Drug | Dosage, usual (adult) | Common side effects | Serious side effects |
Excessive daytime sleepiness | |||
Modafinil | 100 to 400 mg every morning or 200 mg twice per day | Headache, nervousness, nausea, insomnia | Severe rash |
Armodafinil | 150 to 250 mg every morning or 125 mg (half of 250 mg tablet) twice per day | Headache, nervousness, nausea, insomnia | Severe rash |
Solriamfetol | 75 to 150 mg every morning | Headache, nausea, reduced appetite | Cardiovascular effects |
Pitolisant* | 8.9 to 35.6 mg once per day | Headache, insomnia, nausea, anxiety | Severe rash, QT prolongation |
Methylphenidate | 10 to 30 mg twice per day or 20 mg extended release every morning with 10 to 20 mg immediate or extended release every afternoon¶ | Reduced appetite, nausea, headache, insomnia | Abuse potential, psychosis, mania, seizures, cardiovascular effectsΔ |
Dextroamphetamine | 5 to 30 mg twice per day or 10 mg extended release every morning with 10 to 20 mg immediate or extended release every afternoon¶ | Reduced appetite, nausea, headache, insomnia | High abuse potential, psychosis, mania, seizures, cardiovascular effectsΔ |
Amphetamine-dextroamphetamine | 10 to 30 mg twice per day or 20 mg extended release twice per day¶ | Reduced appetite, nausea, headache, insomnia | High abuse potential, psychosis, mania, seizures, cardiovascular effectsΔ |
Oxybates (gamma hydroxybutyrate) | 2.25 to 4.5 grams at bedtime and repeated 3 to 4 hours later◊ | Morning sedation, nausea, dizziness, urinary incontinence, sleepwalking | Abuse potential, confusion, severe sedation, coma§ |
Cataplexy¥ | |||
Venlafaxine | 37.5 to 75 mg twice per day or 37.5 to 150 mg extended release every morning | Transient nausea, headache, insomnia, increase in blood-pressure when given in higher doses | |
Fluoxetine | 20 to 80 mg every morning | Nausea, dry mouth, insomnia | QT prolongation |
Clomipramine | 10 to 150 mg as a single dose every morning or in divided doses | Dry mouth, constipation, sweating, dizziness, somnolence, weight gain, orthostatic hypotension | Cardiotoxicity, seizures, dangerous in overdose‡ |
Protriptyline | 5 to 60 mg as a single dose every morning or in divided doses | Dry mouth, constipation, sweating, anxiety, disturbed nighttime sleep, orthostatic hypotension | Cardiotoxicity, seizures, dangerous in overdose‡ |
Pitolisant | 8.9 to 35.6 mg once per day | Headache, insomnia, nausea, anxiety | Severe rash, QT prolongation |
Oxybates (gamma hydroxybutyrate) | 2.25 to 4.5 grams at bedtime and repeated 3 to 4 hours later◊ | Morning sedation, nausea, dizziness, urinary incontinence, sleepwalking | Abuse potential, confusion, severe sedation, coma§ |
Disrupted nighttime sleep† | |||
Zolpidem | 5 to 10 mg at bedtime | Morning sedation, dizziness | |
Oxybates (gamma hydroxybutyrate) | 2.25 to 4.5 grams at bedtime and repeated 3 to 4 hours later◊ | Morning sedation, nausea, dizziness, urinary incontinence, sleepwalking | Abuse potential, confusion, severe sedation, coma§ |
* Also has anti-cataplexy effects.
¶ Although extended-release formulations are intended to be taken once daily, many patients with narcolepsy find that the clinical effect wears off in four to six hours, necessitating a second dose in the early afternoon.
Δ For additional information, refer to topic review of treatment of attention deficit hyperactivity disorder in adults or adolescents, section on adverse effects.
◊ Dosing provided is for immediate-release formulations (ie, sodium oxybate or oxybate salts). For extended-release sodium oxybate, the usual adult dosage is 4.5 to 9 grams once nightly at bedtime.
§ Combined use with alcohol, sedatives, or hypnotics is specifically contraindicated in United States licensing information.
¥ Anti-cataplexy medications are also useful for problematic sleep paralysis or hypnagogic hallucinations.
‡ For additional information, refer to topic review of tricyclic antidepressants, section on adverse effects.
† Some sleep disruption in narcolepsy may be caused by additional sleep disorders that require specific treatment (examples include obstructive sleep apnea or periodic limb movements of sleep).Do you want to add Medilib to your home screen?