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    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)
      • 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.
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