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PD Middle Molecule Limitation — ESENeph MCQ

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HardPeritoneal DialysisPD Middle Molecule LimitationESENeph

Tolvaptan is started for rapidly progressive ADPKD. Which initial split dose and titration sequence matches Jinarc prescribing?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: E — Use 45+15 mg, 60+30 mg, then 90+30 mg at weekly intervals

Explanation lettering: C = shown as A · E = shown as B · D = shown as C · A = shown as D · B = shown as E

B is correct. Jinarc begins at 45 mg on waking and 15 mg eight hours later. If tolerated, it is titrated at intervals of at least one week to 60+30 mg and then the 90+30 mg target, maintaining the highest tolerable dose. The unequal split is designed for sustained V2-receptor blockade while limiting nocturnal aquaresis.

Reference: Jinarc 90 mg + 30 mg tablets SmPC: https://www.medicines.org.uk/emc/product/6854/smpc