Pharmacotherapy options for cataplexy.

Abstract

INTRODUCTION:

Narcolepsy with cataplexy is a rare disabling sleep disorder characterized by two major symptoms: excessive daytime sleepiness and cataplexy characterized by a sudden bilateral loss of voluntary muscular tone triggered by strong positive emotional factors. Pathophysiological studies have shown that the disease is caused by the early loss of hypothalamic hypocretin neurons.

AREAS COVERED:

Following a literature search on PubMed using "narcolepsy," "cataplexy," "treatment," "medication," and "drug" as keywords, we critically analyzed and reviewed current evidence about optimal management of cataplexy in humans. The management of cataplexy has evolved over the past few years with the widespread use of antidepressants, especially those with adrenergic uptake inhibitor properties and gamma-hydroxybutyrate (sodium oxybate).

EXPERT OPINION:

Based on class 1 evidence studies, first-line pharmacological treatment of cataplexy should be sodium oxybate. Second-line treatment should be antidepressants with norepinephrine/serotonine reuptake inhibitor venlafaxine based on its good benefit-risk ratio; however, this recommendation lacks class 1 evidence and is based on expert opinion only. Given the major developments in understanding the neurobiological basis of cataplexy, future therapeutic targets are clearly oriented toward immune-based therapies at early stages of the disease and hypocretin replacement therapy.

• Authors: Régis Lopez, Yves Dauvilliers
• Journal: Expert opinion on pharmacotherapy (Expert Opin Pharmacother) Vol. 14 Issue 7 Pg. 895-903 (May 2013) ISSN: 1744-7666 [Electronic] England
• PMID: 23521426 (Publication Type: Journal Article, Review)

Chemical References

• Adrenergic Uptake Inhibitors
• Antidepressive Agents
• Intracellular Signaling Peptides and Proteins
• Neuropeptides
• Orexins
• Serotonin Uptake Inhibitors
• Sodium Oxybate

Topics

• Adrenergic Uptake Inhibitors (administration & dosage, pharmacology, therapeutic use)
• Antidepressive Agents (administration & dosage, therapeutic use)
• Cataplexy (drug therapy, physiopathology)
• Drug Therapy, Combination
• Humans
• Intracellular Signaling Peptides and Proteins (metabolism)
• Neuropeptides (metabolism)
• Orexins
• Selective Serotonin Reuptake Inhibitors (administration & dosage, therapeutic use)
• Sodium Oxybate (administration & dosage, pharmacology, therapeutic use)