Severe sleepiness during the day can be treated with high doses of stimulant drugs. The issue is present primarily among the students and adults working the night shift. There are a few classes of drugs that can be used for the treatment of this health problem, but which one is the most suitable? Let us take a look at the list of drugs used for this purpose:
Amphetamines (dextroamphetamine (Dexedrine and Adderall), methamphetamine hydrochloride (Desoxyn), and methylphenidate (Ritalin)) are stimulants of the central nervous system, known for their use in cases of narcolepsy, but also known for their side-effects, such as high blood pressure, anxiety, agitation, and rarely paranoid reactions, as well as their addiction potential. Nevertheless, addiction caused by these drugs is rarely noticed in the cases of individuals suffering from narcolepsy.
Pemoline (Cylert) is used as the medicine for attention disorders, but it is the least efficient of the traditional stimulants. People taking this medicine that has a potential risk of causing toxic side effects on liver and its vessels should be often monitored.
Modafinil (Provigil) has similar effects as other traditional stimulants. Modafinil does not, however, stimulate the CNS like amphetamines do, though the exact way of its mechanism of action is not yet known. There is much less risk of high blood pressure and mental deterioration side effects, because it works differently than the traditional stimulants.
It doesn't have significant effects on the central nervous system, nor causes mood changes, euphoria, and addiction. A headache and nausea are the most common reported side effects, and are mild and temporary. These side effects can be solved by using smaller doses and then by gradual increase you can reach the wanted dose.
Modafinil is usually used once a day. Switching from amphetamine to Modafinil must be controlled closely, in order to stop the reappearing of cataplexy. Increasing or reducing the doses of anti-cataplectic medicine can solve this problem.
Armodafinil (Nuvigil): An oral medicine used for controlling wakefulness similar to Modafinil (Provigil). Armodafinil incites the wakefulness by stimulating the brain; the exact way of its working is unknown, except that it increases the level of dopamine in the brain.
The most common side effect of Armodafinil is a headache. Other side effects include anxiety, dizziness, diarrhea, dry mouth, insomnia, tiredness, and skin rash.
Monoamine oxidase inhibitors (IMAO) - the class of antidepressants known as monoamine oxidase inhibitors (IMAO) can also be used for treating excessive daily sleepiness, such as phenelzine (Nardil) and selegiline (Eldepryl).
The "Anticataplectic drugs" phrase refers to all drugs used for treating cataplexy, the symptoms of REM sleep disorder, the so-called hypnagogic hallucinations, and sleep paralysis.
Tricyclic antidepressants (TCA) are used in smaller doses, unlike other antidepressants, and are often successful in controlling the cataplexy. These drugs work by affecting the neurotransmitter systems in order to suppress REM sleep, and thus alleviate the symptoms of cataplexy.
In some cases, side-effects can limit the usage of TCA, although in most cases the side-effects are temporary. The most common side-effects are called "anticholinergic side effects", involving dry mouth, dry eyes, blurry sight, retention of urine, constipation, impotence, increased appetite, hangover, anxiety, confusion, and headache.
Some of the TCA can disrupt the night sleep in narcoleptic patients. If you suddenly stop using TCA, the symptoms of cataplexy and other connected REM symptoms can appear.
Selective inhibitors of the repeated production of serotonin (SSRI) are also useful for treating cataplexy in the same doses used for treating depression. Most commonly used are fluoxetine (Prozac), paroxetine (Paxil), sertraline (Zoloft), citalopram (Celexa), and venlafaxine (Effexor).
SSRI may not be as efficient as TCA, but they have fewer side effects. Most often reported side-effects are dizziness, frivolity, nausea, and mild tremor, rarely constipation and diarrhea. If you use Fluoxetine (Prozac) late in the day, it can cause insomnia.
Sodium oxybate (Xyrem), also known as gamma-hydroxybutyrate or gHb, is also used for treating cataplexy and excessive daily sleepiness (EDS). This drug is often used in two doses; the first dose is used before sleep and the other four hours later. It treats the disrupted night sleep in case of narcolepsy.
The night dose can help in reducing daily sleepiness and cataplexy. Sodium oxybate is not related to drugs used for inducing sleep (hypnotics), and is not used for treating insomnia. It might cause drowsiness, and it should be used only at night.
Choosing the winner
Considering all the data about these drugs' health benefits on one side, and their side-effects on the other side, we can conclude that the nootropic drugs Modafinil and its enhanced version - Armodafinil, are the most potent and safest cures for narcolepsy and related disorders, despite their possible side-effects and their use only in treating the symptoms and not the cause of narcolepsy and related disorders.