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NOCTIVA
Overactive bladder/enuresis
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Drug Name:

NOCTIVA Rx

Generic Name and Formulations:
Desmopressin acetate 0.83mcg, 1.66mcg; per nasal spray; preservative-free.

Company:
Avadel Pharmaceuticals

Therapeutic Use:

RECENT UPDATES

Monograph added.

Indications for NOCTIVA:

Nocturia due to nocturnal polyuria in adults who awaken ≥2 times per night to void.

Limitations Of use:

Not studied in patients <50yrs of age.

Adult:

<65yrs (without increased risk of hyponatremia): 1 spray (1.66mcg) in either nostril approx. 30mins before bedtime. ≥65yrs (or <65yrs with increased risk of hyponatremia): initially 1 spray (0.83mcg) in either nostril approx. 30mins before bedtime; may increase to 1.66mcg after ≥7 days, if needed, provided the serum sodium has remained normal.

Children:

Not established.

Contraindications:

Hyponatremia, or history of. Polydipsia. Primary nocturnal enuresis. Concomitant loop diuretics, systemic or inhaled glucocorticoids. Renal impairment (eGFR <50mL/min/1.73m2). Known or suspected SIADH secretion. During illnesses that can cause fluid/electrolyte imbalance (eg, gastroenteritis, salt-wasting nephropathies, or systemic infection). CHF (NYHA Class II–IV). Uncontrolled hypertension.

Warnings/Precautions:

Evaluate and confirm diagnosis with 24-hr urine collection prior to initiation. Risk of hyponatremia (may be severe). Monitor serum sodium levels prior to initiating or resuming dose, within 7 days and approx. 1 month after starting or increasing dose, and periodically thereafter. Monitor more frequently for elderly (≥65yrs) or those on concomitant drugs that can increase the risk of hyponatremia. Interrupt or permanently discontinue if hyponatremia occurs; treat appropriately. CHF (NYHA Class I): monitor volume status. Risk of increased intracranial pressure, history of urinary retention: not recommended. Discontinue if concurrent nasal conditions (eg, nasal mucosa atrophy, acute/chronic rhinitis) that may increase absorption, until resolved. Pregnancy: not recommended. Nursing mothers.

Interactions:

See Contraindications. May start or resume Noctiva 3 days or 5 half-lives after glucocorticoid is discontinued (whichever is longer). Concomitant medications that may cause water retention or increase hyponatremia risk (eg, tricyclics, SSRIs, NSAIDs, opioids, chlorpromazine, carbamazepine, lamotrigine, thiazides): monitor serum sodium more frequently. Concomitant other intranasal drugs: not recommended.

Pharmacological Class:

Vasopressin (synthetic).

Adverse Reactions:

Nasal discomfort, nasopharyngitis, nasal congestion, sneezing, hypertension/BP increased, back pain, epistaxis, bronchitis, dizziness; hyponatremia, fluid retention.

Generic Availability:

NO

How Supplied:

Nasal spray—3.5mL (30 sprays)

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