Medications

Drugs that act as stimulants are standard treatments for narcolepsy. They include the following:

• methylphenidate (Ritalin)



• modafinil (Provigil)

• Methylphenidate helps reduce excessive daytime sleepiness, improving the symptoms of narcolepsy in 65%-85% of patients. Methylphenidate, the most frequently used stimulant, improves alertness in a dose-related fashion.



• Unfortunately, these medications have undesirable side effects including headache, irritability, nervousness, and gastrointestinal complaints. Nocturnal sleep may be impaired, thus decreasing sleep time.



• There are theoretical concerns that these drugs may become ineffective if used continuously for long periods. Therefore, some healthcare providers advise people with narcolepsy to abstain from medication one day each week (typically on a weekend; known as a "drug holiday"). During that day, the person should not engage in activities that require being awake, such as driving.

• Modafinil (Provigil) was discovered as a novel drug that promotes long-lasting wakefulness.



• It has been shown in several trials to reduce excessive daytime sleepiness. People treated with modafinil experienced both subjective improvement and objective improvement in sleepiness.



• The most common side effect is headache.



• Its safety in children has not been established.

Cataplectic attacks are usually treated by clomipramine, imipramine, fluoxetine, or sodium oxybate.

• Clomipramine (Anafranil) and imipramine (Tofranil) belong to the family of tricyclic antidepressants. They reduce the frequency of cataplexy in people with narcolepsy.



• Fluoxetine (Prozac) is a selective serotonin reuptake inhibitor that is useful in the treatment of cataplexy. It has fewer side effects than tricyclic antidepressants.

For both excessive daytime sleepiness and cataplexy:

• Sodium oxybate (Xyrem), commonly called gamma hydroxybutyrate, is a central nervous system depressant initially approved for a small subset of people with narcolepsy and cataplexy that does not respond to the other anticataplectic medications. The precise mechanism by which it produces an effect on cataplexy is unknown. It has a history of abuse as a recreational drug; therefore, the FDA approved it as a Schedule III Controlled Substance. After its initial approval for cataplexy, it has become approved for excessive daytime sleepiness in narcolepsy.