Medications for Narcolepsy

The information provided here is meant to give you a general idea about each of the medications listed below. Only the most general side effects are included, so ask your healthcare provider if you need to take any special precautions. Use each of these medications as recommended by your healthcare provider, or according to the instructions provided. If you have further questions about usage or side effects, contact your healthcare provider

Prescription Medications

Stimulants

  • Methylphenidate (Ritalin)
  • Dextroamphetamine (Dexedrine)
  • Pemoline (Cylert)
  • Mazindol (Mazanor, Sanorex)
  • Modafinil (Provigil)

Tricyclic antidepressants

  • Imipramine (Tofranil)
  • Desipramine (Norpramin)
  • Clomipramine (Anafranil)
  • Protriptyline (Vivactil)

Selective serotonin reuptake inhibitors (SSRIs)

  • Fluoxetine (Prozac)
  • Paroxetine (Paxil)
  • Sertraline (Zoloft)

Please note: In March, 2004, the Food and Drug Administration (FDA) issued a Public Health Advisory that cautions physicians, patients, families, and caregivers of patients with depression to closely monitor both adults and children receiving certain antidepressant medications. The FDA is concerned about the possibility of worsening depression and/or the emergence of suicidal thoughts, especially among children and adolescents at the beginning of treatment, or when there’s an increase or decrease in the dose. The medications of concern—mostly SSRIs (Selective Serotonin Re-uptake Inhibitors)—are: Prozac (fluoxetine), Zoloft (sertraline), Paxil (paroxetine), Luvox (fluvoxamine), Celexa (citalopram), Lexapro (escitalopram), Wellbutrin (bupropion), Effexor (venlafaxine), Serzone (nefazodone), and Remeron (mirtazapine). Of these, only Prozac (fluoxetine) is approved for use in children and adolescents for the treatment of major depressive disorder. Prozac (fluoxetine), Zoloft (sertraline), and Luvox (fluvoxamine) are approved for use in children and adolescents for the treatment of obsessive compulsive disorder. For more information, please visit http://www.fda.gov/cder/drug/antidepressants .

Stimulants

Common names include:

  • Methylphenidate (Ritalin)
  • Dextroamphetamine (Dexedrine)
  • Pemoline (Cylert)
  • Mazindol (Mazanor, Sanorex)
  • Modafinil (Provigil)

Stimulants can help you be more alert and awake and can help decrease drowsiness. While using stimulant medications, you should take the following precautions:

  • To avoid difficulty sleeping at night, ask your healthcare provider about taking your last dose before 6:00 PM.
  • Do not stop taking a stimulant drug suddenly.
  • Be sure to have your healthcare provider approve any other medicines you take while you’re using stimulant medications because stimulants can interact with a number of over-the-counter medicines.
  • If you’re taking sustained-release tablets, never crush or chew them.
  • If you have a history of seizures, be sure to tell your healthcare provider. Your medications will have to be carefully chosen.

You may experience the following side effects:

  • Decreased appetite, with potential weight loss
  • High blood pressure
  • Increased agitation, anxiety, jitteriness, or jumpiness
  • Dizziness, drowsiness, or blurred vision*

* Note: You may notice these things when you first begin taking a stimulant medication. Until you know how the medication will affect you, you should avoid driving, operating machinery, and participating in hazardous activities.

Tricyclic Antidepressants

Common names include:

  • Imipramine (Tofranil)
  • Desipramine (Norpramin)
  • Clomipramine (Anafranil)
  • Protriptyline (Vivactil)

You may be given a tricyclic antidepressant if you have symptoms such as cataplexy (attacks of weakness), hallucinations as sleep begins, or sleep paralysis. To avoid stomach upset, take your tricyclic antidepressants with food, unless your doctor has told you otherwise.

Possible side effects include:

  • Low blood pressure
  • High blood pressure
  • Dry mouth
  • Constipation
  • Increased effects from alcohol, sleeping pills, tranquilizers, or sedatives
  • Sensitivity to sun
  • Dizziness, drowsiness, or blurred vision
  • Blood sugar swings in people with diabetes

Anticataplexy Medication

  • Sodium oxybate (Xyrem)

Sodium oxybate is used to treat cataplexy. It is a drug that can be abused, so it is a controlled substance. Abuse can cause serious medical problems, such as trouble breathing, seizures, loss of consciousness, coma, and death. Abuse can also lead to dependence, craving, and withdrawal symptoms. If you are prescribed sodium oxybate by your physician you will have to obtain the medication from one central pharmacy. It is not available anywhere else.

Sodium oxybate can reduce the number of cataplexy attacks, but it must be taken exactly as prescribed. The medication works very fast, so you need to take it only when you are ready to fall asleep. Sodium oxybate must be taken in two doses each night: the first dose is taken right at bedtime and the second dose is taken 2-1/2 to 4 hours later. So you will probably need to wake yourself up to take the second dose. The most common side effects are nausea, dizziness, headache, sleep problems, confusion, vomiting, and bed-wetting.

Do not engage in activities that require alertness, such as driving, for six hours after taking the medication. Do not use alcohol or other sedatives while taking this medication. Your doctor must instruct you in the safe and effective use of this medication

Selective Serotonin Reuptake Inhibitors (SSRIs)

*** see note above

Common names include:

  • Fluoxetine (Prozac)
  • Paroxetine (Paxil)
  • Sertraline (Zoloft)

You may be given an SSRI to treat narcolepsy cataplexy, hallucinations as sleep begins, or sleep paralysis. If this medicine bothers your stomach, you can take it with food.

You should never take MAO inhibitors during SSRI therapy, for two weeks prior to starting SSRI therapy, and for five weeks after stopping SSRI therapy.

Serious side effects of SSRI antidepressants include:

  • Suicidal feelings
  • Anxiety
  • Mania
  • Serious weight loss
  • Seizures
  • Low blood sugar in people with diabetes
  • Dizziness, drowsiness, or blurred vision*

* Note: You may notice these symptoms when you first begin taking a medication. Until you know how the medication will affect you, you should avoid driving, operating machinery, and participating in hazardous activities.

Special Considerations

Whenever you are taking a prescription medication, take the following precautions:

  • Take them as directed—not more, not less, not at a different time.
  • Do not stop taking them without consulting your healthcare provider.
  • Don’t share them with anyone else.
  • Know what effects and side effects to expect, and report them to your healthcare provider.
  • If you are taking more than one drug, even if it is over-the-counter, be sure to check with a physician or pharmacist about drug interactions.
  • Plan ahead for refills so you don’t run out.

References:

National Heart, Lung, and Blood Institute website. Available at: http://www.nhlbi.nih.gov/ .

Textbook of Clinical Neurology . W.B. Saunders Company; 1999.

US Food and Drug Administration. Xyrem (sodium oxybate) oral solution medication guide. Center for Drug Evaluation and Research website. Available at: http://www.fda.gov/cder/drug/infopage/xyrem/default.htm . Accessed on October 20, 2005.



Last reviewed February 2007 by Edward R. Rosick, DO, MPH, MS

Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.

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