Table 2.
Frequently used medicines for narcolepsy (in adults): compound, mechanism of action, maximum dosage per day, half-life, and EMA approval text
| Drug (name) | Mechanism of action | Max. dosage per day | Half-life (h) | EMA approval (official text) Therapeutic indications |
|---|---|---|---|---|
| Modafinil | Dopaminergic | 400 mg | 11–15 h | Treatment of excessive sleepiness associated with narcolepsy with or without cataplexy in adults |
| Pitolisant (Wakix) | Histaminergic (increase of CNS histamine) | 36 mg | 10–12 h | Treatment of narcolepsy with or without cataplexy in adults |
| Sodium oxybate (i.e., Xyrem) | GABAergic | 9 g | 3–4 h | Treatment of narcolepsy with cataplexy in adult patients. |
| Solriamfetol (Sunosi) | Dopaminergic/norepinephrinergic | 150 mg | 7.1 h | To improve wakefulness and reduce excessive daytime sleepiness in adult patients with narcolepsy (with or without cataplexy) |
| Venlafaxine3 (SSRI-antidepressant) | Serotoninergic (and noradrenergic) | For cataplexy usually not higher than 150 mg/day | 15 h | Off-label |
| Clomipramine2 (tricyclic antidepressant) | Norepinephrinergic/serotoninergic | For cataplexy usually not higher than 50mg/day | 21 h | Off-label |
| Methylphenidate | Dopaminergic | 60 mg |
3 h Depend if IR or XR |
Off-label (only in few European countries for EDS in narcolepsy) |
| Dexamphetamine1 (as example for amphetamine-derivates) | Norepinephrinergic (dopaminergic) | 60 mg (morning and/or morning—noon, or on demand) | 11 h | Off-label |
1For other amphetamines to be checked individually
2For other tricyclics to be checked individually
3For other SSRIs/SNRIs to be checked individually