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
- Stimulants to treat daytime sleepiness
- Antidepressants to treat cataplexy
People being treated for narcolepsy should see their doctor every 6 months. It is important to watch for drug side effects, changes in sleep or mood, and other health issues.2
Stimulants 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 stimulants 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 stimulant is taken, side effects can include:2-4
- Headache
- Nausea
- Diarrhea
- Dry mouth
- Dizziness
- Nervousness
- Insomnia
- High blood pressure
- Abnormal heart rhythm
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 stimulants are addictive or easy to abuse.2-4
Antidepressants used to treat cataplexy
Only 1 in 3 people with type 1 narcolepsy with cataplexy have severe enough symptoms to 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 Vivactil (protriptyline) or Anafranil (clomipramine)
The brain chemicals (neurotransmitters) norepinephrine and serotonin play a strong role in reducing REM sleep. Doctors do not know how this relates to cataplexy, but they do know that 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
Other drugs to treat narcolepsy
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 up to 3 months of gradually increasing the dose before it fully controls symptoms. Doctors do not understand how sodium oxybate works to treat narcolepsy. Its distribution is tightly controlled by the government because of its 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.8
Xywav is only available through a restricted program.
What are the possible side effects of prescription drugs for narcolepsy?
It is rare but stimulants, 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 or if you experience any changes that concern you during treatment with prescription drugs.
Before beginning treatment for narcolepsy, tell your doctor about all your health conditions and any other drugs, vitamins, or supplements you are taking. This includes over-the-counter drugs.
