Stimulants can have unpleasant side effects, including:
- Weight loss
- Changes in blood pressure and rapid heartbeat
People with heart disease, hyperthyroidism, glaucoma, anxiety disorder, and high blood pressure should avoid stimulants, or take them only with a doctor's supervision.
These drugs become ineffective if used continuously, and patients are advised to take a drug holiday one day a week or to withdraw gradually and resume treatment at a lower dose. Patients should not engage in activities that require being awake (such as driving) during withdrawal.
Drug Treatments for Cataplexy
Sodium oxybate (Xyrem). Sodium oxybate (Xyrem), also referred to as gamma hydroxybutyrate (GHB), helps reduce the frequency of cataplexy attacks and improve daytime sleepiness. Patients need to take GHB for about 4 weeks before they notice significant benefits. It may take an additional 4 weeks for the drug to reach maximum effect. Food intake can affect the actions of GHB, so patients are advised to take it at a regular time after the evening meal.
The FDA has placed tight restrictions on the use of this drug. Although the drug appears to be effective and safe when used for narcolepsy, it has a history of illegal and "date-rape" use, with street names such as "Grievous Bodily Harm" or "Liquid Ecstasy." (The last term is not the same as "Ecstasy," another street drug with different effects.) In high doses, it can cause dependence over time. Education through the Xyrem Success Program may be valuable to patients and physicians.
Very serious side effects -- including seizures, coma, respiratory arrest, and death -- have been reported in people who abused GHB. Trials of Xyrem, however, have not reported these effects with the doses used in treatment for cataplexy.
Antidepressants. Antidepressant drugs are not approved for treatment of cataplexy, but they are commonly used to manage this condition. Unfortunately, there have been few studies conducted on antidepressant treatment of cataplexy, and there are little data on which type of antidepressant work bests. A 2008 review of antidepressants for narcolepsy noted the lack of good quality evidence to support their use and urged for more clinical trials.
Antidepressants used for cataplexy, hallucinations, sleep paralysis, and management of REM symptoms include:
Review Date: 07/04/2010
Reviewed By: Harvey Simon, MD, Editor-in-Chief, Associate Professor of Medicine, Harvard Medical School; Physician, Massachusetts General Hospital. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.