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Narcolepsy
Gamma-Hydroxybutyrate (GHB)
Generic and Brand Names: Sodium oxybate (Xyrem, Orphan Medical)
GHB is available in Europe and in Canada and is undergoing testing in multicenter trials in the United States. GHB (gamma-hydroxybutyrate) is a natural substance found in cells throughout the body. It is especially high in the brains of newborns and may help protect against sudden infant death syndrome. Sleep researchers believe that GHB may protect the brain against oxygen deprivation ("hibernation chemical"). Research also shows that GHB is an excellent treatment against narcolepsy.
To date, the combined results of clinical trials are very favorable regarding the effectiveness of GHB as an anticataplectic agent, even in individuals with inadequate responses to other agents.
Given at bedtime, GHB reduces the number of daytime sleep attacks and also improves cataplexy, hypnogogic hallucinations, and sleep paralysis. Furthermore, GHB is highly effective in reducing nocturnal sleep disruptions and consolidating nocturnal sleep. It also demonstrates an alerting effect during the day. In other words, the patients seem to be able to get by with a lower dose of stimulant medication to stay alert during the day.
Researchers also found that the sleep of the narcoleptic patients improved while they were taking GHB. The only known side effect of this substance is sleepwalking and that is ectremely rare. GHB provides immediate sedating effects and hence taken only at bedtime or when the person can go to sleep immediately. GHB is awaiting FDA approval in the USA.
Dosage
Common initial dose - 1.5g at HS and 3-4 h later
Usual maximal dose (carefully monitored higher doses may sometimes be required)
- 4.5g at HS and 3-4 h later
Side effects: sedation, nausea, lightheadedness, dizziness
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