Tolvacare Tablet 4's belongs to a group of medicines called vasopressin V2 receptor antagonist used to treat hyponatremia (low levels of sodium) in patients with heart failure, liver disease and hormonal imbalances such as Syndrome of Inappropriate Antidiuretic Hormone (SIADH). Additionally, Tolvacare Tablet 4's is also used to treat autosomal dominant polycystic kidney disease (ADPKD).
 
Tolvacare Tablet 4's contains ‘tolvaptan’ that works by blocking the effect of vasopressin, resulting in decreased water reabsorption, a net increase in free water excretion (aquaresis) and an increase in serum sodium concentrations. This decrease in free water is not associated with an increased excretion of sodium or potassium ions, the increase in serum sodium concentration is solely a result of  increased urine production
 
You are advised to take Tolvacare Tablet 4's for as long as your doctor has prescribed it for you depending on your medical condition. In some cases, you may experience certain common side-effects such as dizziness, headache, dry mouth, fatigue, diarrhoea, thirst and increased urge to urinate. Most of these side-effects do not require medical attention and will resolve gradually over time. However, you are advised to talk to your doctor if you experience these side-effects persistently.
 
Do not take Tolvacare Tablet 4's if you are pregnant as it may cause foetal harm. Consult your doctor before taking Tolvacare Tablet 4's if you are breastfeeding. Tolvacare Tablet 4's is not recommended for children below 18 years as the efficacy and safety have not been established. Tolvacare Tablet 4's may cause dizziness, so drive with caution. Avoid consuming alcohol as it might cause increased dizziness. Inform your doctor about all the medicines you are taking and about your health condition to rule out any unpleasant side-effects.

Tolvacare Tablet 4's belongs to a group of medicines called vasopressin V2 receptor antagonist. Tolvacare Tablet 4's is used to treat hyponatremia (low levels of sodium) in patients with heart failure, liver disease and hormonal imbalances such as Syndrome of Inappropriate Antidiuretic Hormone (SIADH). Besides this, Tolvacare Tablet 4's is also used to treat autosomal dominant polycystic kidney disease (ADPKD). Tolvacare Tablet 4's works by blocking the effect of vasopressin, a hormone which is involved in the formation of cysts in ADPKD patients. By blocking the effect of vasopressin, Tolvacare Tablet 4's slows down the development of cysts in kidneys and reduces the symptoms of the disease. Tolvacare Tablet 4's antagonises the effect of vasopressin, this results in an increase in free water clearance and decreases urine osmolality due to increased urinary excretion, thereby increases serum sodium concentrations.

• Dizziness
• Headache
• Dry mouth
• Fatigue
• Weakness
• Diarrhoea
• Thirst
• Increased urge to urinate

Do not take Tolvacare Tablet 4's if you are allergic to any of its contents, if you have raised liver enzymes in the blood, very low blood volume, if there is no urine production, if you cannot tell that you are thirsty. Inform your doctor if you have liver disease, difficulty in urination, diabetes, high levels of uric acid, advanced kidney disease or if you have to restrict fluid intake due to certain medical conditions. Do not take Tolvacare Tablet 4's if you are pregnant as it may cause foetal harm. Consult your doctor before taking Tolvacare Tablet 4's if you are breastfeeding. Tolvacare Tablet 4's is not recommended for children below 18 years as efficacy and safety have not been established. Tolvacare Tablet 4's may cause dizziness, so drive with caution. Avoid consuming alcohol as it might cause increased dizziness. 

Drug-Drug Interaction: Tolvacare Tablet 4's may interact with antibiotic (clarithromycin, telithromycin, sulfamethoxazole, trimethoprim), anti-fungal (ketoconazole, itraconazole), anti-HIV (ritonavir, indinavir, nelfinavir, saquinavir), antidepressant (nefazodone), aldosterone receptor antagonist (spironolactone), angiotensin receptor inhibitor (valsartan, sacubitril), blood thinner (heparin).

Drug-Food Interaction: Avoid consuming grapefruit juice and St. John’s wort (herbal supplement used to treat depression) while taking Tolvacare Tablet 4's. 

Drug-Disease Interaction: Inform your doctor if you have liver disease, difficulty in urination, diabetes, high levels of uric acid or kidney disease.

• CLARITHROMYCIN
• TELITHROMYCIN
• SULPHAMETHOXAZOLE+TRIMETHOPRIM
• KETOCONAZOLE
• ITRACONAZOLE
• RITONAVIR
• INDINAVIR
• SAQUINAVIR
• NELFINAVIR
• NEFAZODONE
• SPIRONOLACTONE
• VALSARTAN
• SACUBITRIL
• HEPARIN

• Eat a diet rich in whole grains, vegetables, and fruits.
• Avoid smoking and alcohol consumption.
• Maintain a healthy weight with proper diet and exercise.
• Manage stress with meditation, yoga, and massage.
• Drink plenty of fluids.
• Rehydration beverages that contain electrolytes are also helpful.

• Regular monitoring of liver functioning and electrolyte levels while taking Tolvacare Tablet 4's is advised.
• Treatment with Tolvacare Tablet 4's should be started and re-started in a hospital or in the presence of a healthcare professional to monitor the sodium levels in your blood closely.

Hyponatremia: Sodium is an important electrolyte that helps in maintaining water balance in and around the cells. It helps in proper nerve, muscle functioning and maintains stable blood pressure levels. Low levels of sodium in the blood are referred to as hyponatremia. Normal levels of sodium are 135-145 milliequivalance per litre. Hyponatremia occurs when the level is below 135mEq/L. Symptoms include weakness, tiredness, nausea, vomiting, headache, irritability, confusion and muscle spasms.

Autosomal Dominant Polycystic Kidney Disease (ADPKD): It is an inherited disorder in which cysts are developed in the kidney. These cysts are non-cancerous sacs that contain a water-like fluid which puts pressure on the surrounding tissues, leading to reduced kidney function. Symptoms include high blood pressure, swollen abdomen, and back or side pain.