Overactive bladder/enuresis:

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.


<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.


Not established.


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.

Boxed Warning:



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.

Pharmacologic Class:

Vasopressin (synthetic).


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.

Adverse Reactions:

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

Generic Availability:


How Supplied:

Nasal spray—3.5mL (30 sprays)

Pricing for NOCTIVA

3.8g of 0.83mcg/0.1ml nasal spray (Qty: 1)
Appx. price $443