Medications for Narcolepsy

FDA Public Health Advisory for Antidepressants

The FDA advises that people taking antidepressants should be closely observed. For some, the medications have been linked to worsening symptoms and suicidal thoughts. These adverse effects are most common in young adults. The effects tend to occur at the beginning of treatment or when there is an increase or decrease in the dose.

Although the warning is for all antidepressants, of most concern are the SSRI class such as:

• Prozac (fluoxetine]]>), Zoloft (]]>sertraline]]>), Paxil (]]>paroxetine]]>), Luvox (]]>fluvoxamine]]>), Celexa (]]>citalopram]]>), Lexapro(]]>escitalopram]]>)

For more information, please visit: http://www.fda.gov/cder/drug/antidepressants/

Stimulants

Common names include:

• Methylphenidate]]> (Ritalin)
• ]]>Dextroamphetamine]]> (Dexedrine)
• Pemoline (Cylert)
• Mazindol (Mazanor, Sanorex)
• ]]>Modafinil]]> (Provigil)

Stimulants can help you be more alert and awake and can help decrease drowsiness. While using stimulant medications, 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 stop taking a stimulant drug suddenly.
• Be sure to have your doctor approve any other medicines you take while you’re using stimulant medications. Stimulants can interact with a number of over-the-counter medicines.
• If you’re taking sustained-release tablets, never crush or chew them.
• If you have a history of ]]>seizures]]>, be sure to tell your doctor. Your medications will have to be carefully chosen.

You may experience the following side effects:

• Decreased appetite, with potential weight loss
• ]]>High blood pressure]]>
• Increased agitation, ]]>anxiety]]>, jitteriness, or jumpiness
• Dizziness, drowsiness, or blurred vision
• Serious rash (]]>Stevens-Johnson syndrome]]>)

Note: You may notice these things when you first begin taking a stimulant medication. Until you know how the medication will affect you, you should avoid driving, operating machinery, and participating in 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 swings in people with diabetes
• Hyperthermia (elevated body temperature)

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 medical 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 by your doctor, you will have to obtain the medication 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 medication 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 medication. Do not use alcohol or other sedatives while taking this medication. Your doctor must instruct you in the safe and effective use of this medication.

Selective Serotonin Reuptake Inhibitors (SSRIs)

*** see note]]> above

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 bothers 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:

• Suicidal feelings
• Anxiety
• Mania
• Serious weight loss
• Seizures
• Low blood sugar in people with diabetes
• Dizziness, drowsiness, or blurred vision

Note: You may notice these symptoms when you first begin taking a medication. Until you know how the medication will affect you, you should avoid driving, operating machinery, and participating in hazardous activities.