Shiokem 15mg is an aquaretic drug which functions as a selective, competitivevasopressin receptor 2 (V2) antagonist will prevent hyponatremia (low blood sodium levels) along with congestive heart failure, cirrhosis, and the syndrome of inappropriate antidiuretic hormone (SIADH)
Shiokem 15mg decrease the level of a hormone which manage the balance of water and salt (sodium) in the body. High levels of this hormone can cause an imbalance that causes low sodium levels and fluid retention.



10 tablets in 1 strips


Shiokem 15mg is used for the treatment of clinically important hypervolemic and euvolemic hyponatremia contains patients with heart failure and Syndrome of Inappropriate Antidiuretic Hormone (SIADH).


Tolvaptan is a type of selective and competitive arginine vasopressin receptor 2 antagonist. Vasopressin show action on the V2 receptors found in the walls of the vasculature and luminal membranes of renal collecting ducts. By stopping V2 receptors in the renal collecting ducts, aquaporins do not enter themselves into the walls hence inhibiting water absorption. This activity basically results in a rise in urine volume, reduce urine osmolality, and increase electrolyte-free water clearance to decrease intravascular volume and a higher serum sodium level. Tolvaptan is specifically required for heart failure patients as they have higher serum levels of vasopressin.


Time to peak plasma concentration of Shiokem is 2-4 hours and the absolute bioavailability is unknown. Food will not affect the bioavailability of Shiokem.

The plasma protein bounding of Shiokem is 99% and Volume of distribution in healthy subjects is 3L/kg.

Shiokem is metabolism occurs by CYP3A4 enzyme in the liver.

< 1% is excreted in the urine (unchanged form) and through fecal is very small amount of renal elimination.
In oral dose, half-life of Shiokem is 12 hours


Ingredients Tolvaptan
Strength 15mg
Pack 10 tablets in 1 strips

The recommended starting dose for Shiokem is 15 mg administered once daily without food. The dose is increased to 30 mg once daily, after at least 24 hours, to a maximum of 60 mg once daily, as required to achieve the desired level of serum sodium. Do not administer Shiokem for more than 30 days to minimize the risk of liver injury.
Following discontinuation from Shiokem, advised the patients to resume fluid restriction and should be observed for changes in serum sodium and volume status.
Administration of Shiokem should be without food
Grape juice should be avoided during therapy with Shiokem
Overdose :
Administrating monotherapy oral doses up to 480 mg and multiple doses up to 300 mg once in a day for 5 days have been well accepted in studies in healthy subjects. There is no essential antitoxin for Shiokem intoxication. The signs and symptoms of an acute overdose can be expected to be those of extra pharmacologic effect: a increase in serum sodium concentration, polyuria, thirst, and dehydration/hypovolemia.


  • The conditions like Hypernatremia, hypovolemia, and/or dehydration; provoke patient to drink whenever thirsty

  • Risk of potassium level increased

  • Shiokem 15mg produce Osmotic demyelination syndrome is a harm along with too-fast correction of hyponatremia

  • Shiokem 15mg can develops serious and likely fatal liver injury; acute liver failure needed liver transplantation reported; discontinue if laboratory abnormalities or signs or symptoms of liver injury are apparent.


  • Shiokem 15mg interaction with strong CYP3A4 inhibitors like ketoconazole will have highest labelled dose would be normal to cause an even heavy increase in exposure.

  • Shiokem co administration with moderate CYP3A4 inhibitors will increase in exposure of Shiokem 15mg.

  • When concomitant use treated with P-gp inhibitors will have reductions in the dose of Shiokem 15mg

  • Combination of rifampin and Shiokem 15mg decrease exposure to tolvaptan by 85%.

  • Concomitant use of lovastatin, digoxin, furosemide, and hydrochlorothiazide has no clinically relevant impact on the exposure to Shiokem 15mg


Shiokem 15mg is contraindicated with following condition as
• Patients with autosomal dominant polycystic kidney disease because the drug causes severe and possible fatal liver injury.
• Required in acutely raised serum sodium
• Patients inability to sense
• Hypovolemic /hyponatremia

Pregnancy category is C: There are no enough and well tolerated studies of Shiokem 15mg tablets but can be used during pregnancy only if the possible benefits prove the possible risk to the foetus.

Shiokem 15mg excreted in human milk is unknown because most of the drugs are excreted into human milk, due to probable for severe adverse reaction in nursing infants from Shiokem tablets, taking into consideration the Shiokem tablets importance to the mother, a decision should be taken to discontinue breastfed or Shiokem 15mg drug

Store the Shiokem 15mg at 25°C (77°F) exclusively permitted between 15°C and 30°C
Keep away from the children’s reach.

In case the single dose is missed the have the tablet dose immediately before the next dose timing reaches or skip the missed dose and continue the regular schedule.
Avoid having of extra dose at a time. Consult the doctor for further details.

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