Table of ContentsView AllTable of ContentsStimulantsDopamine and Norepinephrine Reuptake Inhibitor (DNRI)Histamine-3 (H3) Receptor Antagonist/Inverse AgonistGamma-Hydroxybutyrate (GHB)AntidepressantsExpert RecommendationsLifestyle Factors
Table of ContentsView All
View All
Table of Contents
Stimulants
Dopamine and Norepinephrine Reuptake Inhibitor (DNRI)
Histamine-3 (H3) Receptor Antagonist/Inverse Agonist
Gamma-Hydroxybutyrate (GHB)
Antidepressants
Expert Recommendations
Lifestyle Factors
Narcolepsyis a chronic brain disorder that disrupts sleep-wake cycles. People with narcolepsy may feel refreshed after waking but often become very sleepy during the day—this is called excessive daytime sleepiness (EDS). They may also experience interrupted sleep at night.
Other symptoms includecataplexy(sudden muscle weakness), vivid hallucinations, andsleep paralysis(a temporary inability to move when falling asleep or waking up).
Various medications that treat narcolepsy are available, and treatment plans can vary based on individual symptoms and other factors. Healthcare providers often start with one medication but may need to add more to fully control symptoms. Many people require a combination of treatments.
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Various stimulants, also known as central nervous system (CNS) stimulants, can treat narcolepsy, including:
Provigil
Provigil (modafinil) is a wakefulness-promoting agent. The U.S. Food and Drug Administration (FDA) has approved it to improve wakefulness in adults with EDS associated with narcolepsy,obstructive sleep apnea (OSA), orshift work disorder (SWD).
The exact way Provigil helps people stay awake is not fully understood. It works similarly to other wakefulness-promoting drugs like Adderall (amphetamine/dextroamphetamine) and Ritalin (methylphenidate), but its effects and mechanisms for working are different.
Stimulants are controlled substances with the potential for abuse and dependence.Provigil is often prescribed as a first choice of treatment, though, because it is less addictive and has fewer side effects compared to certain other stimulants like Adderall and Ritalin.
Provigil helps reduce daytime drowsiness and improve alertness. However, for people with severe sleepiness, Provigil or other first-choice medications may not be sufficient on their own, and additional treatments might be necessary.
Common side effects of Provigil include:
Nuvigil
Nuvigil (armodafinil) is another wakefulness-promoting agent. It is similar to Provigil and has the same FDA-approved uses.
Common side effects of Nuvigil include:
Adderall and Ritalin
If Provigil is not effective, healthcare providers may prescribe stimulants such as Adderall or Ritalin for EDS. However, these medicines have a higher potential for abuse and dependence as well as more potential for serious side effects.
Adderall and Ritalin are both FDA-approved forattention deficit hyperactivity disorder (ADHD)and narcolepsy.
Some examples of common side effects include but are not limited to:
Sunosi (solriamfetol) is classified as a dopamine and norepinephrine reuptake inhibitor (DNRI).
The most common side effects of Sunosi include:
Wakix (pitolisant) is classified as a histamine-3 receptor antagonist/inverse agonist. The way Wakix works is not completely understood. However, it seems to affect histamine-3 (H3) receptors in the brain, which might help improve EDS and cataplexy.
It is FDA-approved to treat:
In adults, the most common side effects are nausea, anxiety, and trouble sleeping. The most common side effects in children 6 years and older are headaches and trouble sleeping.
Gamma-hydroxybutyrate (GHB) drugs are central nervous system (CNS) depressants. Though their exact mechanism is not fully understood, they seem to affectgamma-aminobutyric acid (GABA)receptors in the brain during sleep, which may help regulate sleep and alertness.
GHB drugs include the following:
GHBs can be dangerous when abused or misused (i.e., taken at high doses or for longer periods than prescribed). Some take it illicitly without a medical prescription. Misuse of GHBs comes with serious risks of respiratory depression, seizures, coma, and death.
Taking GHBs with certain medications or substances can increase these risks. These medications include:
Xyrem and Lumryz (but not Xywav) have a high sodium (salt) content, which may be a concern for people with conditions likehigh blood pressure,heart failure, or kidney problems, as well as anyone else who may follow a lowsodiumdiet.
