Noctiva™
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
Background
Noctiva has not been studied in patients less than 50 years of age.
Questions?
MHCP Provider Call Center 651-431-2700 or 800-366-5411