A clinical practice guideline developed by a task force of experts commissioned by the American Academy of Sleep Medicine provides recommendations for treating patients with disorders of hypersomnolence.
Twenty of the recommendations address medications for adult patients, including two new narcolepsy treatments, solriamfetol and pitolisant, approved in 2019 by the FDA. The guideline was published online by the Journal of Clinical Sleep Medicine.
Among the strong recommendations for adults, the guideline said narcolepsy can be treated with modafinil, pitolisant, sodium oxybate, and solriamfetol. It made another strong recommendation to use modafinil for idiopathic hypersomnia.
Conditional recommendations supported using lithium in adult patients with Kleine-Levin Syndrome and armodafinil for hypersomnia secondary to dementia with Lewy bodies, as well as for hypersomnia secondary to traumatic brain injury. Other conditional recommendations supported modafinil for adults with hypersomnia secondary to Parkinson's disease, traumatic brain injury, myotonic dystrophy, or multiple sclerosis. Sodium oxybate received a conditional recommendation for hypersomnia secondary to Parkinson's disease in adults.
The task force evaluated data for individual medications rather than entire medication classes, noting that medications often have enantiomers, racemic compounds, or prodrugs that might also be used for treatment. “Although we did not make class-wide medication recommendations, it may be reasonable to assume that closely related compounds will have similar risks and benefits,” the guideline stated.