MEDICATIONS Narcolepsy can be treated using specific medications: Patients with narcolepsy can be substantially helped, but not cured , by medical treatment. Sleepiness is treated with amphetamine-like stimulants , while the symptoms of abnormal REM sleep (cataplexy, sleep paralysis, hypnagogic hallucinations) are treated using antidepressant compounds. Table 1 lists commonly used pharmacological treatments for narcolepsy-cataplexy. These medications also produce a number of negative side effects, and treatment must be tailored to each individual. Not all subjects need to be treated with antidepressants, as sleepiness is often the most important clinically-relevant problem. High doses of stimulants are required for some patients but not for others. Some patients dislike the side effects of the stimulants and prefer to nap every couple of hours to relieve the excessive daytime sleepiness while taking smaller doses of the stimulants.
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COMPOUNDS
Usual Daily Dose
NOTES Stimulants Methylphenidate-HCl, Ritalin®, RitalinSR® (extended release) 10-60mg The regular formulation has a very short duration of
action. This is often useful when patients want to tailor their treatment
to their daily activities or combine stimulant medication with sheduled
napping.Dextroamphetamine-Sulfate: Dexedrine®, Dextrostat®, Dexedrine-SR® 5-60mg Variable duration of action (Urinary pH and formulation), used in the US Methamphetamine-HCl: Desoxyn@ 5-60mg Better distribution in the brain vs. the periphery, more potent and effective than amphetamine, used in the U.S. Pemoline, Cylert® 20-115mg Less potent and effective, long duration of action, hepatotoxicity Mazindol: Sanorex® 0.5-6mg Weakly effective, rarely used except in the U.K. Modafinil: Provigil® 100-400mg Fewer sympathomimetic effects and side effects, long duration of action, well tolerated but lower potency than amphetamines Anticataplectic Compounds Protriptyline: Triptil®, Vivactil® 5-60mg Anticholinergic effects (dry mouth, blurred vision, constipation, etc.) at high doses, mild stimulant, preferentially adrenergic effects Imipramine: Janimine@, Tofranil® 10-100mg Anticholinergic effects Desipramine: Norpramin®, Pertofran® 25-100mg Same as imipramine but more adrenergic effects Clomipramine, Anafranil® 10-150mg Very effective, mostly used in Europe Fluoxetine, Prozac® 20-60mg Well tolerated but high doses are often needed, less weight gain than with other antidepressants, preferentially serotoninergic Venlafaxine (EffexorSR®) 75-225mg New antidepressant, slow release formulation, acting on both the serotoninergic and adrenergic system, active on cataplexy; limited clinical experience but positive preliminary results Reboxetine (Edronax®) 2-10mg New antidepressant, preferentially acting on the adrenergic system, active on cataplexy, some effects on sleepiness, limited clinical experience but very positive preliminary results. Hypnotic Compounds Sodium Oxybate, Xyrem®) 3-9g Short duration of action, resulting anticatapletic effects during daytime.
Was approved on July 17, 2002. Can be toxic at high doses and should be used under medical supervision.
Hypnotic Benzodiazepines Same as for the treatment of non-narcoleptic insomnias
Disclaimer: All the information provided in this web site
is for educational use only and is not intended to replace valuable
medical advice and guidance by a sleep disorder specialist or/and
a neurologist. This is not an all inclusive list. For more details
on other treatments that have been used,
see: Nishino and Mignot, Prog. Neurobiol, 52: 27-78, 1997.
Medication-Related Sites
Revised 02/07/03