Criteria for Changing Treatment in Narcolepsy: Part 2


Sleep medicine experts review when to consider switching treatment in narcolepsy.

This is a video synopsis/summary of a panel discussion involving Michael Thorpy, MD; Karl Doghramji, MD, FAASM, DFAPA; Clete Kushida, MD, PhD; and Richard K Bogan, MD.

The discussion revolves around reasons for medication switching in narcolepsy patients and strategies for managing these transitions. The primary reason for switching medications is often a decrease in efficacy over time or the emergence of bothersome symptoms beyond daytime sleepiness. Patients may also express interest in trying new medications introduced to the market.

The speaker outlines guiding principles for deciding whether to switch medications, emphasizing maintaining treatment if it still provides a meaningful response, even if efficacy diminishes. Strategies include augmentation with additional medications, drug holidays, or bridge therapy, where a new medication is introduced alongside the current one. When switching to a new agent, a gradual tapering off of the old medication while gradually introducing the new one is preferred.

Regarding sodium oxybate formulations, transitioning from immediate-release to low-sodium oxybate is common due to reduced sodium load. Patients may choose between once-nightly and twice-nightly dosing based on personal preference and lifestyle factors, with younger patients often preferring once-nightly dosing for convenience. Patient preference is a significant factor in medication decisions, with clinicians discussing options and respecting patients' choices.

Video synopsis is AI-generated and reviewed by NeurologyLive editorial staff.

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