We recommend tolvaptan be considered for patients with symptomatic or severe hyponatremia (<130 mmol/L) and persistent congestion despite standard therapy, to correct hyponatremia and the related symptoms (Recommendation Weak, Quality Moderate).

Values and Preferences This recommendation places higher value on the correction of symptoms and complications related to hyponatremia and lesser value on the lack of efficacy of vasopressin antagonists to reduce heart failure related hospitalizations or mortality.