The Takeaway
- Younger children, because of their smaller size and higher metabolism, may need different dosing of medications than teens and adults.
- Prior to and during pregnancy, many women choose to stop their narcolepsy medications, as these could affect fetal development.
- Elderly patients may need adjustments to medications based on their other medical conditions.
As life changes, whether transitioning from high school to college or switching to a new job with different work hours, some adjustments to behavioral strategies may be helpful in order to continue managing the symptoms of narcolepsy. In addition, at some life stages additional factors should be taken into account when considering various medication strategies.
In Children
Children differ from adults in many ways, including how medications affect them. Because of their smaller size, younger children may need lower doses. The timing of medications may also differ, as children can metabolize some medications quickly.
Amphetamines can slow the rate of growth, especially in younger children.1 This effect is small, and most evidence suggests that a child will resume his or her expected rate of growth after medications are discontinued.
On the other hand, oxybates can increase production of growth hormones, 2, 3 although whether this impacts height or weight in children with narcolepsy remains unclear.
During pregnancy
All drugs used to treat narcolepsy carry some risk to fetal development, and women should discuss with their doctors whether to continue their medications during pregnancy. The US Food and Drug Administration categorizes the medications in the Medications for Narcolepsy chart (PDF) as Pregnancy Category C, which means that studies in animals have shown some adverse effect on the fetus. There are no adequate and well-controlled studies in humans, however. One exception are oxybates, which is Category B (animal studies have not found adverse effects on the fetus, but there are no adequate and well-controlled studies in humans).
Many doctors recommend that medications used for narcolepsy should be stopped prior to and during pregnancy unless the risks of sleepiness outweigh the risks of the medications. For example, one woman might be able to function well simply with more frequent naps during the day. Alternately, another woman might choose to continue her medications if she cannot do her job without them.
Women with cataplexy should tell their obstetricians they have narcolepsy, as rarely, cataplexy can occur during labor, making childbirth problematic.
In older patients
Narcolepsy is a lifelong condition. Symptoms are generally stable across adulthood, though sleepiness and cataplexy may improve slightly with age.4 Sleepiness that worsens in adulthood may be caused by the sedating effects of medications or the development of an additional sleep disorder such as obstructive sleep apnea.
With retirement, it may be easier to fit in one or two naps during the day, allowing an individual to reduce the doses of wake-promoting medications.
With age, other medical problems become more common, and some of the standard narcolepsy medications should be avoided. For example, individuals with heart disease should avoid amphetamines and reconsider antidepressant use, as these can cause high blood pressure and irregular heart rhythms. Sodium oxybate contains a moderate amount of sodium and should be avoided by people on a low-salt diet for high blood pressure or heart failure; mixed oxybate salts may be a better alternative.
Elderly people can become confused or unsteady on their feet, so it may be helpful to reduce the doses of, or discontinue, medications such as amphetamines or oxybates. Protriptyline and clomipramine should be avoided in people with heart problems, seizures, or glaucoma.
References
- Faraone SV, Biederman J, Morley CP, Spencer TJ. Effect of stimulants on height and weight: a review of the literature. J Am Acad Child Adolesc Psychiatry 2008; 47:994–1009.
- Van Cauter E, Plat L, Scharf MB, Leproult R, Cespedes S, L'Hermite-Baleriaux M, Copinschi G. Simultaneous stimulation of slow-wave sleep and growth hormone secretion by gamma-hydroxybutyrate in normal young men. J Clin Invest 1997; 100:745–53.
- Donjacour CE, Aziz NA, Frolich M, Roelfsema F, Overeem S, Lammers GJ, Pijl H. Sodium oxybate increases prolactin secretion in narcolepsy patients and healthy controls. Eur J Endocrinol 2011; 164:363–70.
- Dauvilliers Y, Gosselin A, Paquet J, Touchon J, Billiard M, Montplaisir J. Effect of age on MSLT results in patients with narcolepsy-cataplexy. Neurology 2004; 62:46–50.