Bear in mind that a lot of patients who have cataplexy may have a few episodes per week or may not require traditional therapy or a specific therapy for cataplexy itself and are able to manage it by avoiding situations-nothing that I would advocate the patients do, but they may not require a specific therapy directed at the cataplexy. The advantages here are both improvement of daytime sleepiness and very effective improvement of cataplexy. Now, the other patient who presents with excessive daytime sleepiness and cataplexy, where the cataplexy is quite frequent, would probably be most appropriately treated with sodium oxybate-and have 1 drug that addresses multiple facets of the disease by being taken at night, with a second dose 2 to 4 hours later. And for those individuals, if they do feel sleepy at 1 o’clock, 2 o’clock, or if they feel so sleepy that it’s affecting their driving, then a short-acting methylphenidate medication would actually be effective. We may be able to, at that point, assess the patient and evaluate whether to prescribe additional therapy. They may follow with a second dose later in the morning or early afternoon. ![]() And the advantage here: It’s a once-a-day, perhaps twice-a-day formulation. Some may have certain underlying comorbidities for which some of these agents may not be the most appropriate first-line therapy.Īs a general rule, for folks who have narcolepsy type 1 and type 2, the most commonly prescribed group of drugs is the wake-promoting agents. ![]() Patients may present with narcolepsy as a different phenotype, in that some patients may have underlying depression or anxiety. I do not have an algorithm that I put the patient through and then that’s the only algorithm I follow, because all of these medications have their pluses and minuses. Avidan, MD, MPH: That’s a really important question. How do we decide how we’re going to treat a patient with narcolepsy? Do you have a particular sort of algorithm you use, Alon, for treating narcolepsy? What would be your first sort of go-to drug for narcolepsy now?Īlon Y. Thorpy, MD: There are a number of different medications now available to us for the treatment of narcolepsy.
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