Narcolepsy

Question 1

Modafinil

Answer 1

IND: Narcolepsy
MOA: CNS stimulant, unknown. Controlled
BOX: n/a
CON: n/a
ADR: HA/decreased appetite

Question 2

Pitolisant

Answer 2

IND: Narcolepsy
MOA: CNS stimulant, Antagonist/inverse agonist at Histamine 3
BOX: n/a
CON: Hepatic impairment
ADR: HA/QT prolongation

Question 3

Solriamfetol

Answer 3

IND: Narcolepsy
MOA: DA/NE Reuptake inhibitor (similar to CNS stimulant) controlled
BOX: n/a
CON: MAOIs. ENSURE OSA IS ADEQUATELY TREATED FOR AT LEAST ONE MONTH PRIOR TO INITIATING
ADR: HA/CV effects

Question 4

Sodium Oxybate

Answer 4

IND: Narcolepsy
MOA: Na salt of GHB, a metabolite of GABA. Bring delta brainwaves and increase depth of sleep
BOX: CNS depression. Abuse/misuse = seizures, resp depression, coma, death.
Xywav/Xyrem REMS: Screen for ETOH/substance abuse, sleep apnea, respiratory depression dz’s, suicidality. 1 month initial supply, up to 3 months at a time.
CON: ETOH or other sedatives. Enzyme deficiency
ADR: HA/confusion/dizzy. Decreased appetite, weight loss, vomit
ROUTES: Must give on empty stomach, 2+ hours after eating. Dose 1: bedtime. 2: 2.5-4 hours later
Oral solution; Xyrem contains sodium 3g sodium oxybate = 550mg sodium. Xywav = far less sodium