Medications used to treat cataplexy in children* with narcolepsy

Medication	Starting dose	Usual effective dose range	Common side effects	Rare but serious side effects
Sodium oxybate^¶	Doses are administered twice nightly, at bedtime and 2.5 to 4 hours later Recommended starting dose by weight: 20 to <30 kg: ≤2 grams per night in 2 divided doses 30 to <45 kg: ≤3 grams per night in 2 divided doses ≥45 kg: ≤4.5 grams per night in 2 divided doses	2 to 9 grams in 2 divided doses at night Maximum recommended total night dose by weight: 20 to <30 kg: 6 grams 30 to <45 kg: 7.5 grams ≥45 kg: 9 grams	Morning sedation, nausea, weight loss, dizziness, enuresis, sleepwalking, tremor, worsening of OSA	Confusion, severe sedation, central sleep apnea, coma, diversion or misuse^¶
Mixed-salt oxybate (calcium, magnesium, potassium, and sodium oxybates)^¶	Same as for sodium oxybate	Same as for sodium oxybate	Same as for sodium oxybate	Same as for sodium oxybate
Pitolisant^Δ	By weight: <40 kg: 4.45 mg every morning ≥40 kg: 4.45 to 8.9 mg every morning	By weight: <40 kg: 8.9 to 17.8 mg ≥40 kg: 17.8 to 35.6 mg	Headache, insomnia, nausea, anxiety	Severe rash, QT prolongation
Tricyclic antidepressants
Clomipramine^◊	25 mg at bedtime	25 to 100 mg/day at bedtime	Dry mouth, constipation, sweating, blurry vision, somnolence, weight gain, orthostatic hypotension	Cardiotoxicity, seizures, suicidal ideation, bone marrow suppression, serotonin syndrome
Imipramine	25 mg once daily	25 to 75 mg/day in 1 to 2 divided doses
Protriptyline^◊	5 mg once daily	5 to 10 mg/day in 1 to 2 divided doses
Selective serotonin reuptake inhibitors
Fluoxetine	5 to 10 mg once daily	10 to 30 mg once daily	Nausea, insomnia, tremor	Suicidal ideation, prolongation of QT interval, serotonin syndrome
Sertraline	12.5 to 25 mg once daily	25 to 200 mg once daily
Citalopram	10 mg once daily	10 to 40 mg once daily
Serotonin norepinephrine reuptake inhibitors
Venlafaxine	25 mg once daily	37.5 to 75 mg once daily	Nausea, weight loss, dizziness, headache, constipation, insomnia, somnolence, tremor	Suicidal ideation, prolongation of QT interval, serotonin syndrome

OSA: obstructive sleep apnea.

* Doses listed in table are appropriate for children ≥6 years and adolescents (except as noted).

¶ Dosing shown for children ≥7 years and adolescents; guidance for such children weighing <20 kg provided in Lexicomp drug information. In the United States, prescribers must register with the Risk Evaluation and Mitigation Strategies (REMS) program and follow specific safety and monitoring recommendations. Combined use with alcohol, sedatives, or hypnotics is specifically contraindicated in United States licensing information.

Δ Authorized by the European Medicines Agency for use in children ≥6 years and adolescents; in the United States and Canada, approval is limited to adults ≥18 years. Dosing is expressed as pitolisant base and corresponds with tablet strengths available in the United States. International products may express dosing differently (eg, as pitolisant hydrochloride or approximate pitolisant base amount) depending on country. Refer to local product information.

◊ Dosing shown for children ≥10 years and adolescents.

Graphic 104803 Version 7.0

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Medications used to treat cataplexy in children* with narcolepsy