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Medications for Narcolepsy

The information provided here is meant to give you a general idea about each of the medicines listed below. Only the most general side effects are included. Ask your doctor if you need to take any special precautions. Use each of these medicines as recommended by your doctor, or according to the instructions provided. If you have further questions about usage or side effects, talk to your doctor.

Prescription Medications

Stimulants
  • Methylphenidate (Ritalin)
  • Dextroamphetamine (Dexedrine)
  • Mazindol (Mazanor, Sanorex)
  • Modafinil (Provigil)
  • Armodafinil (Nuvigil)
Tricyclic antidepressants
  • Imipramine (Tofranil)
  • Desipramine (Norpramin)
  • Clomipramine (Anafranil)
  • Protriptyline (Vivactil)
Selective serotonin reuptake inhibitors (SSRIs)
  • Fluoxetine (Prozac)
  • Paroxetine (Paxil)
  • Sertraline (Zoloft)
Stimulants
Common names include:
  • Methylphenidate (Ritalin)
  • Dextroamphetamine (Dexedrine)
  • Mazindol (Mazanor, Sanorex)
  • Modafinil (Provigil)
  • Armodafinil (Nuvigil)
Stimulants can help you be more alert and awake and can help decrease drowsiness. While using stimulant medicines, you should take the following precautions:
  • To avoid difficulty sleeping at night, ask your doctor about taking your last dose before 6:00 pm.
  • Do not suddenly stop taking a stimulant drug.
  • Be sure to have your doctor approve any other medicines you take while you are using stimulant medicines. Stimulants can interact with a number of over-the-counter medicines.
  • If you are taking sustained-release tablets, never crush or chew them.
  • If you have a history of seizures , tell your doctor. Your medicines will have to be carefully chosen.
You may experience the following side effects:
Note: You may notice these things when you first begin taking a stimulant medicine. Until you know how the medicine will affect you, you should avoid driving, operating machinery, and doing hazardous activities.
Tricyclic Antidepressants
Common names include:
  • Imipramine (Tofranil)
  • Desipramine (Norpramin)
  • Clomipramine (Anafranil)
  • Protriptyline (Vivactil)
You may be given a tricyclic antidepressant if you have symptoms, such as cataplexy (attacks of weakness), hallucinations as sleep begins, or sleep paralysis. To avoid stomach upset, take your tricyclic antidepressants with food, unless your doctor has told you otherwise.
Possible side effects include:
  • Low blood pressure
  • High blood pressure
  • Dry mouth
  • Constipation
  • Increased effects from alcohol, sleeping pills, tranquilizers, or sedatives
  • Sensitivity to sun
  • Dizziness, drowsiness, or blurred vision
  • Blood sugar changes in people with diabetes
  • Hyperthermia (elevated body temperature)
  • Risk of severe mood and behavior changes, including suicidal thoughts in some patients (Young adults may be at a higher risk for this side effect.)
Anticataplexy Medication
  • Sodium oxybate (Xyrem)
Sodium oxybate is used to treat cataplexy. It is a drug that can be abused, so it is a controlled substance. Abuse can cause serious problems, such as trouble breathing, seizures, loss of consciousness, coma, and death. Abuse can also lead to dependence, craving, and withdrawal symptoms. If you are prescribed sodium oxybate, you will have to get the medicine from one central pharmacy. It is not available anywhere else.
Sodium oxybate can reduce the number of cataplexy attacks. But, it must be taken exactly as prescribed. The medicine works very fast, so you need to take it only when you are ready to fall asleep. Sodium oxybate must be taken in two doses each night. The first dose is taken right at bedtime and the second dose is taken 2-1/2 to 4 hours later. So you will probably need to wake yourself up to take the second dose. The most common side effects are nausea, dizziness, headache, sleep problems, confusion, vomiting, and bed-wetting .
Do not engage in activities that require alertness, such as driving, for six hours after taking the medicine. Do not use alcohol or other sedatives while taking this medicine. Your doctor must instruct you in the safe and effective use of this medicine.
Selective Serotonin Reuptake Inhibitors (SSRIs)
Common names include:
  • Fluoxetine (Prozac)
  • Paroxetine (Paxil)
  • Sertraline (Zoloft)
You may be given an SSRI to treat narcolepsy cataplexy, hallucinations as sleep begins, or sleep paralysis. If this medicine upsets your stomach, you can take it with food.
Do not take MAO inhibitors:
  • During SSRI therapy
  • For two weeks prior to starting SSRI therapy
  • For five weeks after stopping SSRI therapy
Serious side effects of SSRI antidepressants include:
  • Anxiety
  • Mania
  • Serious weight loss
  • Weight gain
  • Seizures
  • Low blood sugar in people with diabetes
  • Dizziness, drowsiness, or blurred vision
  • Arrhythmia
  • Risk of severe mood and behavior changes, including suicidal thoughts in some patients (Young adults may be at a higher risk for this side effect.)
Note: You may notice these symptoms when you first begin taking a medicine. Until you know how the medicine will affect you, you should avoid driving, operating machinery, and doing hazardous activities.

Special Considerations

If you are taking medicines, follow these general guidelines:
  • Take your medicine as directed. Do not change the amount or the schedule.
  • Do not stop taking them without talking to your doctor.
  • Do not share them.
  • Know what the results and side effects. Report them to your doctor.
  • Some drugs can be dangerous when mixed. Talk to a doctor or pharmacist if you are taking more than one drug. This includes over-the-counter medicine and herb or dietary supplements.
  • Plan ahead for refills so you do not run out.

References

Antidepressant use in children, adolescents, and adults. US Food and Drug Administration website. Available at: http://www.fda.gov/Drugs/DrugSafety/InformationbyDrugClass/UCM096273 . Published May 22, 2009. Accessed July 15, 2009.

Goetz CG, Pappert EJ. Textbook of Clinical Neurology . Philadelphia, PA: WB Saunders Company; 1999.

Narcolepsy. Micromedex website. Available at: http://www.thompsonhc.com/hcs/librarian . Accessed February 1, 2010.

Narcolepsy. National Heart, Lung, and Blood Institute. National Institutes of Health website. Available at: http://www.nhlbi.nih.gov/health/dci/Diseases/nar/nar%5Fwhat.html . Updated November 2008. Accessed April 7, 2009.

US Food and Drug Administration. Xyrem (sodium oxybate) oral solution medication guide. Center for Drug Evaluation and Research website. Available at: http://www.fda.gov/cder/drug/infopage/xyrem/default.htm . Accessed October 20, 2005.

2/18/2011 DynaMed's Systematic Literature Surveillance DynaMed's Systematic Literature Surveillance : Serretti A, Mandelli L. Antidepressants and body weight: a comprehensive review and meta-analysis. J Clin Psychiatry. 2010;71(10):1259-1272.

Revision Information

  • Reviewer: Rimas Lukas, MD
  • Review Date: 09/2012 -
  • Update Date: 00/91/2012 -

This content is reviewed regularly and is updated when new and relevant evidence is made available. This information is neither intended nor implied to be a substitute for professional medical advice. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with questions regarding a medical condition.

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