The incidence of hyponatremia was higher in patients 65 years of age or older compared to younger patients. The frequency of serum sodium monitoring should be based on the patient’s risk for hyponatremia. Advise patients to avoid drinks containing caffeine or alcohol before bedtime. Use of NOCDURNA without concomitant reduction of fluid intake may lead to fluid retention and hyponatremia. Limit fluid intake to a minimum from 1 hour before administration until 8 hours after administration. NOCDURNA is contraindicated in patients with the following conditions because fluid retention increases the risk of worsening the underlying condition: During illnesses that can cause fluid or electrolyte imbalance, such as gastroenteritis, salt-wasting nephropathies, or systemic infection.Known or suspected syndrome of inappropriate antidiuretic hormone (SIADH) secretion.Renal impairment with estimated glomerular filtration rate (eGFR) below 50 mL/min/1.73 m 2.Concomitant use with systemic or inhaled glucocorticoids.Hyponatremia or a history of hyponatremia.NOCDURNA is contraindicated in patients with the following conditions due to an increased risk of hyponatremia: Confirm the diagnosis of nocturnal polyuria with a 24-hour urine collection, if one has not been obtained previously.Evaluate the patient for possible causes for the nocturia, including excessive fluid intake prior to bedtime, and address other treatable causes of nocturia.In the NOCDURNA clinical trials nocturnal polyuria was defined as night-time urine production exceeding one-third of the 24-hour urine production. NOCDURNA is indicated for the treatment of nocturia due to nocturnal polyuria in adults who awaken at least 2 times per night to void. If hyponatremia occurs, NOCDURNA may need to be temporarily or permanently discontinued.More frequently monitor serum sodium in patients 65 years of age and older and in patients at increased risk of hyponatremia. Measure serum sodium within 7 days and approximately 1 month after initiating therapy, and periodically during treatment. Ensure the serum sodium concentration is normal before starting or resuming NOCDURNA.NOCDURNA is contraindicated in patients at increased risk of severe hyponatremia, such as patients with excessive fluid intake, illnesses that can cause fluid or electrolyte imbalances, and in those using loop diuretics or systemic or inhaled glucocorticoids.Severe hyponatremia can be life-threatening, leading to seizures, coma, respiratory arrest, or death. Published by Elsevier Inc.IMPORTANT SAFETY INFORMATION FOR NOCDURNA NOCDURNA (desmopressin acetate) sublingual tablets WARNING: HYPONATREMIA ![]() A multidisciplinary approach is necessary to effectively diagnose and manage this bothersome condition.Ĭopyright © 2019. Overall, the pathophysiology of NP is complex and differs from that of other types of nocturia. Desmopressin, a synthetic analog of arginine vasopressin, is the only antidiuretic treatment indicated specifically for nocturia due to NP. Antidiuretic treatment is warranted for patients with nocturia due to NP because, in many patients, it treats the underlying cause (ie, insufficient secretion of antidiuretic hormone arginine vasopressin) that leads to overproduction of urine at night and has been shown to provide statistically significant reductions in nocturnal voids. While drugs for benign prostatic hyperplasia and overactive bladder have demonstrated statistically significant reductions in nocturnal voids, patients often fail to achieve a clinically meaningful response. Lifestyle modifications are the first intervention implemented for the management of nocturia and NP but, as symptoms progress, such measures may be insufficient, and pharmacotherapy may be initiated. ![]() Diagnostic tools, in addition to a thorough history and physical examination, include voiding/bladder diary analyses and questionnaires to diagnose nocturia type (NP, diminished nocturnal/global bladder capacity, global polyuria) and causative factors. It is therefore important to accurately diagnose both the type of nocturia and the potentially associated medical conditions to determine appropriate treatment. Nocturia can be caused by intake, urological, nephrological, hormonal, sleep, and cardiovascular factors. Nocturnal polyuria (NP), characterized by overproduction of urine at night (greater than 20%-33% of total 24-hour urine volume depending on age), is a major contributing factor in most nocturia cases.
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