Effexor XR (venlafaxine hydrochloride extended-release) is the most commonly prescribed antidepressant for managing cataplexy in people with narcolepsy. Prozac (fluoxetine) and Cymbalta (duloxetine) are also good alternatives.
Though oldertricyclic antidepressantslike protriptyline or Anafranil (clomipramine) can be effective, their side effects often make them less ideal for regular use.
Effexor XR
Effexor XRis aserotonin-norepinephrine reuptake inhibitor (SNRI)antidepressant FDA-approved to treatdepressionas well asanxietydisorders. However, some take it off-label (for a non-FDA-approved use) to treat cataplexy from narcolepsy.
Common side effects include:
Prozac
Prozac (fluoxetine) is aselective serotonin reuptake inhibitor (SSRI)antidepressant that the FDA has approved to treat a variety of mental health conditions. It can be taken off-label to treat cataplexy from narcolepsy.
Cymbalta
Cymbalta (duloxetine) is an SNRI antidepressant that is taken to treat depression, anxiety,fibromyalgia, and certain types of pain. Like Effexor XR and Prozac, Cymbalta can be taken off-label to treat cataplexy from narcolepsy.
Cymbalta RecallStarting in October 2024, over 200,000 bottles of duloxetine delayed-release capsules were recalled over concerns about the presence of nitrosamines, which can increase the risk of cancer.If you take duloxetine, check your medication packaging to see if it was part of the affected lots or call your pharmacist to find out. You should also contact your prescriber, as abruptly stopping a medication like duloxetinecan be dangerous.The recalled lots have expiration dates from November 2024 to December 2025. You can check the lot numbers in the FDA enforcement reports released inOctoberandDecember.
Cymbalta Recall
Starting in October 2024, over 200,000 bottles of duloxetine delayed-release capsules were recalled over concerns about the presence of nitrosamines, which can increase the risk of cancer.If you take duloxetine, check your medication packaging to see if it was part of the affected lots or call your pharmacist to find out. You should also contact your prescriber, as abruptly stopping a medication like duloxetinecan be dangerous.The recalled lots have expiration dates from November 2024 to December 2025. You can check the lot numbers in the FDA enforcement reports released inOctoberandDecember.
Starting in October 2024, over 200,000 bottles of duloxetine delayed-release capsules were recalled over concerns about the presence of nitrosamines, which can increase the risk of cancer.If you take duloxetine, check your medication packaging to see if it was part of the affected lots or call your pharmacist to find out. You should also contact your prescriber, as abruptly stopping a medication like duloxetinecan be dangerous.
The recalled lots have expiration dates from November 2024 to December 2025. You can check the lot numbers in the FDA enforcement reports released inOctoberandDecember.
Tricyclic Antidepressants
Protriptyline and Anafranil (clomipramine) are tricyclic antidepressants taken off-label to treat cataplexy. However, they cause many side effects, such as:
Some experts recommend taking low doses on an as-needed basis before social events that may trigger cataplexy.
WarningIt is important to know that abruptly stopping any of these antidepressants can trigger a severe, prolonged episode of cataplexy called status cataplecticus, which can last for hours.
Warning
It is important to know that abruptly stopping any of these antidepressants can trigger a severe, prolonged episode of cataplexy called status cataplecticus, which can last for hours.
Strong recommendations refer to treatments that are effective for most people and are usually the best choice. Conditional recommendations depend on the individual, so healthcare providers should tailor these treatments to each person’s needs and preferences.
Treatment should be individualized based on a person’s age, health, and unique requirements, with regular follow-ups to monitor progress and make adjustments. In addition to medication, nondrug strategies like good sleep habits, therapy, and support at work or school can enhance care.
