drugs what the patient is taking currently which can cause SIADH.
  • Water restriction. Water not more than one liter per day.
  • On drug like Tolsama 15 mg once daily, electrolytes need to be monitored every week.

For more information consult an internal medicine physician online -->

Thank you doctor,

She has been prescribed Myospaz D for her lower back pain that she has been experiencing. She takes two per day after food. She was also asked to take Pantocid before food. Although the pain relief is not there, she lost her appetite for the last three days and we found her serum electrolytes to be 118 against the recommended 135. She takes anxiety medicine, Prothiaden one per day.



Welcome back to

I suggest you stop Prothiaden (Dosulepin/Dothiepin and Methylcobalamin) and Myospaz D (Diclofenac and Metaxalone).

There should be water restriction. Water to only about one liter per day.

Tolsama (Tolvaptan) 15 mg once daily for 15 days. Consult your specialist doctor, discuss with him or her and with their consent take the medicine changes.

For more information consult an internal medicine physician online -->

Thank you doctor,

How do we tackle the lower back pain during this period? She has been diagnosed with grade 1 spondylolisthesis at L4-5.



Welcome back to

I would suggest you consult a kidney specialist or a neurologist who are well trained to treat SIADH (syndrome of inappropriate antidiuretic hormone secretion) and low sodium levels.

You need to consult a physiotherapist who can help dealing with low back pain.

For more information consult an internal medicine physician online -->

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