Stimulants to Treat Narcolepsy

Reviewed by: HU Medical Review Board | Last reviewed: April 2024 | Last updated: April 2024

There are several different wake-promoting drugs that may be prescribed to treat the daytime sleepiness or sleep attacks of narcolepsy. Wake-promoting drugs 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 hours. Others may take several weeks to reach full effect. Even with wake-promoting drugs and strategic daytime naps, most people with narcolepsy are able to stay awake only 70 to 80 percent of what is normal.1

Many people with narcolepsy require more than one medicine to help promote wakefulness. It is important to work closely with your doctor to find the right combination of medicines for you.1

Wake-promoting drugs used for narcolepsy

Many wake-promoting drugs may be prescribed to treat the daytime sleepiness of narcolepsy, including:1,2

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

In the United States, Provigil and Nuvigil (modafinil and armodafinil) are usually prescribed first because they are less addictive and have fewer side effects than older stimulants. However, these drugs do not work for everyone, and the older drugs may still offer a good option for those people.3

What are the possible side effects of Provigil and Nuvigil?

Provigil (modafinil) is the first drug many doctors will prescribe for control of daytime sleepiness without disrupting nighttime sleep. Nuvigil (armodafinil) is a similar drug. Both are taken in the morning.

Side effects are uncommon and include:1,2

  • Headache
  • Nausea
  • Dry mouth
  • Rash
  • Anorexia
  • Diarrhea

A rash can be a sign of serious complications, so it is important to tell your doctor if you develop a rash. These drugs may be a good choice for older people but may not be the right option for those with high blood pressure or heart disease. Abuse of these drugs is rare.1,2

In Canada, modafinil is no longer recommended for women who are pregnant or plan to become pregnant. Both drugs make birth control pills less reliable, so you will need back-up contraception. People with liver or kidney disease should not take Provigil.1

Side effects of Sunosi

The most common side effects of Sunosi (solriamfetol) include:1

  • Headache
  • Nausea
  • Reduced appetite
  • Anxiety
  • Dry mouth
  • Diarrhea

Sunosi should be used with caution in people with a history of psychiatric disorders and severe heart disease. People taking Sunosi should be monitored for heart rate and blood pressure changes.1

Side effects of Wakix

The most common side effects of Wakix (pitolisant) include:1

  • Headache
  • Insomnia
  • Nausea
  • Anxiety

In addition to reducing daytime sleepiness, Wakix may also be prescribed to treat cataplexy in adults. This drug may make birth control pills less reliable. It should not be taken with certain antidepressants or by people with liver or kidney disease.1,4

Side effects of Ritalin, Concerta, Metadate, Methylin, Dexedrine, and Adderall

Each drug has its own set of possible side effects. However, there are some common side effects seen in Ritalin, Concerta, Metadate, Methylin, Dexedrine, and Adderall, including:1,2

  • Reduced appetite
  • Nausea
  • Headache
  • Insomnia

Serious potential side effects are more common at high doses and include:1,2

  • High blood pressure
  • Psychosis or mania
  • Seizures
  • Abnormal heart rhythm
  • Heart attack

In addition, all of these drugs are addictive or easy to abuse.1,2

People being treated for narcolepsy should see their doctor once or twice a year. If your medicine is being adjusted, you should see your doctor more often. It is important to watch for drug side effects, changes in sleep or mood, and other health issues. None of these drugs should be stopped suddenly.2

Side effects can vary depending on the specific wake-promoting drug you are taking. These are not all the possible side effects of wake-promoting drugs for narcolepsy. Talk to your doctor about what to expect when taking wake-promoting drugs. You also should call your doctor if you have any changes that concern you when taking wake-promoting drugs.

Other treatments for narcolepsy

In addition to wake-promoting drugs, other drugs that are used to treat narcolepsy include antidepressants and central nervous system depressants. Your doctor will decide which treatments are best for you based on your individual symptoms and how you respond to different 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.

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Treatment results and side effects can vary from person to person. This treatment information is not meant to replace professional medical advice. Talk to your doctor about what to expect before starting and while taking any treatment.