Symptomatic management of narcolepsy in adults

OSA: obstructive sleep apnea.
* If sleepiness is severe and disabling, some clinicians recommend starting with oxybates rather than one of the less potent wake-promoting medications. Although risks and side effects, as well as cost, may be higher with oxybates, they can offer the best chance of optimal symptom control with monotherapy.
¶ Not all patients with narcolepsy are good are candidates for oxybates, either due to the high cost, inability to adhere to safety requirements, or a comorbidity or concurrent medication that increases risk (eg, untreated OSA, substance abuse, chronic opioids, poorly controlled depression).