Table of contents
- 1. Narcolepsy
.
Narcolepsy
- Treatments:
- Modafinil
- First line pharmacologic agent:
- Good control of sleepiness
- Well tolerated
- Ilicit use is rare.
- No tolerance
- Mechanism of action is not understood, but it's a non-amphetamine. May increase dopaminergic signaling.
- Many trials: significant improvement in 200mg/day and 400mg/day. Start 200, can increase to 400.
- Instruction: take dose in AM. Some Canadian guidelines say take it in early afternoon as well, but pts report PM dose interferes with sleep.
- Side Effects (uncommon):
- Headache, nausea, dry mouth, anorexia.
- High BP (dose dependent), SJS, caution in pts with heart arrhythmias.
- Metabolized by P450 enzymes that interfere with OCP (use alternative contraception)
- First line pharmacologic agent:
- Methylphenidate
- Amphetamine-based CNS stimulant.
- Considered 2nd line b/c many sympathomimetic S/E
- Dose: 10mg BID (last one no later than 3pm)
- S/E
- Increases systolic BP by 5mmHg
- Some reports of "sudden death" in children and adults (link unknown).
- Can exacerbate psychosis/anorexia, lower seizure threshold.
- Amphetamines
- Dextraoamphetamine (5mg bid) and methamphetamine (5mg bid)
- Amphetamine salts (Adderall)
- Most potent wakefulness-promoting drugs.
- Same S/E problems as methylphenidate.
- Dextraoamphetamine (5mg bid) and methamphetamine (5mg bid)
- Modafinil
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