Treating Narcolepsy with Medications
Medication is the most common way to manage narcolepsy. Patients with narcolepsy can be substantially helped, but not cured. Selecting the best medications is a complex process and many people require more than one medication. It is not uncommon for patients to try more than one type of medication before finding the best treatment to manage the symptoms. Finding the best dosage may also take some time.
Sleepiness is often treated with amphetamine-like stimulants , while the symptoms of abnormal REM sleep (cataplexy, sleep paralysis, hypnagogic hallucinations) are treated using antidepressant compounds.
Below is a list of commonly used pharmacological treatments for narcolepsy-cataplexy. These medications also produce a number of negative side effects, so 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. 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.
This medication list is not intended to replace valuable medical advice and guidance by a sleep disorder specialist or/and a neurologist. It is not an all inclusive list.
Compounds |
Usual Daily Dose |
Notes |
Stimulants |
||
100-400mg |
Fewer sympathomimetic effects and side effects, long duration of action, well tolerated but lower potency than amphetamines |
|
50-250mg |
Part of the active compound present in modafinil (the R-isomer) with a longer duration of action |
|
10-60mg |
The formulation and use of either or both isomer(s) make a significant difference in effect. 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 scheduled napping. |
|
5-60mg |
Variable duration of action (Urinary pH and formulation), used in the US. The formulation and use of either or both isomer(s) make a significant difference in effect. |
|
20-115mg |
Less potent and effective, long duration of action, hepatotoxicity |
|
Anticataplectic Compounds |
||
75-225mg |
New antidepressant, slow release formulation, acting on both the serotoninergic and adrenergic system, active on cataplexy |
|
10-20mg |
Similar profile to venlafaxine. Must check Liver Function test during use. |
|
10-80mg |
Norepinephrine reuptake inhibitor, used for ADHD, some effect on sleepiness as well |
|
5-60mg |
Anticholinergic effects (dry mouth, blurred vision, constipation, etc.) at high doses, mild stimulant, preferentially adrenergic effects |
|
10-100mg |
Anticholinergic effects |
|
25-100mg |
Same as imipramine but more adrenergic effects |
|
10-150mg |
Very effective, mostly used in Europe |
|
20-60mg |
Well tolerated but high doses are often needed, less weight gain than with other antidepressants, preferentially serotoninergic |
|
Hypnotic Compounds |
||
3-9g |
Short duration of action, resulting anticatapletic effects during daytime. Helps alleviate daytime sleepiness. Was approved on July 17, 2002. |
|
Hypnotic Benzodiazepines |
|
Same as for the treatment of non-narcoleptic insomnias |