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Treatments and drugs
By Mayo Clinic staffThere is no cure for narcolepsy, but medications and lifestyle modifications can help you manage the symptoms.
Medications
Medications for narcolepsy include:
- Stimulants. Drugs that stimulate the central nervous system are the primary treatment to help people with narcolepsy stay awake during the day. Doctors often try modafinil (Provigil) first for narcolepsy because it isn't as addictive as older stimulants and doesn't produce the highs and lows often associated with older stimulants. Side effects of modafinil are uncommon, but they may include headache, nausea, dry mouth, anorexia and diarrhea. Modafinil may increase blood pressure, especially at high doses. Some people need treatment with methylphenidate (Concerta, Ritalin, others) or various amphetamines. Although these medications are effective, they may cause side effects, such as nervousness and heart palpitations, and can be addictive.
- Selective serotonin or norepinephrine reuptake inhibitors (SSRIs, SNRIs). Doctors often prescribe these medications, which suppress REM sleep, to help alleviate the symptoms of cataplexy, hypnagogic hallucinations and sleep paralysis. They include atomoxetine (Strattera), fluoxetine (Prozac, Sarafem, others) and venlafaxine (Effexor). The most common side effects include decreased sexual desire and delayed orgasm. Other side effects may wane over time. They can include digestive problems, jitteriness, restlessness, headache and insomnia.
- Tricyclic antidepressants. These older antidepressants, such as protriptyline (Vivactil) and imipramine (Tofranil), are effective for cataplexy, but many people complain of side effects, such as dry mouth and constipation.
- Sodium oxybate (Xyrem). This medication may be prescribed for severe cataplexy. Sodium oxybate helps to improve nighttime sleep, which is often poor in narcolepsy. In high doses it may also help control daytime sleepiness. It must be taken in two doses, one at bedtime and one up to four hours later, and it can take two to three months to achieve its full effect, although benefits will be apparent early on. Xyrem can have serious side effects, such as nausea, bed-wetting and worsening of sleepwalking. Too high a dose can lead to difficulty breathing, coma and death.
If you have other health problems, such as high blood pressure or diabetes, ask your doctor how the medications you take for your other conditions may interact with those taken for narcolepsy.
Certain over-the-counter drugs, such as allergy and cold medications, can cause drowsiness. If you have narcolepsy, your doctor will likely recommend that you avoid taking these medications.
- Narcolepsy fact sheet. National Institute of Neurological Disorders and Stroke. http://www.ninds.nih.gov/health_and_medical/pubs/narcolepsy.htm. Accessed April 8, 2010.
- Scammel T. Diagnosis and neurobiology of narcolepsy. http://www.uptodate.com/home/index.html. Accessed April 8, 2010.
- Scammel T. Treatment of narcolepsy. http://www.uptodate.com/home/index.html. Accessed April 8, 2010.
- Wise MS, et al. Treatment of narcolepsy and other hypersomnias of central origin. Sleep. 2007;30:1712.
- Narcolepsy. National Heart, Lung, and Blood Institute. http://www.nhlbi.nih.gov/health/dci/Diseases/nar/nar_all.html. Accessed April 11, 2010.
- Morgenthaler TI, et al. Practice parameters for the treatment of narcolepsy and other hypersomnias of central origin. Sleep. 2007;30:1705.
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