Elsevier

Sleep Medicine

Volume 16, Issue 1, January 2015, Pages 9-18
Sleep Medicine

Review Article
Clinical and practical considerations in the pharmacologic management of narcolepsy

https://doi.org/10.1016/j.sleep.2014.10.002Get rights and content
Under a Creative Commons license
open access

Highlights

  • Management of narcolepsy, an incurable, chronic neurologic disorder, remains challenging.

  • A variety of factors affect treatment decisions; the patient should be an active participant.

  • Subjective and objective measures of excessive daytime sleepiness (EDS) can be used to provide guidance on meeting treatment goals.

  • We highlight clinically relevant treatment recommendations to manage patients with narcolepsy.

Abstract

Despite published treatment recommendations and the availability of approved and off-label pharmacologic therapies for narcolepsy, the clinical management of this incurable, chronic neurologic disorder remains challenging. While treatment is generally symptomatically driven, decisions regarding which drug(s) to use need to take into account a variety of factors that may affect adherence, efficacy, and tolerability. Type 1 narcolepsy (predominantly excessive daytime sleepiness with cataplexy) or type 2 narcolepsy (excessive daytime sleepiness without cataplexy) may drive treatment decisions, with consideration given either to a single drug that targets multiple symptoms or to multiple drugs that each treat a specific symptom. Other drug-related characteristics that affect drug choice are dosing regimens, tolerability, and potential drug–drug interactions. Additionally, the patient should be an active participant in treatment decisions, and the main symptomatic complaints, treatment goals, psychosocial setting, and use of lifestyle substances (ie, alcohol, nicotine, caffeine, and cannabis) need to be discussed with respect to treatment decisions. Although there is a lack of narcolepsy-specific instruments for monitoring therapeutic effects, clinically relevant subjective and objective measures of daytime sleepiness (eg, Epworth Sleepiness Scale and Maintenance of Wakefulness Test) can be used to provide guidance on whether treatment goals are being met. These considerations are discussed with the objective of providing clinically relevant recommendations for making treatment decisions that can enhance the effective management of patients with narcolepsy.

Keywords

Narcolepsy
Cataplexy
Treatment
Diagnosis
Excessive daytime sleepiness

Cited by (0)