NOCTIVA (desmopressin)

NOCTIVA (desmopressin)

SELF ADMINISTRATION

Indications for Prior Authorization:

• Treatment of nocturia due to nocturnal polyuria in adults over 50 years of age who awaken at least 2 times per night to void

Patients must meet the following criteria for the indication(s) above:

• Patient is 50 years of age or older, AND
• Prescribed by or in consultation with a urologist, a geriatrician, or an endocrinologist, AND
• Diagnosis of nocturnal polyuria, as confirmed by a 24-hour urine collection, before treatment initiation and the patient meets one of the following:
  • Nocturnal urine volume exceeds 20% of the total 24-hour urine volume in patients <65 years of age, OR
  • Nocturnal urine volume exceeds 33% of the total 24-hour urine volume in patients 65 years of age or older, AND
• The patient has tried non-pharmacologic techniques or lifestyle interventions to manage the nocturia (e.g. nighttime fluid restriction, avoidance of caffeine and alcohol, earlier timing of medications, leg elevation and/or use of compression stockings), AND
• Prior to desmopressin therapy, the patient awakens at least two times per night to void, AND
• The patient has serum sodium concentrations within the normal range (135-145 mmol/L), AND
• The patient has tried oral desmopressin acetate tablets, AND
• The prescribing physician has verified that the patient does not have the following conditions/circumstances in which use of Noctiva is not recommended:
  • Currently receiving loop diuretics (e.g. furosemide, torsemide, bumetanide), OR
  • Currently receiving systemic or inhaled glucocorticoids, OR
  • Renal impairment with an eGFR <50 mL/min/1.73m², OR
  • NYHA Class II or IV congestive heart failure, OR
  • Polydipsia, OR
  • Known or suspected syndrome of inappropriate antidiuretic hormone (SIADH) secretion, OR
  • Uncontrolled hypertension, OR
  • Illnesses that can cause fluid or electrolyte imbalance

Condition(s) not recommended for Approval:

• Primary nocturnal enuresis

Dosing:

• Patients <65 years of age who are not at increased risk for hyponatremia: 1 spray of 1.66 mcg in either nostril nightly approximately 30 minutes before going to bed
• Patients 65 years of age or older OR younger patients at risk for hyponatremia: use 0.83 mcg nightly, which can be increased to 1 spray of 1.66 mcg after at least 7 days, if needed, provided the serum sodium has remained normal

Approval:

• 1 year