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Source: Dopp JM, Phillips BG. Sleep–wake disorders. In: DiPiro JT, Talbert RL, Yee GC, Matzke GR, Wells BG, Posey LM, eds. Pharmacotherapy: A Pathophysiologic Approach. 10th ed. New York, NY: McGraw-Hill; 2017. http://accesspharmacy.mhmedical.com/content.aspx?bookid=1861§ionid=134128126. Accessed March 27, 2017.
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Possible environmental influences.
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Affects 0.03–0.06% of adult Americans.
Incidence may be higher in men than women.
Usually occurs in second decade of life and increases in severity through third and fourth decades.
Can occur in children and adolescents.
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CLINICAL PRESENTATION
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MEANS OF CONFIRMATION AND DIAGNOSIS
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TREATMENT: NONPHARMACOLOGIC THERAPY
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TREATMENT: PHARMACOLOGIC THERAPY
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Pharmacotherapy focuses on excessive daytime sleepiness and cataplexy (Table 1).
Excessive daytime somnolence.
Modafinil 200 mg each morning standard treatment.
Armodafinil (the active R-isomer of modafinil) is also available.
Amphetamines and methylphenidate have higher likelihood of abuse and tolerance.
Side effects include:
Insomnia.
Hypertension.
Palpitations.
Irritability.
Selegiline may also be beneficial.
Cataplexy.
Sodium oxybate (γ-hydroxybutyrate; potent sedative-hypnotic) improves excessive daytime sleepiness and decreases episodes of sleep paralysis, cataplexy, and hypnagogic hallucinations.
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