The Stanford Center for Sleep Sciences and Medicine

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

Modafinil

 100-400mg

Fewer sympathomimetic effects and side effects, long duration of action, well tolerated but lower potency than amphetamines

Armodafinil

50-250mg

Part of the active compound present in modafinil (the R-isomer) with a longer duration of action

Methylphenidate-HCl

 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.

Dextroamphetamine-Sulfate

 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. 

Pemoline

 20-115mg

Less potent and effective, long duration of action, hepatotoxicity

Anticataplectic Compounds

Venlafaxine

75-225mg

New antidepressant, slow release formulation, acting on both the serotoninergic and adrenergic system, active on cataplexy

Duloxetine

10-20mg

Similar profile to venlafaxine.  Must check Liver Function test during use.

Atomoxetine

10-80mg

Norepinephrine reuptake inhibitor, used for ADHD, some effect on sleepiness as well

Protriptyline

 5-60mg

Anticholinergic effects (dry mouth, blurred vision, constipation, etc.) at high doses, mild stimulant, preferentially adrenergic effects

Imipramine

 10-100mg

Anticholinergic effects

Desipramine

 25-100mg

Same as imipramine but more adrenergic effects

Clomipramine

 10-150mg

Very effective, mostly used in Europe

Fluoxetine

 20-60mg

Well tolerated but high doses are often needed, less weight gain than with other antidepressants, preferentially serotoninergic

Hypnotic Compounds

Sodium Oxybate

 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

 

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