Narcolepsy: treatment of cataplexy

Sodium oxybate

• This is the first line treatment
• The dose is 4.5g daily in two divided doses before 2.5 to 4 hours apart
• It may cause weight loss

Tricyclics

Selective serotonin receptor inhibitors (SSRIs)

Serotonin norepinephrine reuptake inhibitors (SNRIs)

Histamine H3 receptor inverse agonist

Investigational drugs

References

1. Billiard M, Bassetti C, Dauvilliers Y, et al; EFNS Task Force. EFNS guidelines on management of narcolepsy. Eur J Neurol 2006; 13:1035-1048.
2. Barateau L, Lopez R, Dauvilliers Y. Management of narcolepsy. Curr Treat Options Neurol 2016; 18:43. 
3. Schinkelshoek MS, Smolders IM, Donjacour CE, et al. Decreased body mass index during treatment with sodium oxybate in narcolepsy type 1. J Sleep Res 2019; 28:e12684.
4. Husain AM, Ristanovic RK, Bogan RK. Weight loss in narcolepsy patients treated with sodium oxybate. Sleep Med 2009; 10:661-663.
5. Dauvilliers Y, Bassetti C, Lammers GJ, et al. Pitolisant versus placebo or modafinil in patients with narcolepsy: a double-blind, randomised trial. Lancet Neurol 2013; 12:1068-1075.
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Related checklists

• Narcolepsy: clinical features
• Narcolepsy: secondary causes
• Narcolepsy: diagnostic criteria and assessment scales
• Narcolepsy: differential diagnosis
• Narcolepsy: investigations
• Narcolepsy: treatment of hypersomnia