Use of Narcolepsy Treatments in Different Patients: Part 1

Opinion
Video

Drs Thorpy, Dogan, Doghramji, and Kushida detail which medications to use in various patients with 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 the use of various medications, including pitolisant, modafinil, solriamfetol, and other stimulants, in treating narcolepsy-related daytime sleepiness.

For patients with mild to moderate daytime sleepiness, pitolisant or modafinil may be considered initially. If sleepiness persists, a second medication may be added. For more severe cases, particularly those with cataplexy, oxybate medications are recommended due to their effectiveness in treating cataplexy and improving sleep stability.

Solriamfetol is highlighted as an ideal medication for daily use to mitigate daytime sleepiness throughout the day. It has a low potential for drug interactions and is not metabolized in the liver, making it suitable for patients with hepatic disorders. However, it is not effective as an anticataplexic agent.

The panel acknowledges that individual responses to these medications vary, with some patients responding better to one medication over another in terms of efficacy and adverse events. The importance of monitoring cardiovascular parameters, particularly blood pressure and heart rate, when prescribing solriamfetol is emphasized, although significant changes in these parameters have not been commonly observed.

Rescue doses of immediate-release stimulants may be used to manage episodes of severe sleepiness, especially during the afternoon, improving patients' quality of life and work productivity.

In conclusion, treatment decisions for narcolepsy-related daytime sleepiness should be individualized, considering the patient's symptoms, severity, comorbidities, and response to therapy. Close monitoring and periodic reassessment are essential to optimize treatment outcomes and minimize potential side effects.

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

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