What is Sodium Oxybate: Uses, Dosage, Side Effects and More

Sodium oxybate is a prescription medication that helps people with narcolepsy manage their symptoms and get better sleep. This unique medicine works on your brain's sleep-wake cycle to reduce sudden sleep attacks during the day and improve nighttime rest.

You might know this medication by its brand name Xyrem or Lumryz. It's a carefully controlled substance that requires special handling and monitoring by your healthcare team. Let's explore what you need to know about this important sleep disorder treatment.

What is Sodium Oxybate?

Sodium oxybate is the sodium salt of gamma-hydroxybutyric acid (GHB), a naturally occurring substance in your brain. It's specifically designed to treat narcolepsy, a neurological condition that affects your ability to control sleep and wake cycles.

This medication comes as a liquid solution that you take by mouth at bedtime. It's classified as a controlled substance because it can be habit-forming and requires careful medical supervision. Your doctor will provide detailed instructions on how to use it safely.

The medication works differently from typical sleep aids. Instead of just making you drowsy, it helps regulate your brain's natural sleep architecture and reduces the abnormal REM sleep patterns that characterize narcolepsy.

What is Sodium Oxybate Used For?

Sodium oxybate treats two main symptoms of narcolepsy in adults and children 7 years and older. It helps control excessive daytime sleepiness and reduces episodes of cataplexy, which are sudden muscle weakness attacks triggered by strong emotions.

Excessive daytime sleepiness with narcolepsy isn't just feeling tired after a poor night's sleep. It involves overwhelming urges to sleep that can happen at any time, making it difficult to stay awake during normal activities like work, school, or conversations.

Cataplexy episodes can range from mild muscle weakness to complete muscle collapse while you remain conscious. These attacks often happen when you laugh, get excited, or experience other strong emotions. Sodium oxybate can significantly reduce both the frequency and severity of these episodes.

Your doctor might also prescribe this medication for other sleep-related conditions, but narcolepsy remains its primary approved use. The treatment helps restore more normal sleep patterns and improves your quality of life.

How Does Sodium Oxybate Work?

Sodium oxybate works by acting on specific receptors in your brain called GABA-B receptors. These receptors help regulate your sleep-wake cycle and the different stages of sleep your brain goes through each night.

This medication is considered a strong and effective treatment for narcolepsy symptoms. It helps consolidate your nighttime sleep, meaning you spend more time in deep, restorative sleep stages. This improved nighttime rest naturally reduces your daytime sleepiness.

The drug also affects your brain's control over muscle tone during emotional experiences. By stabilizing these neural pathways, it helps prevent the sudden muscle weakness that characterizes cataplexy attacks.

Unlike many sleep medications that can leave you feeling groggy, sodium oxybate works with your natural sleep cycles. Most people find they feel more refreshed and alert during the day when their nighttime sleep improves.

How Should I Take Sodium Oxybate?

You'll take sodium oxybate twice each night, with doses spaced 2.5 to 4 hours apart. The first dose should be taken at bedtime when you're ready to go to sleep immediately. Set an alarm to wake up for your second dose.

Always take this medication on an empty stomach, at least 2 hours after eating. Food can interfere with how well your body absorbs the medicine and may reduce its effectiveness. You should prepare both doses before going to bed.

Mix each dose with about 2 ounces of water in the child-resistant dosing cups provided with your medication. Drink the entire mixture right away. Keep the prepared doses at your bedside so you don't need to get up for the second dose.

Your bedroom should be prepared for safety since this medication works quickly. Remove any obstacles between your bed and bathroom, and make sure you have easy access to water and your second dose. Never leave your bed for other activities after taking either dose.

How Long Should I Take Sodium Oxybate For?

Most people with narcolepsy need to take sodium oxybate long-term to maintain symptom control. This isn't a medication you take for a few weeks and then stop. It's typically a chronic treatment that continues as long as it remains effective and well-tolerated.

Your doctor will start you on a low dose and gradually increase it over several weeks until you reach the right amount for your symptoms. This process usually takes 8 to 12 weeks, during which you'll have regular check-ups to monitor your progress.

Some people see improvements in their sleep quality within the first few weeks, while full benefits for daytime sleepiness and cataplexy may take longer to develop. Your healthcare team will track your response and adjust your treatment plan accordingly.

Never stop taking sodium oxybate suddenly without talking to your doctor first. Your body can become dependent on the medication, and stopping abruptly might cause withdrawal symptoms or a return of your narcolepsy symptoms.

