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Drug: Noctiva™ (desmopressin) [Avadel Specialty Pharmaceuticals, LLC]

December 2018

Therapeutic Area: Nocturnal polyuria

Approval criteria

  • Patient must have a diagnosis of nocturnal polyuria AND
  • Patient must be at least 50 years of age AND
  • Patient does not have central diabetes insipidus AND
  • Patient does not have hemophilia A or von Willebrand disease AND
  • Patient is not pregnant AND
  • Patient has tried behavioral measures substantiated by supporting document provided at time of request

Denial criteria

  • Patient must not have any of the following contraindications:
    • Hyponatremia
    • Polydipsia
    • Primary nocturnal enuresis
    • Current condition that causes fluid or electrolyte imbalance
    • Syndrome of inappropriate antidiuretic hormone secretion (SIADH)
    • Concomitant use of loop diuretics or systemic of inhaled glucocorticoids
    • eGFR < 50 mL/min/1.73m2
    • NYHA Class II-IV CHF
    • Uncontrolled hypertension

Quantity limits

  • 1 bottle (3.8 g) per 30 days


Noctiva has not been studied in patients less than 50 years of age.


MHCP Provider Call Center 651-431-2700 or 800-366-5411

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