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Sleep–Wake Disorders
Published in Philip B. Gorelick, Fernando D. Testai, Graeme J. Hankey, Joanna M. Wardlaw, Hankey's Clinical Neurology, 2020
Margaret Kay-Stacey, Eunice Torres-Rivera, Phyllis C. Zee
Although there are no specific FDA-approved medications for IH, stimulants and wake-promoting agents are treatment options, and modafinil is considered as the first-line therapy.44 Methylphenidate is the second-line option and medications such as amphetamines and pitolisant, which are also used to treat narcolepsy, can also be considered if other options fail. Planned naps are not typically helpful in treating IH because they tend to make patients feel worse, as they tend to be unrefreshing and long.
Physiology of Sleep and Sleep Disorders
Published in John C Watkinson, Raymond W Clarke, Terry M Jones, Vinidh Paleri, Nicholas White, Tim Woolford, Head & Neck Surgery Plastic Surgery, 2018
Management of narcolepsy includes planned napping, sleep hygiene and psychosocial support. Sleepiness may respond to stimulants including modafinil, dexamphetamine or methylphenidate. Cataplexy may respond to REM sleep-suppressing medications including tricyclic and SSRI antidepressants. Sodium oxybate or pitolisant may control cataplexy as well as sleep fragmentation and excessive daytime sleepiness.
Solriamfetol for the treatment of excessive daytime sleepiness associated with narcolepsy
Published in Expert Review of Clinical Pharmacology, 2019
Pitolisant is a new drug with a specific action that increases hypothalamic levels of histamine [33]. It has been approved in Europe for the treatment of narcolepsy, but not yet approved by the FDA in the close-up period. Pitolisant can increase histamine concentrations in the hypothalamus by antagonizing histamine (H3) auto-receptors in the tuberomammillary nucleus, the origin of wake-promoting histaminergic neurons [34,35]. Recent placebo-controlled studies have confirmed a positive effect on cataplexy symptoms with improved wakefulness in people with narcolepsy [36]. It can be used as first-line treatment or may become a useful addition to conventional treatments in narcolepsy and cataplexy [37,38]. The most frequent adverse events of pitolisant were headache, irritability, anxiety, and nausea.
Advances in pharmaceutical treatment options for narcolepsy
Published in Expert Opinion on Orphan Drugs, 2018
Tatsunori Takahashi, Sakai Noriaki, Mari Matsumura, Chenyu Li, Kayo Takahashi, Seiji Nishino
Pitolisant is a new and only histaminergic H3-receptor inverse agonist approved by the European Medicines Agency to treat narcolepsy in adults. Dauvilliers et al. reported that pitolisant decreased EDS compared with placebo, but was not non-inferior to modafinil [80]. Recently, the safety and efficacy of pitolisant on cataplexy in patients with narcolepsy was reported [81]. The study was a randomized, double-blind, placebo-controlled trial and the primary end point was the change in the average number of cataplexy attacks per week (weekly cataplexy rate: WCR) between the 2 weeks of baseline and the 4 weeks of stable dosing period. The result showed that the WCR of the pitolisant group during the stable dosing period significantly decreased compared with that of the placebo group. Although treatment-related adverse events were more common in the pitolisant group, most of them were mild or moderate (e.g. headache, irritability, anxiety, and nausea). The study indicates the short-term usefulness of pitolisant for narcolepsy in patients with narcolepsy.
Pharmacotherapy of residual excessive sleepiness among continuous positive airway pressure (CPAP) treated patients with sleep apnea
Published in Expert Opinion on Pharmacotherapy, 2022
Ali A. El-Solh, Avantika Rudraraju, Divij Pasrija, Hoang Bui
The most common adverse events of pitolisant include insomnia, nausea, and anxiety [69]. Pitolisant has been associated with prolongation of the QT interval. Its use with class 1A antiarrhythmic agents (quinidine, procainamide, disopyramide), class 3 antiarrhythmic agents (amiodarone, sotalol), antipsychotic drugs (ziprasidone, chlorpromazine, thioridazine), and antibacterial agents (moxifloxacin) should be avoided. Pitolisant is contraindicated in patients with severe hepatic impairment. Patients with moderate liver disease classified as Child-Pugh Class B may receive pitolisant up to 17.8 mg daily. A similar dosage is recommended for patients with moderate-to-severe renal impairment. The use of pitolisant in patients with end-stage renal disease is not recommended.