Narcolepsy Drug Treatment
Narcolepsy drug treatment using Gamma Hydroxybutyrate, Selegiline, and antidepressants are effective way of controlling the symptoms of narcolepsy, but mostly all narcolepsy drug treatment methods has got their own side effects.
Narcolepsy Drug Treatment: Gamma-Hydroxybutyrate (GHB)
Gamma hydroxybutyrate (Xyrem), also referred to as sodium oxybate or GHB. GHB acts as an effective narcolepsy drug treatment. It is proving to reduce the frequency of cataplexy attacks and to improve daytime sleepiness.
It takes about four weeks for significant benefits, which reach their peak at about eight weeks. Food intake can affect its activity, so patients are advised to take it at a regular time after the evening meal.
Xyrem has been approved by the FDA for narcolepsy drug treatment, but with tight restrictions on its use. In high doses, it can cause dependence in over time. In addition very serious side effects, including seizures, coma, respiratory arrest, and death have been reported in people who abused it.
Trials of Xyrem, however, have not reported these effects with the doses used in narcolepsy drug treatment for cataplexy. Patients still report side effects, although they tend to be mild. They include nausea, headache, dizziness, urine leakage, and sleepwalking.
Narcolepsy Drug Treatment: Monoamine Oxidase Inhibitors (Selegiline)
Another narcolepsy drug treatment is Selegiline (Eldepryl, Movergan), also known as deprenyl. It is an antioxidant drug that blocks monoamine oxidase B, an enzyme that degrades dopamine and may play a role in narcolepsy drug treatment.
Adverse Effects. Selegiline has side effects that are important:
- It has adverse interactions with nearly every antidepressant, some very serious. Patients suffering from depression should discuss all narcolepsy treatment options with their physician.
- People taking any monoamine oxidase inhibitor are at risk for high blood pressure if they consume tyramine-containing foods or beverages, including aged cheeses, most red wines, vermouth, dried meats and fish, canned figs, fava beans, and concentrated yeast products.
Narcolepsy Drug Treatment: Antidepressants
Antidepressants have been very useful narcolepsy drug treatment. It is effective controlling symptoms of narcolepsy, particularly cataplexy.
Tricyclic Antidepressants. The tricyclic antidepressants protriptyline (Vivactil), clomipramine (Anafranil), imipramine (Janimine, Tofranil), and viloxazine appear to suppress REM sleep and may be added to the stimulant regimen in severe cases.
These antidepressants do not cause sedation and are useful in managing cataplexy, sleep paralysis, and hypnagogic hallucinations (the hallucinations that occur between sleep and wakefulness).
Side effects are fairly common with these medications and many people cannot tolerate them. The most often reported include the following:
- Blurred vision.
- Sexual dysfunction.
- Weight gain.
- Difficulty in urinating.
- Dry mouth.
- Blood pressure may drop suddenly when sitting up or standing.
Tricyclics can have serious, although rare, side effects.
- They tend to cause disturbances in heart rhythm, which can pose a danger for some patients with certain heart diseases.
- They can cause fatal overdose.
- Also of concern is a study reporting that tricyclics, particularly imipramine, may be responsible for 10% of cases of a lung disease called idiopathic pulmonary fibrosis (IPF), which can cause lung inflammation and scarring. Initial symptoms are breathlessness and dry cough. The two newer tricyclics, mianserin and dothiepin, also increased the risk.
- Abrupt withdrawal, notably from clomipramine, has caused severe and prolonged cataplexy in some cases.
Narcolepsy Drug Treatment: Selective Serotonin Reuptake Inhibitors (SSRI):
Selective serotonin reuptake inhibitors (SSRIs) may also be helpful in combination with stimulants for narcolepsy drug treatment. For example, fluoxetine (Prozac), the standard SSRI, and citalopram (Celexa), another SSRI, have been reported to be effective in treating cataplexy that does not respond to standard narcolepsy treatments.
Side effects include the following:
- Agitation, insomnia, mild tremor, and impulsivity occur in 10% and 20% of people who take SSRIs, these symptoms may be particularly problematic in patients who also suffer from anxiety, sleeplessness, or both. Such side effects may persist. On the other hand, about 20% of SSRI-treated patients experience drowsiness, which may be counteracted by taking the medication at bedtime.
- Some weight loss during the first few weeks of narcolepsy drug treatment may occur, but over time patients on maintenance narcolepsy drug treatment typically return to their pretreatment weight.
- Dry mouth is common and can increase the risk for cavities and mouth sores.
- Nausea and gastrointestinal problems. These effects usually wear off over time.
- Sexual dysfunction, including delayed or loss of orgasm and low sexual drive, occurs in 30% to 40% of patients on SSRIs and accounts for a substantial amount of noncompliance.