For adults with narcolepsy, the American Academy of Sleep Medicine (AASM) strongly recommends these medications:
Additionally, for adults, the AASM provides conditional recommendations for:
For children and adolescents with narcolepsy, the guidelines suggest considering these treatments:
A Word from Verwell HealthThere are several treatment options available for narcolepsy, both medicinal and nonmedicinal (lifestyle changes). That said, there may be some trial and error while finding the best treatment options, so try not to get discouraged if the first one doesn’t work for you.—LINDSAY COOK, PHARMD, MEDICAL EXPERT BOARD
A Word from Verwell Health
There are several treatment options available for narcolepsy, both medicinal and nonmedicinal (lifestyle changes). That said, there may be some trial and error while finding the best treatment options, so try not to get discouraged if the first one doesn’t work for you.—LINDSAY COOK, PHARMD, MEDICAL EXPERT BOARD
There are several treatment options available for narcolepsy, both medicinal and nonmedicinal (lifestyle changes). That said, there may be some trial and error while finding the best treatment options, so try not to get discouraged if the first one doesn’t work for you.
—LINDSAY COOK, PHARMD, MEDICAL EXPERT BOARD
Summary
Narcolepsy is a chronic brain disorder that causes excessive daytime sleepiness (EDS) and can sometimes lead to additional symptoms such as cataplexy (a sudden, temporary loss of muscle control).
Treatment for narcolepsy typically includes medications such as stimulants, dopamine and norepinephrine reuptake inhibitors (DNRIs), histamine-3 (H3) receptor antagonists/inverse agonists, and antidepressants.
In addition to medication, lifestyle considerations can help manage symptoms. These might include maintaining a regular sleep schedule, avoiding stimulants before bedtime, and practicing relaxation techniques. Consult your healthcare provider to develop a personalized treatment plan for your needs.
23 SourcesVerywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.National Institute of Neurological Disorders and Stroke.Narcolepsy.UpToDate.Treatment of narcolepsy in adults.DailyMed.Label: Modafinil tablet.U.S. Drug Enforcement Administration.Drug scheduling.DailyMed.Label: Nuvigil- armodafinil tablet.DailyMed.Label: Ritalin- methylphenidate hydrochloride tablet.DailyMed.Label: Adderall- dextroamphetamine saccharate, amphetamine aspartate, dextroamphetamine sulfate, and amphetamine sulfate tablet.Prescribers' Digital Reference.Ritalin.Prescribers' Digital Reference.Adderall.DailyMed.Label: Sunosi- solriamfetol tablet, film coated.DailyMed.Label: Wakix- pitolisant hydrochloride tablet, film coated.DailyMed.Label: Lumryz- sodium oxybate for suspension, extended release.DailyMed.Label: Xyrem- sodium oxybate solution.DailyMed.Label: Xywav- calcium, magnesium, potassium, and sodium oxybate solution.Aran A, Einen M, Lin L, et al.Clinical and therapeutic aspects of childhood narcolepsy-cataplexy: a retrospective study of 51 children.Sleep. 2010;33(11):1457-1464. doi:10.1093/sleep/33.11.1457DailyMed.Label: Effexor XR- venlafaxine hydrochloride capsule, extended release.DailyMed.Label: Prozac- fluoxetine hydrochloride capsule.DailyMed.Label: Cymbalta- duloxetine hydrochloride capsule, delayed release.Food and Drug Administration.What to Know and Do About Possible Nitrosamines in Your Medication.DailyMed.Label: Protriptyline hydrochloride tablet, film coated.DailyMed.Label: Anafranil- clomipramine hydrochloride capsule.Maski K, Trotti LM, Kotagal S, et al.Treatment of central disorders of hypersomnolence: an American Academy of Sleep Medicine clinical practice guideline.J Clin Sleep Med. 2021;17(9):2047-2085. doi:10.5664/jcsm.9328Barker EC, Flygare J, Paruthi S, Sharkey KM.Living with narcolepsy: current management strategies, future prospects, and overlooked real-life concerns.Nat Sci Sleep. 2020;12:453-466. doi:10.2147/NSS.S162762
