Prescription Medications to Treat Narcolepsy

Narcolepsy cannot be cured, but often it can be controlled with a combination of prescription drugs and lifestyle changes. The types of medicines that can help improve the symptoms of narcolepsy include:^1-4

• Wake-promoting drugs to treat daytime sleepiness
• Antidepressants to treat cataplexy
• Other anti-cataplexy/wakefulness drugs such as Xyrem^® (sodium oxybate) or Xywav™ (calcium, magnesium, potassium, sodium oxybates)

People being treated for narcolepsy should see their doctor once or twice a year. If medicines are being adjusted, they should see their doctor more often. It is important to watch for drug side effects, changes in sleep or mood, and other health issues.²

Wake-promoting drugs to treat narcolepsy

Stimulants help keep the person with narcolepsy awake during the day. These drugs also help the person remain alert during important times, such as during work, school, or driving. Some of these drugs work within days.

Provigil^® (modafinil) is the first drug many doctors will prescribe for control of daytime sleepiness caused by narcolepsy. Nuvigil^® (armodafinil) is a similar drug. Both are taken in the morning to prevent nighttime sleep problems. Side effects are uncommon and include headache, nausea, dry mouth, anorexia, rash, and diarrhea. Neither drug is approved for people younger than 17.^2-6

Small studies show that modafinil, in particular, may help prevent sleep attacks while driving. In Canada, modafinil is no longer recommended for women who are pregnant or plan to become pregnant.³

Other wake-promoting drugs used to treat the daytime sleepiness of narcolepsy include:^3,4

• Sunosi^® (solriamfetol)
• Wakix^® (pitolisant)
• Ritalin^®, Concerta^®, Metadate^® (methylphenidate)
• Dexedrine^® (dextroamphetamine)
• Adderall^® (mixed amphetamine salts)

Depending on which wake-promoting drug is taken, side effects can include:^2-4

• Headache
• Nausea
• Diarrhea
• Dry mouth
• Dizziness
• Nervousness
• Insomnia
• High blood pressure
• Abnormal heart rhythm
• Life-threatening rash

Several of these drugs should not be taken by people with liver or kidney disease. Modafinil and pitolisant may make birth control pills less reliable. Several wake-promoting drugs are addictive or easy to abuse.^2-4

Antidepressants used to treat cataplexy

Not all people who experience cataplexy will need drug treatment. When cataplexy control is necessary, antidepressants from 3 drug classes may be prescribed, including:^3,4

• Selective serotonin reuptake inhibitors (SSRIs) such as Prozac^® (fluoxetine)
• Serotonin-norepinephrine reuptake inhibitors (SNRIs) such as Effexor^® (venlafaxine)
• Tricyclics such as Anafranil™ (clomipramine)

The brain chemicals (neurotransmitters) norepinephrine and serotonin play a strong role in reducing REM sleep. There are complex mechanisms involved that are not fully understood. But antidepressants have been used off-label to treat cataplexy for many years. Antidepressants help control the sudden loss of muscle control.^3,4

The SSRIs and SNRIs are generally prescribed first these days. That is because while tricyclic antidepressants work well to control cataplexy, tricyclics have more bothersome side effects such as dry mouth, sweating, and constipation.^3,4

Drugs to treat sleepiness and cataplexy

Xyrem^® (sodium oxybate) helps control daytime sleepiness, cataplexy, nighttime sleep problems, hallucinations, and sleep paralysis. It is a liquid that may be prescribed for those older than age 7. While highly effective, it may take several months of gradually increasing the dose before it fully controls symptoms. Distribution of Xyrem is tightly controlled by the government because of Xyrem's potential for abuse and overdose.^3,7

Xywav™ (calcium, magnesium, potassium, and sodium oxybates) is another drug that helps control both cataplexy and excessive daytime sleepiness in people older than age 7. It has 92 percent less sodium than Xyrem, which could help reduce the risk of heart disease in people at higher risk.⁸

Xywav is only available through a restricted program.

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

It is rare, but wake-promoting drugs, antidepressants, and sodium oxybate sometimes cause serious side effects, including:³

• 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 prescription drugs for narcolepsy. You also should call your doctor if you have any changes that concern you when taking prescription drugs for narcolepsy.

Before beginning treatment for narcolepsy, tell your doctor about all your health conditions and any other drugs, vitamins, or supplements you take. This includes over-the-counter drugs.