What Are the Side Effects of Sodium Oxybate?

Like all medications, sodium oxybate can cause side effects, though not everyone experiences them. The most common side effects are usually mild and often improve as your body adjusts to the medication.

Here are the side effects you might experience, starting with the most common ones:

• Nausea and vomiting, especially when first starting treatment
• Dizziness or feeling unsteady, particularly when getting up
• Headaches that may occur during the day
• Bedwetting or increased urination at night
• Sleepwalking or unusual sleep behaviors
• Tremor or shaking, usually mild
• Weight loss due to decreased appetite

These common side effects typically become less bothersome as your body adapts to the medication over several weeks.

Some people may experience more serious side effects that require immediate medical attention. While these are less common, it's important to know what to watch for:

• Severe confusion or memory problems
• Difficulty breathing or slow, shallow breathing
• Unusual behavior or agitation
• Signs of depression or suicidal thoughts
• Severe allergic reactions with rash, swelling, or difficulty breathing

Contact your healthcare provider right away if you experience any of these more serious symptoms. Your safety is the top priority, and your medical team can help adjust your treatment if needed.

Who Should Not Take Sodium Oxybate?

Certain people should not take sodium oxybate due to safety concerns or potential interactions with other conditions. Your doctor will carefully review your medical history before prescribing this medication.

You should not take sodium oxybate if you have sleep apnea or other breathing problems that worsen during sleep. The medication can further depress your breathing, which could be dangerous. Your doctor may need to treat these conditions first.

People with liver problems should avoid this medication because your liver processes sodium oxybate. If your liver isn't working properly, the drug could build up to dangerous levels in your system. Regular liver function tests may be needed if you have mild liver issues.

This medication is not recommended if you have a history of drug or alcohol abuse. Sodium oxybate can be habit-forming, and people with addiction histories may be at higher risk for misuse. Your doctor will carefully weigh the benefits and risks.

Pregnant and breastfeeding women should discuss the risks and benefits with their healthcare provider. The medication can pass to babies through breast milk, and its effects during pregnancy are not fully understood.

Sodium Oxybate Brand Names

Sodium oxybate is available under several brand names, with Xyrem being the most well-known and widely prescribed version. This liquid formulation has been the standard treatment for narcolepsy for many years.

Lumryz is a newer extended-release version that you take once per night instead of twice. This formulation may be more convenient for some people, though it works similarly to the traditional twice-nightly dosing.

Both medications contain the same active ingredient and provide similar benefits for narcolepsy symptoms. Your doctor will help determine which formulation might work best for your lifestyle and treatment needs.

Generic versions of sodium oxybate are also becoming available, which may offer cost savings while providing the same therapeutic effects. Your pharmacist can discuss options that might be covered by your insurance plan.

Sodium Oxybate Alternatives

While sodium oxybate is often considered the gold standard for narcolepsy treatment, several alternative medications can help manage symptoms. Your doctor might recommend these if sodium oxybate isn't right for you or doesn't provide adequate symptom control.

Stimulant medications like modafinil, armodafinil, or traditional amphetamines can help with excessive daytime sleepiness. These work differently by promoting wakefulness rather than improving nighttime sleep quality.

For cataplexy specifically, antidepressants such as venlafaxine or fluoxetine can be effective. These medications help stabilize the brain circuits that control muscle tone during emotional experiences.

Newer medications like pitolisant and solriamfetol offer additional options for daytime sleepiness with different mechanisms of action. Your doctor can help determine which combination of treatments might work best for your specific symptoms.

Is Sodium Oxybate Better Than Modafinil?

Sodium oxybate and modafinil work differently and are often used together rather than as competing treatments. Sodium oxybate improves nighttime sleep quality and treats cataplexy, while modafinil primarily addresses daytime sleepiness.

For comprehensive narcolepsy treatment, sodium oxybate is often considered more effective because it addresses multiple symptoms and the underlying sleep architecture problems. Many people find their daytime alertness improves naturally when their nighttime sleep becomes more restorative.

Modafinil is generally easier to take and has fewer restrictions, making it a good option for people who can't tolerate sodium oxybate or don't need treatment for cataplexy. It's also commonly used as an add-on treatment for breakthrough daytime sleepiness.

Your doctor will consider your specific symptoms, lifestyle, and treatment goals when deciding between these medications. Many people with narcolepsy ultimately benefit from a combination approach that includes both treatments.