Narcolepsy: Treatment Issues

Pharmacologic management of patients with narcolepsy is usually based on treating the separate symptoms of cataplexy and excessive daytime sleepiness (EDS). For treating cataplexy, the most widely used medications include the antidepressants venlafaxine, imipramine, and protriptyline, usually at lower doses than prescribed with depression, and sodium oxybate. Monoamine oxidase inhibitors are also sometimes used, but much less frequently. The U.S. Food and Drug Administration has approved 4 medications for EDS: dextroamphetamine, methylphenidate, modafinil, and sodium oxybate. Sodium oxybate is the only drug approved for treating both cataplexy and EDS. Modafinil and sodium oxybate have similar, long-term efficacies in treating EDS at prescribed doses.