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Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.National Institute of Neurological Disorders and Stroke.Narcolepsy.UpToDate.Treatment of narcolepsy in adults.DailyMed.Label: Modafinil tablet.U.S. Drug Enforcement Administration.Drug scheduling.DailyMed.Label: Nuvigil- armodafinil tablet.DailyMed.Label: Ritalin- methylphenidate hydrochloride tablet.DailyMed.Label: Adderall- dextroamphetamine saccharate, amphetamine aspartate, dextroamphetamine sulfate, and amphetamine sulfate tablet.Prescribers' Digital Reference.Ritalin.Prescribers' Digital Reference.Adderall.DailyMed.Label: Sunosi- solriamfetol tablet, film coated.DailyMed.Label: Wakix- pitolisant hydrochloride tablet, film coated.DailyMed.Label: Lumryz- sodium oxybate for suspension, extended release.DailyMed.Label: Xyrem- sodium oxybate solution.DailyMed.Label: Xywav- calcium, magnesium, potassium, and sodium oxybate solution.Aran A, Einen M, Lin L, et al.Clinical and therapeutic aspects of childhood narcolepsy-cataplexy: a retrospective study of 51 children.Sleep. 2010;33(11):1457-1464. doi:10.1093/sleep/33.11.1457DailyMed.Label: Effexor XR- venlafaxine hydrochloride capsule, extended release.DailyMed.Label: Prozac- fluoxetine hydrochloride capsule.DailyMed.Label: Cymbalta- duloxetine hydrochloride capsule, delayed release.Food and Drug Administration.What to Know and Do About Possible Nitrosamines in Your Medication.DailyMed.Label: Protriptyline hydrochloride tablet, film coated.DailyMed.Label: Anafranil- clomipramine hydrochloride capsule.Maski K, Trotti LM, Kotagal S, et al.Treatment of central disorders of hypersomnolence: an American Academy of Sleep Medicine clinical practice guideline.J Clin Sleep Med. 2021;17(9):2047-2085. doi:10.5664/jcsm.9328Barker EC, Flygare J, Paruthi S, Sharkey KM.Living with narcolepsy: current management strategies, future prospects, and overlooked real-life concerns.Nat Sci Sleep. 2020;12:453-466. doi:10.2147/NSS.S162762
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
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DailyMed.Label: Modafinil tablet.
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DailyMed.Label: Nuvigil- armodafinil tablet.
DailyMed.Label: Ritalin- methylphenidate hydrochloride tablet.
DailyMed.Label: Adderall- dextroamphetamine saccharate, amphetamine aspartate, dextroamphetamine sulfate, and amphetamine sulfate tablet.
Prescribers' Digital Reference.Ritalin.
Prescribers' Digital Reference.Adderall.
DailyMed.Label: Sunosi- solriamfetol tablet, film coated.
DailyMed.Label: Wakix- pitolisant hydrochloride tablet, film coated.
DailyMed.Label: Lumryz- sodium oxybate for suspension, extended release.
DailyMed.Label: Xyrem- sodium oxybate solution.
DailyMed.Label: Xywav- calcium, magnesium, potassium, and sodium oxybate solution.
Aran A, Einen M, Lin L, et al.Clinical and therapeutic aspects of childhood narcolepsy-cataplexy: a retrospective study of 51 children.Sleep. 2010;33(11):1457-1464. doi:10.1093/sleep/33.11.1457
DailyMed.Label: Effexor XR- venlafaxine hydrochloride capsule, extended release.
DailyMed.Label: Prozac- fluoxetine hydrochloride capsule.
DailyMed.Label: Cymbalta- duloxetine hydrochloride capsule, delayed release.
Food and Drug Administration.What to Know and Do About Possible Nitrosamines in Your Medication.
DailyMed.Label: Protriptyline hydrochloride tablet, film coated.
DailyMed.Label: Anafranil- clomipramine hydrochloride capsule.
Maski K, Trotti LM, Kotagal S, et al.Treatment of central disorders of hypersomnolence: an American Academy of Sleep Medicine clinical practice guideline.J Clin Sleep Med. 2021;17(9):2047-2085. doi:10.5664/jcsm.9328
Barker EC, Flygare J, Paruthi S, Sharkey KM.Living with narcolepsy: current management strategies, future prospects, and overlooked real-life concerns.Nat Sci Sleep. 2020;12:453-466. doi:10.2147/NSS.S162762
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