Narcolepsy may be treated with several types of prescription medications. While often not the first choice of treatment due to safety concerns, gamma-hydroxybutyrate may be used in certain cases.

Narcolepsy is a chronic condition that causes disruptive sleep symptoms. Among the most common symptoms include:

  • excessive daytime sleepiness (EDS)
  • muscle weakness (cataplexy)
  • hallucinations
  • sleep paralysis

Due to the disruptive nature of narcolepsy symptoms, a doctor may prescribe medications that can help. One possibility is gamma-hydroxybutyrate (GHB) for EDS and cataplexy. However, this drug is not a first-line treatment due to safety risks.

Keep reading to learn more about GHB for narcolepsy, including what research says about the benefits and possible risks, and how this drug compares with other treatment options.

About narcolepsy

Narcolepsy is a rare, lifelong neurological condition that causes abnormal sleep patterns, including sudden daytime drowsiness and disrupted sleep at night. A sleep medicine doctor, primary care doctor, neurologist, or collaborative team of these medical professionals typically diagnoses and treats the condition.

Learn more about narcolepsy here.

GHB is one possible treatment option for narcolepsy. The prescription drug version, sodium oxybate, is thought to help improve two primary symptoms of narcolepsy: EDS and cataplexy.

  • EDS is the most common symptom seen in narcolepsy. It causes persistent sleepiness and sudden “sleep attacks” despite getting enough sleep at night.
  • Cataplexy describes extreme and sudden muscle weakness and loss of control while awake. In severe cases, a person may collapse.

GHB vs sodium oxybate: What’s the difference?

Both GHB and sodium oxybate are considered central nervous system (CNS) depressants.

It’s important to know that sodium oxybate contains the sodium salt of GHB. While not exactly the same drug, both terms are often used interchangeably. GHB is also a street drug and is not technically approved for any medical purpose.

Over the last few decades, researchers have also looked into the possible benefits and effects of GHB for narcolepsy.

For example, one 2019 systematic review and meta-analysis found GHB was effective in treating EDS and cataplexy, though the medication was also not well tolerated.

A 2020 review suggests that GHB might help narcolepsy by reducing the number of sleep disruptions at night, but the research noted that the medication is known for side effects that may cause people to not want to stay on it.

The previously discussed findings support much earlier research going back to 1986, when one clinical review found that GHB could result in less fragmented sleep when taken in conjunction with stimulants during the day. Since then, prescription formulas have been approved for the use of narcolepsy.

The Food and Drug Administration (FDA) first approved Xyrem, a brand name of sodium oxybate, for the treatment of narcolepsy in 2002. The agency later approved a generic version of sodium oxybate for narcolepsy in 2017.

The medication is specifically approved for treating EDS and cataplexy with this condition. Notably, it’s also the only approved treatment for cataplexy in narcolepsy. Xyrem is also a Schedule III controlled substance.

Furthermore, sodium oxybate is only prescribed alongside a risk evaluation and mitigation strategy (REMS) program, which involves strict enrollment and pharmacy requirements. The drug is not sold at retail pharmacies. It’s only available through certified pharmacies approved to dispense the drug.

Sodium oxybate comes in a liquid form taken by mouth. The most common starting adult dosage is 2.25 grams (g) taken twice in the evening.

A doctor may eventually increase the dosage to 9 g per night. In fact, the previously mentioned 2019 review also suggests that the greatest narcolepsy symptom relief with GHB was noted in 9 g per night doses. Cataplexy was most improved within 4 weeks at this dose.

While approved for EDS and cataplexy associated with narcolepsy, sodium oxybate is not widely used because of potential serious risks, including:

This medication is also known to have addictive qualities. The FDA cautions that GHB in both prescription and illegal forms can be abused or misused. The drug should not be mixed with alcohol due to extreme sedative effects.

Other common side effects of this medication include:

Due to the possible effects on fetal development, GHB/sodium oxybate is not recommended for pregnant people.

GHB is not the only treatment option for narcolepsy. Also, there’s currently no treatment that is considered 100% effective in all people with narcolepsy. Finding the right medication for you may require a bit of trial and error.

Aside from GHB, consider talking with a doctor about the following other treatments for this condition:

Additionally, a doctor may recommend lifestyle changes that can help complement any medications you take for narcolepsy. This includes the following:

  • maintaining a sleep schedule as best as you can
  • engaging in relaxing activities before bed
  • taking short, regularly scheduled naps
  • exercising 20 minutes per day or more but avoid working out 4 to 5 hours before your scheduled bedtime
  • avoiding drinking alcohol or consuming caffeine before bed
  • quitting smoking if you smoke
  • avoid eating close to your bedtime and specifically eating large meals at night

Overall, GHB is thought to be an effective treatment for EDS and cataplexy from narcolepsy. The downside is that it is not well-tolerated due to side effects and potential complications.

A doctor will carefully determine whether GHB is an appropriate option for treating your symptoms of narcolepsy. Having a detailed discussion with your doctor about all the potential benefits and risks of taking GHB can help you make the most informed decision about the medication.