TABLE 4 ] .

Current and Future Treatment Options for Narcolepsy and Idiopathic Hypersomnia

Medication	Disorder	AASM Recommendationa or Level of Evidence if No Recommendation
For treatment of daytime sleepiness
Modafinil	Narcolepsy	Narcolepsy: standard
	IH	IH: option, but RCT published subsequent to recommendation
Armodafinil	Narcolepsy	See recommendation for modafinil
	IH	…
Sodium oxybate	Narcolepsy	Standard (for both sleepiness and cataplexy)
Amphetamine, methamphetamine, dextroamphetamine, methylphenidate	Narcolepsy	Narcolepsy: guideline
	IH	IH: option
Ritanserin (not available in United States)	Narcolepsy	Option
Selegiline	Narcolepsy	Option (for both sleepiness and cataplexy)
Pitolisant (not available in the United States)	Narcolepsy	Narcolepsy: RCT published subsequent to recommendation (RCT to evaluate effect on cataplexy is ongoing)
	IH	IH: clinical case series
Clarithromycin	Narcolepsy type 2	Clinical case series (RCT results pending)
	IH	Clinical case series (RCT results pending)
Levothyroxine	IH (with long sleep time)	Clinical case series
For treatment of cataplexy
Sodium oxybate	Narcolepsy	Standard (for both sleepiness and cataplexy)
Venlafaxine, SSRIs, tricyclic antidepressants, reboxetine (not available in the United States)	Narcolepsy	Guideline
Selegiline	Narcolepsy	Option (for both sleepiness and cataplexy)

AASM = American Academy of Sleep Medicine; RCT = randomized controlled trial; SSRI = selective serotonin reuptake inhibitor. See Table 2 legend for expansion of other abbreviation.

^aAASM recommendations follow these criteria: “Standard” refers to an accepted treatment reflecting high-quality evidence (highest recommendation); “guideline” refers a treatment supported by level 2 or substantial level 3 evidence (middle level of recommendation); “option” refers to a treatment with conflicting (or inconclusive) evidence or expert opinion (lowest level of recommendation).⁹³