![]() ![]() Avidan, MD, MPH: I think it’s more of the former. When those stimulants do have a slight effect on cataplexy, do you think it’s mainly because they are affecting the alertness and sleepiness and, therefore, there’s not that pressure for developing cataplexy? Or do you think it’s a more specific effect on cataplexy?Īlon Y. Thorpy, MD: That’s the only one that’s FDA approved. However, the 1 drug-currently the only drug-in the United States that actually has an impact on cataplexy is, in fact, sodium oxybate. But if we have someone with narcolepsy type 1 who has more difficulties with cataplexy, certainly a stimulant may have better activity. That is 1 differentiation, although the wake-promoting agents are not marketed or prescribed specifically to address cataplexy. The traditional wake-promoting agents do not. ![]() Avidan, MD, MPH: The traditional stimulants do have some effect on cataplexy. Thorpy, MD: Do the traditional stimulants and the modafinils have any effect on cataplexy, or are they just for the sleepiness?Īlon Y. With newer ones now available, we have new mechanisms of action and new opportunities for management. So those were the 4 primary treatments up until recently. So it is, in fact, a hypnotic, and it does work in consolidating nocturnal sleep. When nocturnal sleep is improved, daytime functioning improves as well. We give it at night, and it works by fundamentally improving nocturnal sleep. Sodium oxybate is very different than the traditional stimulants because it’s not a stimulant and it’s not taken during the day. Sodium oxybate also came around at the same time. The wake-promoting agents have the advantage of being taken once a day without inducing the sympathetic hyperactivity, which is often unique to the amphetamine-type medications. And later on, armodafinil, the (R)-isomer of modafinil. We’re specifically talking about modafinil. In the 1990s, we saw the development of 2 medications that share 2 different mechanisms of action. Thorpy, MD: Specifically, you’re talking about the amphetamine agents and methylphenidate, is that right?Īlon Y. They work very effectively, but they often have some adverse effects often related to their mechanism of action of being somewhat sympathomimetics. Avidan, MD, MPH: The traditional medications for narcolepsy have been psychostimulants, which have probably been around the longest. ![]() With regard to the medications, Alon, what medications do we currently use for narcolepsy?Īlon Y. Thorpy, MD: You really need to have comprehensive management of a patient diagnosed with narcolepsy, and it’s important to deal with the lifestyle, psychosocial aspects as well. ![]()
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