![]() Several authoritative organizations have published recommendations to reduce sodium intake to 1,500 mg/day), chronic treatment/long-term exposure to medication (≥2 years), and presence of comorbidities, specifically hypertension and diabetes. Sodium intake increases risk of hypertension and cardiovascular outcomes, particularly stroke, independent of blood pressure. Īt the recommended dosage range for adults (6–9 g/night), SXB treatment contributes 1,100–1,640 mg to daily sodium intake. The most common adverse events (AEs) reported with SXB in adult and pediatric studies were nausea, dizziness, vomiting, somnolence, enuresis, tremor, headache, weight decreased, and decreased appetite. Randomized controlled trials conducted in more than 700 adult and pediatric participants with narcolepsy have demonstrated that SXB significantly reduces cataplexy attacks and EDS. Antidepressants are frequently prescribed off-label for the treatment of cataplexy, despite limited evidence from controlled clinical trials of efficacy or safety. Wake-promoting agents (WPAs) such as modafinil and stimulants such as methylphenidate or amphetamine are frequently taken for the treatment of EDS in patients with narcolepsy. French consensus guidelines and other treatment recommendations are similar. European Federation of Neurological Societies (EFNS) guidelines (published prior to marketing approval of SXB in Europe) recommend SXB as a first-line treatment for cataplexy based on class I evidence (level A) and provisionally recommended SXB for EDS and DNS (designated as poor sleep). American Academy of Sleep Medicine (AASM) practice parameters designate SXB as a standard of care for the treatment of cataplexy, EDS, and DNS, based on level 1 evidence. Sodium oxybate (SXB Xyrem) is approved in the United States for the treatment of cataplexy or EDS in patients 7 years of age and older with narcolepsy and in Europe and Canada for the treatment of adult patients with narcolepsy with cataplexy. EDS and cataplexy are two of the main pentad of symptoms, which also include disrupted nighttime sleep (DNS), sleep-related (hypnagogic/hypnopompic) hallucinations, and sleep paralysis. The frequency of cataplexy also varies, from sporadic to frequent. facial weakness) to complete attacks leading to postural collapse. ![]() Cataplexy presentation differs widely among patients, from subtle partial attacks where loss of muscle tone is localized (e.g. The cardinal symptom of narcolepsy is excessive daytime sleepiness (EDS) many patients with narcolepsy also experience cataplexy. Narcolepsy is a lifelong neurologic disorder that profoundly impairs quality of life, productivity, and social functioning requires long-term treatment in many patients and has a worldwide estimated prevalence of 0.02%–0.067%. ![]()
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