Nocturia is a complex condition that not only significantly affects quality of life, but may be an
indicator of systemic disease. Initial assessment includes a detailed history and physical examination and completion of a frequency volume chart to help identify underlying causes, such as
sleep disorders, bladder storage disorders, and
polyuria. Treatment with alpha-blockers or
antimuscarinic medications may help if the underlying cause is determined to be
benign prostatic hyperplasia or
overactive bladder, respectively. Treatment options for nocturnal
polyuria have been limited to behavioral
therapy and
off-label use of timed
diuretics and
desmopressin.
Desmopressin acetate nasal spray (Noctiva™, Avadel Pharmaceuticals, Chesterfield, MO) was approved by the US Food and Drug Administration in 2017 for the treatment of
nocturia due to nocturnal
polyuria in adults who awaken at least twice nightly and has shown efficacy in reducing nocturnal voids by ≥50% in up to 49% of patients in clinical trials.