Desmopressin acetate (Noctiva)


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


  • 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


  • 1 year
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