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Xyrem
Xyrem (generic name: sodium oxybate) is a central nervous system (CNS) depressant used to treat narcolepsy, specifically for managing cataplexy (sudden loss of muscle control) and excessive daytime sleepiness (EDS) in adults and children aged 7 years and older. Sodium oxybate is a form of gamma-hydroxybutyrate (GHB), a naturally occurring substance in the brain that helps regulate sleep. It is typically taken at night to improve nighttime sleep and reduce daytime sleepiness and cataplexy episodes.
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Frequently Asked Questions
How long does it take for Xyrem to start working?
Some patients may begin to see improvements in their sleep quality and daytime symptoms within a few days to weeks, but full benefits may take several weeks.
Can I take Xyrem during the day?
No, Xyrem is only meant to be taken at night because of its strong sedative effects. Taking it during the day can lead to excessive drowsiness and impaired functioning.
What should I do if I miss my second dose of Xyrem?
If you miss your second dose and wake up after more than 4 hours, skip the dose and resume your normal dosing schedule the next night. Do not take a double dose to make up for a missed one.
Is Xyrem safe for long-term use?
Yes, Xyrem can be used long-term under the supervision of a healthcare provider, but regular follow-up is necessary to monitor for side effects and to ensure the medication is working effectively.
Can I stop taking Xyrem suddenly?
Do not stop taking Xyrem abruptly without consulting your healthcare provider. Stopping suddenly may cause withdrawal symptoms or an increase in narcolepsy symptoms.
Comprehensive Drug Guide
How Does Xyrem Work?
Sodium oxybate, the active ingredient in Xyrem, is a CNS depressant that enhances slow-wave sleep (deep sleep) and reduces nighttime awakenings. It works by activating GABA(B) receptors, which leads to a sedative effect, promoting restorative sleep and reducing daytime symptoms of narcolepsy, such as cataplexy and excessive daytime sleepiness.
Common Dosages
- 0.5 g/mL oral solution
Typical Dosing
- Xyrem is typically taken twice per night. The initial dose is taken at bedtime, and a second dose is taken 2.5 to 4 hours later.
- The recommended starting dose is 4.5 g per night, divided into two doses. The dose may be gradually increased to a maximum of 9 g per night.
- Xyrem must be diluted with water before ingestion.
Typical Dosing
FDA Approved Indications
- Treatment of cataplexy in patients with narcolepsy.
- Treatment of excessive daytime sleepiness (EDS) in patients with narcolepsy.
Who Shouldn't Take Xyrem?
- Known hypersensitivity to sodium oxybate or any of the components in the formulation.
- Concurrent use of alcohol or sedative-hypnotics, as these substances can enhance the CNS depressant effects of Xyrem and lead to dangerous side effects such as respiratory depression and coma.
Advice From The Pharmacist
- Take Xyrem exactly as prescribed: Follow the two-dose schedule carefully. Set an alarm to wake up for the second dose if needed.
- Do not drink alcohol or use sedatives while taking Xyrem, as this increases the risk of serious side effects, including respiratory depression, coma, or death.
- Dilute each dose with water as instructed by your healthcare provider before taking it.
- Xyrem may cause drowsiness, so be cautious when driving or operating machinery until you know how it affects you.
- Store Xyrem securely, as it is a controlled substance with potential for abuse.
Side Effects of Xyrem
Common Side Effects
- Nausea
- Dizziness
- Headache
- Drowsiness
- Confusion
Uncommon/Severe Side Effects
- Respiratory depression
- Severe allergic reactions (rash, swelling, difficulty breathing)
- Depression or suicidal thoughts
- Sleepwalking or other unusual nighttime behaviors
Risks and Warnings of Xyrem
- CNS Depression and Respiratory Risks: Xyrem is a potent CNS depressant and can cause respiratory depression. The risk is higher when combined with alcohol or other CNS depressants. Patients should avoid using these substances while on Xyrem.
- Abuse and Misuse: Sodium oxybate is the sodium salt of gamma-hydroxybutyrate (GHB), a substance with a history of abuse. Xyrem is subject to strict prescribing and dispensing regulations due to its potential for abuse.
- Depression and Suicidal Ideation: Xyrem has been associated with depression and suicidal thoughts. Patients should be closely monitored for mood changes or signs of depression.
Interactions with Xyrem
Common Drug Interactions
- Alcohol and sedatives: Combining Xyrem with alcohol, benzodiazepines, or opioids increases the risk of dangerous side effects like respiratory depression, coma, and death.
- CNS depressants: Other drugs that depress the central nervous system, such as antipsychotics or barbiturates, may increase the sedative effects of Xyrem.
Alternatives to Xyrem
- Modafinil (Provigil): A stimulant medication used to treat excessive daytime sleepiness in narcolepsy.
- Armodafinil (Nuvigil): Similar to modafinil, used for narcolepsy and shift work sleep disorder.
- Solriamfetol (Sunosi): A stimulant that promotes wakefulness and treats excessive daytime sleepiness in narcolepsy.
- Pitolisant (Wakix): A histamine receptor antagonist that treats narcolepsy by increasing wakefulness.
