Types of Medication for Narcolepsy

Narcolepsy is a chronic sleep disorder characterized by excessive daytime sleepiness, sleep paralysis, hallucinations, and loss of muscle control triggered by a strong emotion such as laughter (cataplexy). People with narcolepsy may fall asleep during any type of activity.

There are two types of narcolepsies:

1. Type I: Characterized by excessive daytime sleepiness, cataplexy, and deficiency of hypocretin (a chemical substance in the brain) that controls arousal, wakefulness, and appetite.
2. Type II: Characterized by continuous excessive sleepiness without cataplexy. 

People without sleep disorders sleep more than those with narcolepsy.

There is no cure for narcolepsy; however, medications and lifestyle changes can help manage the symptoms. The most used medications include

1. Stimulants: These drugs stimulate the central nervous system and help people stay awake during the day.
   • Some examples include:
     • Modafinil
     • Armodafinil
     • Sunosi
     • Pitolisant
     • Methylphenidate
2. Selective serotonin reuptake inhibitors or serotonin and norepinephrine reuptake inhibitors: They suppress rapid eye movement sleep that is responsible for cataplexy, hypnagogic hallucination, and sleep paralysis.
   • Some examples include:
     • Fluoxetine
     • Venlafaxine
3. Tricyclic antidepressants: These work by reducing cataplexy.
   • Some examples include:
     • Protriptyline
     • Imipramine
     • Clomipramine
4. Sodium oxybate: Xyrem is highly beneficial for cataplexy.
   • Other advantages include:
     • Improves nighttime sleep
     • Controls daytime sleepiness

Stimulants are the primary choice for treating narcolepsy. Mostly, modafinil and armodafinil are effective for daytime sleepiness. Sodium oxybate is highly effective for cataplexy.

Common side effects of stimulants include:

• Headache
• Nausea
• Anxiety
• Nervousness 
• Heart palpitations

Common side effects of selective serotonin reuptake inhibitors or serotonin and norepinephrine reuptake inhibitors include:

• Weight gain
• Insomnia
• Digestive problems

Common side effects of tricyclic antidepressants include:

• Dry mouth
• Light-headedness

Common side effects of sodium oxybate include:

• Nausea
• Bed-wetting
• Worsening of sleepwalking

This is not a complete list of side effects and other serious side effects or health problems that may occur because of the use of this drug. Call your doctor for medical advice about serious side effects or adverse reactions. You may report side effects or health problems to the FDA at 1-800-FDA-1088.

Most narcolepsy drugs should be taken if the benefits outweigh the risk during pregnancy. Sodium oxybate is the only exception as it may be acceptable during pregnancy, but there aren’t many studies to prove the same. If you are pregnant or plan to become pregnant, your physician may suggest that you stop taking your medicines or switch to a lower dose.

Consult your doctor about the safest drug during pregnancy.

It is better to avoid alcohol while taking narcolepsy medication as it can lead to the following side effects:

• Disrupted sleep
• Increased fatigue
• Sleep paralysis
• Trouble breathing