NarcolepsyNetwork

Narcolepsy Medications | Lifestyle Adjustments | Alternative Therapies

Disclaimer: No medication works equally well for every individual. In addition, narcolepsy is known to have more than one underlying cause. The following discussion is intended to provide general information. Only your physician can determine what is right for you.

Treatment of Excessive Daytime Sleepiness

Medications used to relieve sleepiness are all stimulants or wake promoting medications. These include various forms of Amphetamines [Dextroamphetamine (Dexedrine®, Dexedrine SR®), Methamphetamine (Desoxin®), Mixed Amphetamine Salts (Adderall®)]; Methylphenidate (Ritalin®), Armodafinil (Nuvigil ®) and Modafinil (Provigil®). Another medication, Pemoline (Cylert®), which worked well for some people, was withdrawn from the market because it could damage the liver and even cause death. Patients may find that some of these medications work well for them, some not as well, and others not at all. Some medications are quick acting, but their effects are often short lived. Other medications act more slowly, but work for longer periods of time. Sometimes, it is necessary for the doctor to prescribe several medicines simultaneously to be taken several times throughout the day so that the patient can become alert and stay alert for a reasonable length of time.

COMMON MEDICATIONS USED TO CONTROL SLEEPINESS (PDF)

Treatment of REM Symptoms

Drug therapy for REM Intrusion is aimed at the most serious of these symptoms, Cataplexy, but also works to relieve Hypnagogic and Hypnopompic Hallucinations, Sleep Paralysis and Disrupted Nighttime Sleep. It is commonly treated by the use of Antidepressants which suppresses REM Sleep. There are several classes of Antidepressants:

• Serotonin Norepinephrine Reuptake Inhibitors like Venlafaxine (EffexorSR®);
• Norepinephrine Reuptake Inhibitors like Atomoxetine (Strattera®);
• Selective Serotonin Reuptake Inhibitors like Fluoxetine (Prozac®) and Sertraline (Zoloft®) ;
• Older Tricyclic Antidepressants like Protriptyline (Triptil® and Vivactil®), Imipramine (Janimine® and Tofranil®), Desipramine (Norpramine® and Pertofran®), and Clomipramine (Anafranil®).

There is also a newer medication that can help relieve both Sleepiness and REM Intrusion, Sodium Oxibate (Xyrem®). In addition, it will also help with Disrupted Nighttime Sleep. This medicine is unlike any of the others. It is a liquid that is taken in divided doses at bed time and again about four hours later. Also, unlike the others it promotes Stages 3 and 4 Sleep (also known as Deep or Consolidated Sleep). It can reduce the need for both alerting and REM Intrusion reducing drugs.

COMMON MEDICATIONS USED TO CONTROL REM SLEEP INTRUSION (PDF)

There is continuing research on Narcolepsy, how the sleep/wake cycle works, and new medications. Our bodies and lifestyles change as we age, and our physiology can adapt to our medicines. Because of these factors, it is likely that it will be necessary to occasionally readjust prescriptions, dosages, and the times we take them.

It is pointless to simply prescribe a medicine and let the patient do whatever she or he wants without regard to the consequences. Not enough emphasis is placed on counseling those with Narcolepsy about the need for regular and sufficient sleep including naps, good Sleep Hygiene, diet that can reduce sleepiness, Light Therapy that can promote alertness, participation in a Support Group where one can share problems and learn solutions and coping mechanisms, and exercise that can energize.

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