Prescription Medications to Treat Narcolepsy

There is not yet a cure for narcolepsy. But prescription drugs and lifestyle changes can help you control symptoms.

Drugs that can improve symptoms of narcolepsy include:¹

• Wake-promoting drugs to treat daytime sleepiness
• Antidepressants to treat cataplexy (brief periods of muscle weakness or paralysis)
• Other drugs to treat daytime sleepiness and cataplexy

The right drug for you depends on your symptoms, age, side effects, and other factors. During any treatment, you should see your doctor at least once a year. You may need to see them more often if they are adjusting your medicine. Talk to your doctor about the risks and benefits of all treatment options.²

Goals of narcolepsy medicines

With any drug your doctor prescribes, the key objective is to find drugs that cause the most benefits with the fewest problems. This may take time. Sometimes, the first choice is not the best. Treatment works best when it combines the right drugs, behavioral strategies, and management of other conditions.^1,2

Some common goals of narcolepsy drugs include:^1,2

• Improving alertness through the day, especially at school and work
• Reducing or eliminating cataplexy
• Addressing other symptoms (such as sleep paralysis and hypnagogic hallucinations)
• Minimizing side effects

Wake-promoting drugs to treat daytime sleepiness

Stimulants help keep you awake during the day. These drugs help you maintain alertness during important times like work, school, or driving.¹

Some of these medicines start working within days. The most common wake-promoting drugs used to treat daytime sleepiness include:^1,2

• Provigil® (modafinil)
• Nuvigil® (armodafinil)
• Ritalin®, Concerta®, Metadate® (methylphenidate)
• Dexedrine® (dextroamphetamine)
• Adderall® (mixed amphetamine salts)
• Sunosi® (solriamfetol)
• Wakix® (pitolisant)

Provigil is often the first drug used to treat mild to moderate sleepiness. Nuvigil is a newer version with a longer half-life. Both drugs work by increasing brain levels of dopamine, a chemical that increases alertness. They usually improve alertness for about 8 hours.^1,3

Amphetamines work better for more severe sleepiness. They increase brain levels of dopamine and other wake-promoting chemicals. Different forms improve alertness for different lengths of time. The risks of amphetamines depend on the dose. They can be addictive and easy to abuse.^1,3

Sunosi and Wakix are newer drugs. They work by increasing brain levels of many wake-promoting chemicals. They improve daytime sleepiness throughout the day. They also tend to cause less side effects.¹

Antidepressants to treat cataplexy

Cataplexy happens in about half of people with narcolepsy. The decision to treat cataplexy depends on its severity and potential risk of negative side effects. Drugs used to treat cataplexy are highly effective and can even help some people get rid of it completely.¹

Three types of antidepressants have been used for decades to treat cataplexy:^1-3

• Selective serotonin reuptake inhibitors (SSRIs): Prozac® (fluoxetine)
• Serotonin-norepinephrine reuptake inhibitors (SNRIs): Effexor® (venlafaxine)
• Tricyclic antidepressants: Anafranil™ (clomipramine), Vivactil® (protriptyline)

Antidepressants increase levels of norepinephrine and serotonin. This reduces rapid eye movement (REM) sleep. Cataplexy happens because of REM sleep paralysis during wakefulness. Reducing REM sleep controls the loss of muscle control.^1,2

SSRIs and SNRIs are often used first. They are very effective and less likely to cause serious side effects. Tricyclic antidepressants also work well. But they can cause bothersome side effects.¹

Drugs to treat sleepiness and cataplexy

Some drugs treat both daytime sleepiness and cataplexy. These drugs are called oxybates. They work by depressing the central nervous system. This reduces brain activity to produce deep sleep through the night. After several weeks of regular use, oxybates improve daytime sleepiness and cataplexy.^1-4

Oxybates used to treat sleepiness and cataplexy include:^1,2,5

• Xyrem® and Lumryz® (sodium oxybate)
• Xywav® (mixed oxybate salts)

Oxybates are taken as a liquid right at bedtime. Xywav and Xyrem may need an additional dose in the middle of the night. These drugs are available only through a restricted program. This is because they have a high potential for abuse and misuse. Using oxybates with alcohol or other sedating drugs can cause serious side effects.^1,4,5

What are the possible side effects of prescription drugs for narcolepsy?

Side effects depend on the specific drug you take. Common side effects of narcolepsy drugs include:¹

• Headache
• Nausea, dry mouth, or low appetite
• Disrupted sleep
• Anxiety
• High blood pressure
• Sweating
• Constipation

More serious side effects are also possible. Amphetamines and oxybates have boxed warnings, the strictest warning from the US Food and Drug Administration (FDA). They have this warning because of the risk of abuse and misuse. Narcolepsy drugs can also cause:^1,2,5

• Trouble breathing
• Abnormal heart rhythm
• Heart attack
• Seizures
• Coma
• Psychosis, mania, confusion
• Suicidal thoughts
• Severe rash
• Sleep apnea

These are not all the possible side effects of prescription drugs for narcolepsy. Talk to your doctor about what to expect when taking narcolepsy drugs. You also should call your doctor if you have any changes that concern you.

Before beginning treatment for narcolepsy, tell your doctor about all your health conditions. This includes a history of:^1,5

• High blood pressure or heart problems
• Misusing drugs
• Liver or kidney disease
• Sleep apnea
• Depression or anxiety
• Trouble breathing

Tell your doctor about any other drugs, vitamins, or supplements you take. This includes over-the-counter drugs. Some narcolepsy drugs interfere with birth control pills. Talk to your doctor to see if you should use other forms of birth control.¹