All drugs used to treat narcolepsy are orphan drugs. They were developed for other purposes but have been found useful in treating the symptoms of narcolepsy. No drugs have been developed specifically for this disorder. Although a drug is not indicated for treating a certain condition, a doctor may prescribe any medication he believes to be in the best interest of the patient.
There are two schools of thought among sleep disorders specialists in their approach to medications. The goal is not to be curing the symptoms, since that is not presently a possibility. At best, symptoms can be controlled. The difference of opinion is over the extent to which symptoms should be brought under control, the maximum levels of drugs acceptable to do the job, and whether naps should be used to help maintain alertness and reduce the need for larger dosages.
Should the goal be to keep the patient awake and alert all day, regardless of the dosages needed and without benefits of naps or to keep the patient functioning at an acceptable level in order to perform daily tasks, using the minimum effective dosage and including therapeutic naps during the day to reduce sleepiness and increase alertness?
While the debate continues, currently the most widely accepted approach is to prescribe minimum dosage and the scheduling of naps during the day. The benefits of any drug must be carefully weighed against adverse side effects. Every drug carries with it a price to be paid in negative effects. The higher the dosage, the higher the price. Itâ€™s better not to go into that kind of debt unless you have to.
The following is a generalized guide to the most commonly used medications. Recommended dosages vary greatly. The current approach is to use lower dosages.
Central nervous system (CNS) stimulants used to treat excessive daytime sleepiness and automatic behavior:
- Ritalin available 10-60mg/day.
- Dextroamphetamin (Dexedrine) 5-60mg/day.
- Methamphetamine (Desoxyn) not generally prescribed 15-80mg/day.
Stimulant used to treat excessive daytime sleepiness (EDS) and cataplexy Mazindol (sanorex) less useful for severe narcolepsy. 4-8mg/day in divided dosages.
Antidepressants used to treat cataplexy, hypnagogic hallucinations and sleep paralysis:
- Protriptyline (Vivactil) 10-40mg/day non-sedating may improve EDS if associated with stimulant.
- Imipramine (Tofranil) 25-200mg/day
- Desimpramini (Norpramin) 25-200mg/day
- Clomipramine (Anafranil) 25-200mg/day
- Fluoxetine (Prozac) 20-60mg/day
Note: With the exception of fluoxetine, all antidepressants listed are tricyclic antidepressants (TCAs). Most TCAs have a sedating effect and should be taken at bedtime to avoid worsening excessive daytime sleepiness (EDS) and stimulant interaction. (Some people find it necessary to be taken them during the day to control cataplexy). Should not be stopped abruptly due to possibility of rebound cataplexy should not be taken in combination with monoamine oxidase inhibitors (MAOIs) or other antidepressants. May causes worsening of periodic limb movements of sleep and impotency problems.
Warning: Prazosin, used to lower blood pressure, reportedly has produced \dangerous side effect of narcoleptic patients using Ritalin and Vivactil.
Monoamine Oxidase Inhibitors (MAOIs) not usually recommended due to potential hazardous reactions.
- Phenylzine (Nardil) may be useful in treating difficult cases of narcolepsy cataplexy.
- Selegiline (Eldepryl) has none of the tryramine related side effects and may be useful in treating excessive daytime sleepiness (EDS).
Sedative/hypnotics (to be taken bedtime)
- Temazepan (Restoril) 15-30mg
- Triazolam (Halcion) 0.125-0.25mg
- Flurazepam (Dalmane) 15-30mg long lasting
- B.Barbiturates not usually prescribed
Warning: Should not be used if apnea is present. Do not take with alcohol; do not drive while under the influence of hypnotics.
Note: Information on drugs included here is intended only as a source of general information. Consult your doctor or pharmacist before taking any medications.