Other prescription drugs that used off-label for narcolepsy symptoms include stimulants, and antidepressants. The FDA, according to its website, has also approved Sunosi (solriamfetol), Provigil (modafinil), Nuvigil (amodafonil), methylphenidate and amphetamine for improving narcolepsy symptoms in adults. It is recommended as the standard of care by the American Academy of Sleep Medicine (AASM), and in 2018, it gained FDA approval as the first and only treatment for pediatric patients with narcolepsy. Xyrem (sodium oxybate) is the only FDA approved and marketed treatment for two symptoms of narcolepsy, excessive daytime sleepiness and cataplexy. Watson, MD, MSc, director of the Harborview Medical Center Sleep Clinic in Washington, pitolisant is a safe and effective treatment for sleepiness in patients with narcolepsy with limited abuse potential.Ĭommon adverse events related to its use include insomnia, anxiety, nausea, headache, upper respiratory infection, musculoskeletal pain, increased heart rate and decreased appetite, the manufacturer noted. According to a press release from its manufacturer, pitolisant is a histamine 3-receptor antagonist/inverse tablet for adults with narcolepsy taken each morning.Īccording to Nathaniel F. Wakix (pitolisant, Harmony Biosciences), the newest pharmacological agent for excessive daytime sleepiness associated with narcolepsy, was approved by the FDA in August. Overweight or obesity are more common in patients with narcolepsy than in the general population, and some patients with narcolepsy have comorbid obstructive sleep apnea.” “Patients with narcolepsy are at increased risk for depression and anxiety. “Narcolepsy can be socially disabling if unrecognized and untreated,” she said. Schuetz said patients with narcolepsy are vulnerable to several comorbidities, necessitating treatment. If the patient falls asleep in less than 8 minutes on average over the five naps and has REM sleep within minutes of falling asleep this indicates excessive daytime sleepiness and that the patient likely has narcolepsy. The second is a multiple sleep latency test, in which patients are asked to take five short naps separated by 2 hours over the course of a day. The first is a polysomnogram to determine whether REM sleep takes place early in the sleep cycle and to rule out if the patient’s symptoms result from another condition, like sleep apnea. To confirm the diagnosis of narcolepsy even without spinal fluid analysis, patients should undergo two tests, both of which can be conducted at a sleep clinic. Unfortunately, this test is not readily available and may be normal in type 2 narcolepsy.Īccording to the NIH, if patients have low levels of the brain hormone, sleep studies are recommended. “Ideally, patients who report narcolepsy’s symptoms should undergo a spinal tap to ascertain hypocretin levels in their cerebrospinal fluid,” he said. “Further, the patient is not unconscious rather, he or she has lost muscle tone.”īogan and others explained how to properly diagnose narcolepsy. “Cataplexy is usually only experienced in a patient’s arms, legs and/or face,” Bogan continued. “Many patients get their information about narcolepsy from movies and TV shows,” which often portray narcolepsy-related paralysis by showing someone going limp from head to toe, suddenly unconscious. He added that cataplexy may cause the most confusion for patients. The symptom that differentiates the two types of narcolepsy is cataplexy - partial or generalized flaccid paralysis precipitated by anticipatory excitement, laughter, anger or surprise - which is only experienced by patients with type 1, Schuetz said.īogan said patients ultimately diagnosed with narcolepsy are most likely to report excessive daytime sleepiness first. Patients with type 1 or type 2 narcolepsy also experience hallucinations that occur at the start or the end of sleep brief periods of generalized paralysis upon awakening abrupt involuntary sleep episodes, and disturbed nocturnal sleep. She said patients with both types of the condition experience excessive daytime sleepiness. Schuetz, MD, MS, MSc, a sleep medicine specialist at Michigan Medicine’s Sleep Disorders Center. Patients with narcolepsy either have Type 1 or Type 2 narcolepsy, according to Sonja G. 7 - Healio Primary Care spoke with experts about the symptoms of narcolepsy, treatment options and more. In recognition of Narcolepsy Awareness Week - Dec.
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