Michael Thorpy, MD, discussed current and emergent treatment choices available for the sleep disorder in a symposium throughout the SLEEP 2016 meeting.
Overall targets of narcolepsy treatment consist of enhancing the safety of the patient as well as managing symptoms. “The targets of treatment are to get hold of under manage the excessive daytime sleepiness, which is usually the main symptom in all of patients along with narcolepsy. There are others symptoms that patients along with narcolepsy have actually that might should be controlled as well,” Michael Thorpy, MD, professor of clinical neurology at Albert Einstein College of Medicine in Brand-new York, explains in an e-mail interview along with Sleep Review. Thorpy presented on the subject at the “Finest Practices for Managing Narcolepsy and Obstructive Sleep Apnea: Evidence-Based Strategies and Solutions” symposium on June 13 in Denver, Colo. “Treating narcolepsy is a lot more compared to merely treating excessive sleepiness and cataplexy, however calls for management of all of the ancillary symptoms of narcolepsy.”
As such, treatment targets might consist of reducing daytime sleepiness, cataplexy, sleep paralysis, nightmares and hallucinations, and disturbed nocturnal sleep. Thorpy notes that treatment ought to likewise permit a patient to function much better in life (such as perform much better in school, on the job, and socially), as well as enhance the safety of the patient and the general public. “Patients along with narcolepsy can easily fall or have actually sudden sleep episodes that might put them at risk of either a motor auto accident or an accident even about the house…particularly if they’re working along with any kind of dangerous equipment. enhancing not only their symptoms [and] quality of life however likewise preventing any kind of risk to the patient or to others as a result of the sleepiness [should be a goal of treatment].”
Current Treatments
During the symposium, Thorpy detailed the personal mechanisms of different alerting agents. These include: caffeine, along with the mechanism of adenosine receptor antagonist; modafinil, for which the mechanism is not clear, however appears to be predominately by dopamine; histamine receptor 3 inverse agonists (H3R); hypocretin agonists; and sympathomimetic, which is created to raise neurotransmission of dopamine, serotonin, and norepinephrine.
“There are two main types of drugs that one would certainly consider; the drugs that enhance alertness and wakefulness throughout the daytime and those that suppress cataplexy. After that there are others medications that can easily be used to treat additional narcolepsy symptoms or in order to enhance the quality of sleep,” Thorpy says.
There are two crucial precautions for patients that use modafinil and armodafinil, Thorpy notes: they can easily reduce oral contraceptives efficacy (they raise the metabolism of ethinylestradiol) and can easily create severe rashes and allergic reactions. Of the traditional stimulants, Adderall, a dopamine and norepinephrine-releasing agent, is yet another medication available for managing narcolepsy symptoms. Available in two formulations—instant release (IR) and extended release (XR)—only the IR is indicated for narcolepsy, Thorpy says.
According to Thorpy, sodium oxybate is the only medication that can easily treat all of symptoms of narcolepsy and can easily enhance overall cognitive functioning. This medication has actually a number of benefits, including reducing vivid dreams, nightmares, and hallucinations; enhancing nocturnal sleep; and reducing sleep paralysis. “I believe that the sodium oxybate is the most right agent for patients that have actually the diagnosis of narcolepsy due to the fact that it’s the only drug that treats all of the symptoms of narcolepsy. It’s a quite efficient medication at treating all of those symptoms,” he says.
But there are certain precautions for healthcare professionals and users to be aware of along with sodium oxybate (even though Thorpy says it is well tolerated among most patients). It can easily create nausea and headaches. It ought to not be used along with hypnotics, alcohol, or depressant medications. Also, due to the fact that it has actually the potential to create respiratory depression, it ought to not be prescribed to patients along with untreated obstructive sleep apnea. In addition, caution ought to be exercised along with patients that could be depressed, and Thorpy recommends healthcare professionals ask patients regarding suicidal ideation or previous attempts.
Overall, sodium oxybate is an efficient first-line drug for the treatment of narcolepsy for patients along with narcolepsy type 1 and 2, and an effectual second-line of treatment ought to consist of modafinil or armodafinil for sleepiness and venlafaxine or atomoxetine for cataplexy. Thorpy says the combination of sodium oxybate and modafinil produces the most efficient treatment of excessive sleepiness.
“all of medications have actually potential adverse effects and it’s a matter of weighing out in a particular patient exactly what would certainly be the right medication and the balance between the effectiveness and potential for adverse effects,” Thorpy says.
On the Horizon
Thorpy likewise addressed emerging treatments for narcolepsy, which he categorized in two ways: non-hypocretin-based therapies and hypocretin-based therapies. Non-hypocretin-based therapies consist of monoaminergic reuptake inhibitors, histamiergic H3 antagonist/inverse agonists, monoaminergic stimulating agents, and TRH analogues. Hypocretin-based therapies consist of peptide agonists, gene therapy, hypocretin cell transplantation, and nonpeptide agonists.
Future narcolepsy treatments might target hypocretin and histaminergic systems, Thorpy says. “Further down the line, we would certainly chance that medications that affect the hypocretin system, which is reasonable in patients along with narcolepsy, might become available and could be quite useful, [although it is] most likely to be several years,” he says.
Also, a Brand-new wakefulness-promoting drug is under development by Jazz Pharmaceuticals. Thorpy says, “JZP-110…is currently under investigation, and first reports that have actually been published indicate that this has actually a helpful affect on alertness. It looks as though this medication is going to be a quite helpful alternative to the wake-promoting medications that we have actually at the moment.”
In addition to gaining a much better perspective on Brand-new treatment directions in narcolepsy, Thorpy hopes that attendees of the presentation found the guide concerning the use of sodium oxybate to be the most valuable for their clinical practice. “I believe one of the biggest modifications has actually actually been the use of sodium oxybate, which for some physicians is relatively new. Sodium oxybate is a medication that we didn’t have actually a great deal of experience along with a few years back, however over the years…we’ve come to know and already know exactly how to use this medication and we’ve seen its effectiveness.”
The symposium was sponsored by Vox Media and supported by an independent educational grant from Jazz Pharmaceuticals.
Cassandra Perez is associate editor for Sleep Review. CONTACT cperez@nullallied360.com
