Medications for Treating and Managing Narcolepsy

Narcolepsy is a rare condition that affects less than 1% of people in the United States. It’s considered a sleep disorder, as it influences the way your brain manages your sleep and wake cycles.

There are two types of narcolepsy, both chronic in nature:

• Type 1 includes cataplexy, or the sudden inability to control your facial or bodily muscles.
• Type 2 includes other symptoms of narcolepsy, without cataplexy.

With both types of narcolepsy, you may experience:

• excessive daytime sleepiness (EDS)
• hallucinations
• insomnia or interrupted sleep
• waking up in the middle of the night
• sleep paralysis (being awake but unable to move)

When it comes to a chronic condition like narcolepsy, there’s no “one size fits all” solution.

You may have success with a combination of different strategies, so don’t be afraid to try out various treatment options until you find the formula that works for you.

A well-rounded treatment plan may include:

• medication
• lifestyle changes
• self-care strategies
• therapy

To date, the Food and Drug Administration (FDA) has approved seven prescription medications to treat narcolepsy.

Xyrem (sodium oxybate)

Xyrem (sodium oxybate) is a central nervous system (CNS) depressant. While you’re resting, it increases the amount of time that you spend in a deep sleep state.

Since 2002, sodium oxybate has been FDA approved for use in adults living with narcolepsy. In 2018, the FDA approved its use in children over 7 years old.

Sodium oxybate may help you:

• reduce EDS
• allow you to sleep through the night
• help you wake up feeling refreshed (instead of drowsy)
• prevent cataplexy

Common side effects can include:

• feeling dizzy
• drowsiness
• incontinence (wetting the bed)
• upset stomach
• vomiting
• tremors

Sodium oxybate is a Schedule III controlled substance because it has the potential for dependency and misuse. If you have a history of a substance use disorder, letting your doctor know before starting this medication can help them determine if this treatment is right for you.

Provigil (modafinil)

Provigil (modafinil) is a prescription stimulant that may help prevent EDS. It shifts the level of neurotransmitters in your brain to help you feel more awake and alert so you may want to consider taking it in the morning to best complement your sleep and wake cycle.

It’s FDA approved for use in adults living with narcolepsy over 18 years old. It has not yet been approved for use in children.

Research has noted some common side effects, including:

• anxiety
• back pain
• congestion
• difficulty sleeping
• diarrhea
• headaches
• nausea

Provigil is a Schedule IV controlled substance, which means it may create dependency with long-term use. It’s recommended to tell your doctor if you have a personal history of substance use disorder.

Also, Provigil may not be the right medication for you if you have a heart condition because stimulants may increase your heart rate.

Nuvigil (amodafonil)

Similar to Provigil, Nuvigil (amodafonil) is a prescription stimulant that can help keep you awake and reduce EDS associated with narcolepsy.

It’s FDA approved to treat symptoms in adults over 18 years old but not yet approved for treatment in children.

The most commonly reported side effects include:

• anxiety
• diarrhea
• headaches
• upset stomach
• trouble sleeping

Nuvigil is a Schedule IV controlled substance. You may want to consider talking with your doctor if you think you may be at risk for substance use disorder.

In addition, Nuvigil may not be the best stimulant for you if you have a history of:

• anxiety
• depression
• psychosis
• a heart condition

Ritalin (methylphenidate)

You may be familiar with the brand name Ritalin (methylphenidate) for its association with attention deficit hyperactivity disorder (ADHD), but it’s an effective stimulant for the treatment of narcolepsy symptoms, as well.

It works by activating the CNS and increasing the level of dopamine, a feel-good neurotransmitter in your brain, to help you stay more alert during the day.

Methylphenidate is FDA approved for adults and children over 6 years old.

Some common side effects include:

• anxiety
• difficulty sleeping
• dizziness
• feeling jittery
• fever
• dry mouth
• increased heart rate
• rash
• elevated blood pressure
• reduced appetite
• tremors
• upset stomach

Methylphenidate is a Schedule II controlled substance. When taken as prescribed, there is a low risk of dependency. However, letting your doctor know if you have a history of substance use disorder can be helpful in determining if this medication is right for you.

Also, if you have elevated blood pressure or any heart condition, you may want to talk with your doctor about its risks and benefits based on your health history.

Adderall (amphetamine)

Adderall (amphetamine), is a popular brand-name amphetamine that’s generally used as an ADHD treatment, but it can also help prevent daytime tiredness for those living with narcolepsy.

Like Ritalin, Adderall stimulates the CNS and encourages the production of the neurotransmitter dopamine, which can help you stay wide awake.

Amphetamine is an FDA-approved narcolepsy treatment for adults and children over 6 years old.

Some common side effects of this medication may include:

• anxiety
• constipation
• dizziness
• dry mouth
• headache
• indigestion
• reduced appetite
• trouble sleeping
• weight loss

Amphetamine is a Schedule II controlled substance and has an FDA boxed warning due to its high rate of misuse. It may create a dependency if taken in a way other than prescribed. If you have a history of substance use, talking with your doctor can help them determine whether this drug can and should be included in your treatment plan.

If you have high blood pressure or a heart condition, letting your doctor know before you begin taking this medication can also be helpful in weighing the benefits and risks of adding it as a treatment option.

Sunosi (solriamfetol)

Sunosi (solriamfetol) is a newer addition to the list of narcolepsy medications. As of 2019, it’s approved for use in adults who have symptoms of narcolepsy.

It belongs to a class of antidepressant medications known as dopamine-norepinephrine reuptake inhibitors (NDRIs).

Sunosi works to treat narcolepsy by interacting with two neurotransmitters in the brain, dopamine and norepinephrine, to help reduce daytime sleepiness.

Some common side effects may include:

• anxiety
• difficulty sleeping
• headache
• lowered appetite
• upset stomach

Sunosi has the potential to create a dependency for some people. It’s a Schedule IV controlled substance. If you have a history of substance use, telling your doctor can be helpful when discussing possible benefits and risks.

This medication can also elevate your blood pressure and change your heart rate, you may want to consider letting your doctor know if you have a history of hypertension or cardiac conditions, especially if you are over 65 years old.

Wakix (pitolisant)

As the newest addition to this list, Wakix (pitolisant) belongs to a class of medications known as histamine-3 blockers.

This substance can increase the activity of histamine neurotransmitters in your brain, which can help keep you awake and stabilize your muscles.

In 2019, Wakix was FDA approved for use in adults experiencing EDS. In 2020, it was approved to help treat cataplexy as well, another common narcolepsy symptom.

There are a few commonly reported side effects. These may include:

• anxiety
• headache
• insomnia
• muscle aches
• upper respiratory infection
• upset stomach

Wakix is the only narcolepsy medication on the market that is not a controlled substance, so it may be an ideal choice for those who want to avoid taking habit-forming medications.

Narcolepsy may feel like it’s impacting every area of your life. However, with the right treatment plan, managing your symptoms is possible.

It’s common for narcolepsy treatment to include multiple components, like:

• medication
• self-care
• therapy
• lifestyle adjustments

Medication can be helpful in improving quality of life for some people living with this condition.

There are seven FDA-approved medications currently available, ranging from antidepressants to stimulants that can help address disruptive narcolepsy symptoms, such as EDS and cataplexy.

If you feel medication may be necessary, your doctor can recommend the best one for your symptoms and medical history. You may have to try more than one prescription to find what works best for you.

With treatment and other supportive resources, there is hope for effectively managing narcolepsy.