See this article by RemedyOne clinical pharmacist, Jason Peterson, R.Ph. as it originally appeared in Pharmaphorum.
People who live with narcolepsy — about one out of every 2,000 Americans — don’t have many options when it comes to treatment. The milder form of narcolepsy includes symptoms of excessive daytime sleepiness and can be treated with a stimulant like Provigil, Adderall or Dexedrine in order to get people through their day.
In addition to excessive daytime sleepiness, up to 60 percent of narcolepsy cases include cataplexy, which is a sudden loss of muscle control. When patients experience intense emotion, either positive or negative, they are rendered unconscious.
Without being properly diagnosed and treated, there is no amount of focus, concentration or alertness that can stave off cataplexy. For years, Jazz Pharmaceuticals has dominated the market in treating narcolepsy with cataplexy. But increased competition is on the horizon.
Classic treatment options
Sodium oxybate — which in the late 1980s was marketed to bodybuilders and then became known as GHB and criminally used as a date rape drug — has been sold under the brand name Xyrem after gaining FDA approval in 2002. In order to bring it to market, a special program called Risk Evaluation and Mitigation Strategy (REMS) had to be put in place where only eligible patients could access the drug through a very strict process.
Both the physician and the patient have to be registered and the drugs can only come from a primary source through limited distribution. This is a practice very common among cancer drugs.
Other than the reputation and infamous notoriety of the drug, Xyrem had another drawback. It contains 109 percent of the American Heart Association’s ideal daily allowance for sodium intake. In 2020, and in an attempt to abate the drawback, Jazz got FDA approval for Xywav, which is a mixture of calcium, magnesium and potassium salts that contains 92 percent less sodium than Xyrem.
Wake up and go to sleep
The irony of these two narcolepsy drugs that work to normalize the sleep-wake cycle is that they have to be taken twice per night. Patients have the first dose before they go to sleep, then wake up two and a half to four hours later for the second.
Taking the drug at bedtime allows patients to sleep through the night, with the second dose carrying them through a night of restful sleep. As a result, they shouldn’t have as many symptoms the next day.
Read the complete article on Pharamaphorum.
