Surprising Possible Side Effect of Xywav in Narcolepsy

By Jeffrey McGovern, MD, FAASM, FCCP

” Mount your mind to mirth and also joviality, which disallows a thousand injuries and also extend life”– William Shakespeare ( The Subjugating of the Shrew, Scene 2 intro)

Narcolepsy is a condition largely identified by extreme daytime drowsiness and also indicators of rapid eye movement sleep (RAPID EYE MOVEMENT)- rest dissociation materialized in kind 1 pattern as cataplexy and also uncommon symptoms of rapid eye movement on polysomnography (PSG) and also numerous rest latency screening (MSLT). A crucial function of the medical diagnosis is the visibility of a mean rest latency much less than or equivalent to 8 mins and also 2 or even more sleep-onset rapid eye movement durations (SOREMPs) on an MSLT.¹

Therapy alternatives consist of interest to rest health along with an array of older and also more recent notifying and also wake-promoting representatives. As narcolepsy has actually been related to cataplexy and also fragmented rest, the intro of salt oxybate and also lately low-sodium oxybate– or calcium, magnesium, potassium, and also salt oxybates (brand: Xywav)– has actually assisted to lower both linked attributes.

Situation Record of Mirth in Person on Xywav

The individual is a 43-year-old woman with a household background of narcolepsy. She initially provided one year prior to with extreme daytime drowsiness (Epworth Drowsiness Rating of 12/24) without indicators of rest apnea or uneasy legs disorder. After a cautious background and also physical, she undertook in-lab PSG adhered to straight by MSLT with 5 snoozes. The PSG disclosed a rest performance of 97% with rapid eye movement latency at 54 mins and also rapid eye movement thickness of 29%. There was no proof of rest apnea or arm or leg motions. The MSLT disclosed a mean rest latency of 24 secs with SOREMPs in snoozes 2, 3, and also 5. She refuted any type of background of cataplexy and also was identified with narcolepsy kind 2.

Her rest pattern was considered to be ample. She wished to go over the duty of wake-promoting representatives. A routine consisting of solriamfetol 150 mg (brand: Sunosi) was started, however as a result of fragmented rest and also recurring drowsiness, salt oxybate at separated dosages was begun . For a number of months she stayed wide-awake without recurring drowsiness throughout the day. Throughout the COVID pandemic when she was restricted to function from residence, she determined to quit the salt oxybate and also make up with daytime napping. She refuted back then any type of unfavorable impacts from the nighttime routine. Not utilizing her salt oxybate led regrettably to her insurance coverage not accepting refills of this drug as they thought she was noncompliant.

After an extended period of allure from the workplace viewpoint, insurance coverage lastly authorized the resumption of nighttime drug in the kind of calcium, magnesium, potassium, and also salt oxybate. The individual began Xywav in the evening at equal dosages to salt oxybate. In set up follow-up, she remained to stay certified and also continue track with both medications (based upon medical testimonial and also tracking of her Pennsylvania Medication Monitoring Program).

In a current follow-up, she recognized conformity with her routine however confessed to a feeling of mirth because beginning Xywav. She attempted not to take the nighttime routine with resultant extreme daytime drowsiness however resolution of the mirth– which she referred to as a pleasurable experience and also not related to rage. She additionally reported that this experience reduced with consuming. She refuted it was an issue and also demanded proceeding the routine, provided its general advantage. Various other reasons were explored and also dismissed as an etiology of her mirth.

Rest Medication Context

Calcium, magnesium, potassium, and also salt oxybate is suggested for the therapy of cataplexy and also extreme daytime drowsiness in individuals 7 years old and also older with narcolepsy.² The security of calcium, magnesium, potassium, and also salt oxybate in individuals with narcolepsy was reviewed in a 16-week double-blind, placebo-controlled, randomized withdrawal research study in individuals with cataplexy that formerly were taking salt oxybate or an additional anticataplectic drug. The individuals attained a secure, bearable, and also efficient dose over 8 weeks. There were no records of sensations of mirth or giddiness in this medical test of Xywav in individuals with narcolepsy.³

The security of calcium, magnesium, potassium, and also salt oxybate was additionally reviewed with a double-blind, placebo-controlled, randomized withdrawal research study in individuals with idiopathic hypersomnia. The distinction in this research study versus the narcolepsy test is that the energizers or notifying representatives were enabled if the individuals were taking the exact same application routine for over 2 months. The representatives provided consisted of solriamfetol. A lot of the individuals (53%) were taking an energizer representative. Once again, there were no records of sensations of mirth or giddiness in individuals.⁴

The individual’s record of mirth while taking Xywav is plainly the reverse of the reported negative effects of anxiety and also, in much less serious instances, hostile actions.² The individual still keeps in mind positive waking impacts of the nighttime medication, and also it is feasible that the experience of mirth might be improving her conformity. Feasible etiologies for this impact might be the enhancement of the energizer (solriamfetol). The security research study supplied by Jazz Drugs did not consist of individuals with energizer treatment in their narcolepsy arm.

On top of that, although the individual refuted any type of sensations of stress and anxiety while taking her routine for narcolepsy, the experience of mirth might stand for a forme fruste of stress and anxiety. The decreasing of the mirth by taking in food is most likely as a result of the impact on bioavailability.

Duty of the Rest Professional

This situation highlights the symptom of mirth in an individual with narcolepsy taking calcium, magnesium, potassium, and also salt oxybates, additionally understood by the brand Xywav. Provided the significance of this medication in the armamentarium of the rest expert, it is necessary to question individuals concerning all negative effects, also those that might be happily experienced.

Referrals

American Academy of Rest Medication. International Category of Rest Disorders, 3^rd ed. 2014; 146-61.
XYWAV ® (calcium, magnesium, potassium, and also salt oxybates) dental option, CII. Recommending info. Jazz Pharmaceuticals Inc.
XYWAV ® (calcium, magnesium, potassium, and also salt oxybates) dental option, CII. Recommending info. Jazz Pharmaceuticals Inc. Research 1; NCT03030599.
XYWAV ® (calcium, magnesium, potassium, and also salt oxybates) dental option, CII. Recommending info. Jazz Pharmaceuticals Inc. Research 2; NCT03533114.