Narcolepsy: current treatment options and future approaches

Figures & data

Table 1 Recommendations for the treatment of narcolepsy. A. Excessive daytime sleepiness/sleep attacks. B. Cataplexy, sleep paralysis, and hypnagogic hallucinations. C. Disturbed nocturnal sleep

A
•	Conservative therapy	•	More recent therapy
	Modafinil 100–400 mg/day in a split dose, possibly supplemented with either methylphenidate or sodium oxybate		Sodium oxybate at a starting dose of 4.5 g/night, divided into 2 equal doses of 2.25 g, incremented by 1.5 g at a 2-week interval, up to a maximum of 9 g, possibly supplemented with modafinil
	Dexamphetamine in case of severe and Intractable EDS
B
•	Conservative therapy	•	More recent therapy
	– first line Venlafaxine 37.5–300 mg/day or Atomoxetine 40–60 mg/day		Sodium oxybate at a starting dose of 4.5 equal doses of 2.25 g, incremented by 1.5 g at a 2-week interval, up to a maximum of 9 g
	– second line Clomipramine 10–60 mg/day or SSRI
C
•	Conservative therapy	•	More recent therapy
	Benzodiazepine or nonbenzodiazepine hypnotic: one tablet at bedtime		Sodium oxybate at a starting dose of 4.5 g/night divided into 2 equal doses of 2.25 g, incremented by 1.5 g at a 2-week interval, up to a maximum of 9 g

Table 2 Approval of the various medications by European and US agencies. A. Medications for EDS and sleep attacks (B, Belgium, DK, Denmark, F, France, D, Germany, CH, Switzerland). B. Medications for cataplexy (I, Italy, SP, Spain, S, Sweden, CH Switzerland, UK, United Kingdom, B, Belgium, DK, Denmark, F, France, D, Germany) (RIs, reuptake inhibitors). C. Medications for disturbed nocturnal sleep of narcolepsy with cataplexy patients

A
Medications	EMEA	US FDA
Modafinil	approved	approved
Sodium oxybate	approved	approved
Methylphenidate	approved in B, DK, F, D, CH	approved
Dexamphetamine	not approved	approved
Methamphetmine	not approved	not approved
Mazindol	not approved	not approved
Selegiline	not approved	not approved
B
Medications	EMEA	US FDA
Sodium oxybate	approved	approved
Clomipramine	approved in I, SP, S, CH, UK	not approved
Protriptyline	not approved	not approved
SSRIs	approved in B, DK, F, D, CH	not approved
Noradrenaline RIs	not approved	not approved
Nor./serotonin RIs	not approved	not approved
Mazindol	not approved	not approved
Selegiline	not approved	not approved
C
Medications	EMEA	US FDA
Benzodiazepines or nonbenzodiazepines	not approved	not approved
Sodium oxybate	not approved	not approved