Clinical pearls for the treatment of narcolepsy

Narcolepsy is a chronic neurologic state in which patients experience an irrepressible need to sleep or lapses into sleep. The hallmark symptom of narcolepsy is excessive daytime sleepiness, but patients may also experience other symptoms, such as cataplexy, sleep attacks, disturbed nighttime sleep, or sleep-related hallucinations. Narcolepsy has 2 distinct classifications, narcolepsy type 1 and narcolepsy type 2, and only patients with narcolepsy type 1 experience cataplexy. Treatment of narcolepsy must be individualized to patient-specific variables, including symptoms, co-occurring conditions, adverse effects, drug interactions, pregnancy potential, and lifestyle factors. These variables introduce complexities that must be appropriately acknowledged and monitored. Monitoring adverse effects, individualized medication selection, management of key interactions, and care for narcolepsy in patients with reproductive potential are explored through 3 patient cases.