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Article Narcolepsy: Current treatment options and future approaches

Treatment options may vary from a single drug that targets several symptoms, or multiple medications each for a specific symptom. Use of modafinil/armodafinil for daytime sleepiness, antidepressants (selective serotonin and dual serotonin and noradrenaline reuptake inhibitors) for cataplexy, and sodium oxybate for both symptoms. Other psychostimulants can also be used, such as methylphenidate, pitolisant and rarely amphetamines.

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Article Treatment Options for Narcolepsy

You need to tailor the treatment to the patient.

I usually discuss all the potential treatment modalities when I confirm the diagnosis and then chose what I think will be best.

read some good review article on treatment of the disease and then get some eperience.

Review ArticleUpdate on the pharmacologic management of narcolepsy: mechanisms of action and clinical implications

Author links open overlay panelMichael J.ThorpyaRichard K.BoganbShow morehttps://doi.org/10.1016/j.sleep.2019.09.001Get rights and content

Highlights

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Pathophysiology of narcolepsy provides many targets for pharmacologic intervention.

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Excessive daytime sleepiness treatments mainly act on dopamine and norepinephrine.

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Mechanism of action of treatments for cataplexy is less well characterized.

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Histamine pathways offer a novel mechanism of action in the treatment of narcolepsy.

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Combination therapy often includes medications with differing mechanisms of action.

Abstract

Narcolepsy is a chronic, debilitating neurological disorder of sleep-wake state instability. This instability underlies all narcolepsy symptoms, including excessive daytime sleepiness (EDS), symptoms of rapid eye movement (REM) sleep dysregulation (ie, cataplexy, hypnagogic/hypnopompic hallucinations, sleep paralysis), and disrupted nighttime sleep. Several neurotransmitter systems promote wakefulness, and various neural pathways are involved in regulating REM sleep-related muscle atonia, providing multiple targets for pharmacologic intervention to reduce EDS and cataplexy. Medications approved by the US Food and Drug Administration (FDA) for the treatment of EDS in narcolepsy include traditional stimulants (eg, amphetamines, methylphenidate), wake-promoting agents (eg, modafinil, armodafinil), and solriamfetol, which mainly act on dopaminergic and noradrenergic pathways. Sodium oxybate (thought to act via GABAB receptors) is FDA-approved for the treatment of EDS and cataplexy. Pitolisant, a histamine 3 (H3)-receptor antagonist/inverse agonist, is approved by the European Medicines Agency (EMA) for the treatment of narcolepsy with or without cataplexy in adults and by the FDA for the treatment of EDS in adults with narcolepsy. Pitolisant increases the synthesis and release of histamine in the brain and modulates the release of other neurotransmitters (eg, norepinephrine, dopamine). Antidepressants that inhibit reuptake of serotonin and/or norepinephrine are widely used off label to manage cataplexy. In many patients with narcolepsy, combination treatment with medications that act via different neural pathways is necessary for optimal symptom management. Mechanism of action, pharmacokinetics, and abuse potential are important considerations in treatment selection and subsequent medication adjustments to maximize efficacy and mitigate adverse effects in the treatment of patients with narcolepsy.

modafinil