Sample 3 (treatment-naïve) started their first narcolepsy-specific pharmacological therapy between Jand June 30, 2017, and had not received any narcolepsy-specific medication for at least 12 months earlier. Sample 2 (narcolepsy incident) received their first narcolepsy diagnoses between Jand June 30, 2017, without any previous narcolepsy diagnosis since July 1, 2013. As the management of long-term narcolepsy requires regular evaluation and may include frequent drug switching, dose adjustments, and combination therapies, it poses a challenge to treating physicians. Generally, guidelines recommend that pharmacological treatment decisions should be based on clinical considerations, including the type of narcolepsy, comorbid conditions, and specific patient needs.
Benzodiazepines may be used to treat other symptoms of narcolepsy, including hallucinations and fragmented sleep. Ephedrine, dextroamphetamine, and monoamine oxidase (MAO) inhibitors are recommended as second-line therapy for EDS. Additionally, it is known that several antidepressants may be prescribed off-label to treat cataplexy examples include venlafaxine, fluoxetine, reboxetine, and citalopram. Pitolisant is approved for both NT1 and NT2 conditions. The psychostimulants modafinil, methylphenidate, and, recently, solriamfetol are approved medications for EDS in Germany, while sodium oxybate and the antidepressant clomipramine are approved for the treatment of narcolepsy with the NT1. The majority of patients additionally require pharmacological treatment to manage the main symptoms of narcolepsy. Adjustments in behavior and lifestyle include regular sleep schedules, scheduled daytime naps, dietary changes, and preventing sleep deprivation. Treatment for narcolepsy consists of pharmacological therapies as well as behavioral and lifestyle changes.
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