There is no cure for narcolepsy, but medications can be part of helping you manage the symptoms.
Stimulants, Antidepressants & medications for quality sleep are used in many different combinations or by itself. Let’s list your possibilities here, since your doctor most likely can’t tell you all of them during a consult.
Stimulants – The primary treatment to help people with narcolepsy stay awake during the day are drugs that stimulate the central nervous system. Nowadays Modafinil and Armodafinil are often tried first before turning to the older stimulants that contain methylphenidate which can be addictive and may cause more side effects. Adderall, Concerta, Ritalin, Aptensio XR, or various amphetamines.
- Modafinil (Provigil) – Promotes wakefulness and is used to treat excessive sleepiness caused by sleep apnea, narcolepsy, or shift work sleep disorder.
- Armodafinil (Nuvigil)- Promotes wakefulness and is used to treat excessive sleepiness caused by sleep apnea, narcolepsy, or shift work sleep disorder.
- Adderall – Contains a combination of amphetamine and dextroamphetamine and is used to treat attention deficit hyperactivity disorder (ADHD) and narcolepsy. May be habit-forming.
- Concerta (methylphenidate) – Affects chemicals in the brain and nerves that contribute to hyperactivity and impulse control. May be habit-forming.
- Aptensio XR (methylphenidate) – used to treat attention deficit disorder (ADD), attention deficit hyperactivity disorder (ADHD), and narcolepsy. May be habit-forming.
- Ritalin (methylphenidate) – used to treat attention deficit disorder (ADD), attention deficit hyperactivity disorder (ADHD), and narcolepsy. May be habit-forming.
- Vyvanse (lisdexamfetamine) – used to treat attention deficit hyperactivity disorder (ADHD) in adults and in children who are at least 6 years old. May be habit-forming.
- Wakix (pitolisant) – is an antagonist/inverse agonist of the histamine-3 receptor, used to treat excessive daytime sleepiness or cataplexy (sudden loss of muscle strength) in adults with narcolepsy.
- Sunosi (solriamfetol) – is a prescription medicine used to treat excessive daytime sleepiness in adults with narcolepsy or in those whose sleep is disrupted by sleep apnea.
Antidepressants – Often prescribed since they suppress REM sleep and help alleviate the symptoms of cataplexy, sleep paralysis and hypnagogic hallucinations. These are the 3 types of antidepressants mostly prescribed.
1. Selective serotonin reuptake inhibitors (SSRIs) – A type of antidepressant that work by increasing levels of serotonin within the brain. Serotonin is a neurotransmitter that carries messages between brain cells and contributes to well-being, good mood, appetite, as well as helping to regulate the body’s sleep-wake cycle and internal clock. Stay alert to negative changes in your mood or symptoms. source=https://www.drugs.com/drug-class/ssri-antidepressants.html
- Prozac (fluoxetine)
- Lexapro (escitalopram)
- Trazadone (Desryl)
2. Serotonin and norepinephrine reuptake inhibitors (SNRIs) – Increase levels of serotonin and norepinephrine in the brain by blocking or delaying their reuptake by nerves. Serotonin is a neurotransmitter that carries messages between brain cells and contributes to well-being, good mood, appetite, as well as helping to regulate the body’s sleep-wake cycle and internal clock. Norepinephrine is another neurotransmitter that works closely with dopamine and serotonin systems and is thought to help mobilize the brain for action, increasing alertness, and the retrieval of memory.
- Effexor (venlafaxine)
- Cymbalta (duloxetine)
3. Tricyclic antidepressants (TCAs) – A group of older antidepressants that all have a similar structure and all work in a similar way. They work by increasing levels of two neurotransmitters, norepinephrine and serotonin. Some TCAs affect these neurotransmitters more than others which explains why some TCAs work better for narcolepsy then others or are more likely to cause side effects such as constipation, dry mouth, or sedation.
- Anafranil (clomipramine)
- Tofranil (imipramine)
- Vivactil (protriptyline)
- Amitriptyline (Elavil, Endep)
Sleep – Some night time medications help to improve the quality of nighttime sleep. The kind of sleep people with narcolepsy often lack. These are often highly effective for cataplexy and daytime sleepiness.
- Xyrem (sodium oxybate) – A central nervous system depressant. It is used to treat cataplexy (sudden loss of muscle strength) and reduce daytime sleepiness caused by narcolepsy in adults and children at least 7 years old. In the U.S. Xyrem is available only from a certified pharmacy under a special program. Your doctor must be registered in the program in order to prescribe this medicine for you. Contains high level of salt.
- Xywav (oxybate)– A central nervous system depressant. An oral solution containing a combination of calcium, magnesium, potassium, and sodium oxybates. Contains low level of salt. Xywav is for use in adults and children at least 7 years old.
- Baclofen – Baclofen is a muscle relaxer and an antispasmodic agent used to treat muscle pain, spasms, and stiffness in people with multiple sclerosis or spinal cord injury or disease. As many other medications in this list, baclofen is an off label medication, used for narcolepsy as it can promote quality nighttime sleep.