How to Find the Best Narcolepsy Medication for You

Medications usually are the main treatment for narcolepsy. They aren’t a cure, but they can help you manage the symptoms of this brain disorder. But it’s important to take the time to find the right drug or mix of drugs for you.

Medications for Narcolepsy

The most effective medications with the fewest side effects are different for everyone. You may need to try several drugs and different doses before you find the right treatment.

Some medications relieve the daytime sleepiness that can be dangerous. Other drugs target the temporary muscle weakness called cataplexy that affects people who have type 1 narcolepsy. A few drugs treat both symptoms.

Stimulants

Armodafinil (Nuvigil) and Modafinil (Provigil). Stimulants help keep you awake and alert. Your doctor may try one of these first if you have mild daytime drowsiness.

Possible side effects include:

  • Headache
  • Nausea
  • Anxiety

Armodafinil and modafinil may interfere with birth control pills and other hormonal contraceptives. Use backup birth control to lessen your chances of getting pregnant.

Amphetamine. Your doctor may suggest this stronger stimulant if you have severe daytime sleepiness or if armodafinil or modafinil hasn’t helped.  Amphetamines include:

  • Amphetamine and dextroamphetamine mix (Adderall)
  • Dextroamphetamine (Dexedrine)
  • Methylphenidate (Aptensio XR, Concerta, Ritalin)

Side effects may include:

  • Sleep disturbance
  • Nervousness
  • Shakiness
  • Irregular heart rhythms

These medications may not be right for you if you have high blood pressure or heart disease. Some people can get addicted to amphetamines for the highs they cause.

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Gamma-Hydroxybutyrate (GHB)

These help you sleep deeply at night so you’re less sleepy and more alert in the day. Your doctor may prescribe depressants first if you have cataplexy attacks often.

You take one dose right before bed and another 3-4 hours later. You can’t mix them with alcohol, narcotic pain relievers, or other sedatives. If you do, you can have problems breathing, fall into a coma, or die.

The FDA has approved two GHB formulations for treating narcolepsy. Both contain sodium oxybate, a powerful medication that can be habit-forming. Another name for sodium oxybate is GHB, liquid drops that some people use illegally to get high, which is often called the date rape drug.

Sodium oxybate (Xyrem). It may cause dizziness, an upset stomach, or make you wet the bed or sleepwalk. It’s also very high in salt. It may not be right for you if you have high blood pressure, kidney problems, or certain heart conditions.

Calcium, magnesium, potassium, and sodium oxybate (Xywav). This newer medication can cause many of the same side effects as Xyrem. But it has 90% less salt than the older drug.

Antidepressants

Several different kinds can treat cataplexy. Some may help with the sleep paralysis and hallucinations around the time of sleep that narcolepsy can cause. Antidepressants include:

  • Selective serotonin reuptake inhibitors (SSRIs)
  • Serotonin and norepinephrine reuptake inhibitors (SNRIs)
  • Tricyclic antidepressants (TCAs)

TCAs are older drugs that can cause dry mouth, lightheadedness, and constipation. SSRIs and SNRIs can cause weight gain, insomnia, and digestive problems.  

Solriamfetol (Sunosi). This was approved in 2019 to treat excessive daytime sleepiness. Its most common side effects are headache, nausea, decreased appetite, insomnia, and anxiety. Unlike some other narcolepsy medications, it doesn’t keep your birth control pills from working. It may not be right for you if have high blood pressure or some heart conditions or mental illnesses.

Selective Histamine 3 Receptor Antagonist/Inverse Agonist

This medication helps your body release more of a brain chemical called histamine, which encourages wakefulness.

Pitolisant (Wakix). It’s prescribed for daytime sleepiness. It also may prevent episodes of cataplexy. Pitolisant is not likely to be addictive. Possible side effects include headache, nausea, anxiety, trouble sleeping, and an irregular heartbeat. It may not be right for you if you have liver or kidney problems, or certain heart conditions.

Researchers are studying other possible narcolepsy treatments for approval. They include drugs that act on the histamine chemical system, hypocretin replacement, gene therapy, and immunotherapy.

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When to Talk to Your Doctor

If your current medications don’t control your daytime drowsiness or other symptoms enough, ask your doctor if something else might work better. Adjusting the dosage, switching to a different medication, or combining  drugs may be options. Also let you doctor know about any side effects that bother you.

WebMD Medical Reference Reviewed by Neha Pathak, MD on September 11, 2020

Sources

SOURCES:

Sleep Foundation: “Narcolepsy: Medication and Treatment,” “Narcolepsy: Cataplexy,” “Narcolepsy: Medications for Sleepiness.”

Healthy Sleep (Division of Sleep Medicine at Harvard Medical School): “Narcolepsy Medications,” “Narcolepsy: Changes Across the Lifespan.” 

CNS Drugs: “Recently approved and upcoming treatments for narcolepsy.”

Mayo Clinic: “Narcolepsy,” “Pitolisant (Oral Route).” 

MedlinePlus: “Modafinil,” “Armodafinil,” “Sodium Oxybate.”

National Institute of Neurologic Disorders and Stroke: “Narcolepsy Fact Sheet.”

Nature and Science of Sleep: “Living with narcolepsy: Current management strategies, future prospects, and overlooked real-life concerns.”

Regulatory Affairs Professional Society: “FDA Approvals Roundup: Xywav, Qutenza, Orphengesic.”

FDA: “Full Prescribing Information: Xywav,” “Full Prescribing Information: Wakix,” “Full Prescribing Information: Sunosi.”

TeensHealth: “GHB.”

Medscape: “FDA Okays Pitolisant (Wakix) for Narcolepsy.”

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