The Treatment of Narcolepsy and Cataplexy

Narcolepsy may affect as many as 250 000 Americans. It involves a neurologic defect in the regulation of sleep and wakefulness. The chief symptoms are sleepiness, inappropriate sleep episodes, and cataplexy. Narcoleptic patients also frequently complain of hypnagogic hallucinations, sleep paralysis, and automatic behavior, as well as disturbed nocturnal sleep. Narcolepsy usually develops in adolescence and is a life-long illness. Satisfactory treatment is not available at the present time. The current treatments of choice include general measures (such as patient and family counseling and frequent napping) and drug treatments, including methylphenidate for sleepiness and sleep episodes and imipramine for cataplexy. Medication dosages must be adjusted for individual patients. Pharmacists have a special responsibility to monitor narcoleptic patients by becoming familiar with the disease and its symptoms and by encouraging patients to follow their drug regimens and to take drug holidays under the supervision of the physician when the drug dose becomes excessive.