Alon Y. Avidan, MD, MPH, offers some useful strategies for determining the first-line treatment for narcolepsy.
So there’s quite a number of different medications available to us now they say how do we decide you know how we’re going to treat a patient with narcolepsy do you have a particular sort of algorithm you use alarm for treating narcolepsy what would be your first sort of go-to drugs for narcolepsy now that’s a really important question i have to say that i do
Not have an algorithm that i fit a patient through and and that’s the only algorithm i follow because all of these medications have their pluses and minuses patients may present with narcolepsy not different as a different phenotype in that some patients may have underlying depression or anxiety some may have a certain aside or certain underlying comorbidities
For which some of these agents may not be the most appropriate first-line therapy and now i’ll just say that as a journal role for folks who have narcolepsy type 1 and type 2 the one drug that most people have resorted to or the group of drugs are the weight promoting agents and the advantage here it’s a once a day perhaps twice a day type formulation patients
Take it in the morning they may follow with the second dose say later in the morning or early afternoon and there may be an ability at that point to assess the patient and take a and an evaluative additional add-on therapy needs to be taken and and for those individuals if they do feel sleepy at one o’clock or if they feel sleepy to the point that it’s affecting
Their driving then a short-acting method methylphenidate a medication methamphetamine would would actually be effective now the the other patient who presents with a excessive daytime sleepiness and cataplexy and where the cataplexy is quite frequent that particular patient would probably be most appropriately treated with sodium oxley you have one drug that
Has addresses multiple facets of the disease by being taken at night and with the second dose two to four hours later and the advantage here is both improvement of daytime sleepiness and very effective improvement of cataplexy bear in mind that a lot of patients who have complex ii may have a few episodes per week or individuals who may not require a traditional
Therapy or a specific therapy for cataplexy itself and are able to manage it by avoiding situations nothing that i would advocate the patients do but they may not require a specific therapy directed at the addict cataplexy now having this se outline i think that with the new agent the potala scient sorry i’m fertile the ability now to be able to provide treatments
For those who still have daytime sleepiness with the traditional stimulants and awake promoting agents and knowing that between 10 to 60 percent of those patients still experience significant daytime sleepiness that is paralyzing them i think the ability to then go to other groups of treatments and maybe provide add-on therapy is is probably going to be advocated
For because not one patient would be treated with one drug that will do the magic itself and then that we will have to experiment with multiple add-on therapies based on the patient phenotype
Transcribed from video
Deciding Which Drug to Use in Narcolepsy By Neurology Live
