Wake-Promoting Agents to Treat Idiopathic Hypersomnia

While there is no cure for idiopathic hypersomnia yet, there are treatments that can help manage symptoms. One common type of treatment is wake-promoting agents. Doctors prescribe these drugs to help people stay awake.^1,2

How do wake-promoting agents work?

Wake-promoting agents are a type of prescription drug. They are different from traditional stimulants. Stimulants like amphetamines speed up the whole nervous system. Wake-promoting agents work in a more specific way. They target certain areas of the brain to boost wakefulness.¹

Scientists do not know exactly how these drugs work. They do know that the drugs affect chemicals in the brain. These chemicals are called neurotransmitters. One important chemical is dopamine. Dopamine helps the brain control sleep and wake cycles. Wake-promoting agents stop the brain from reabsorbing dopamine too quickly. This leaves more dopamine available. This helps you feel more awake and alert during the day.¹

Examples of wake-promoting agents

There are 2 main drugs in this class used for excessive sleepiness.²

Modafinil (Provigil®)

Modafinil is a common drug for sleep disorders. It comes as a tablet. Sometimes doctors prescribe it for idiopathic hypersomnia. This is often an "off-label" use. That means the FDA approved the drug for other sleep problems, but doctors know it helps people with IH too.^2,3

Armodafinil (Nuvigil®)

Armodafinil is very similar to modafinil. It is a slightly different chemical form of the same drug. Some people find it lasts longer in the body. Like modafinil, doctors may prescribe it off-label for IH.^2,4

Other wake-promoting options

Doctors sometimes prescribe other drugs to treat idiopathic hypersomnia. Some of these are newer drugs. Others are older drugs used in new ways.²

• Pitolisant (Wakix®) – Research shows that pitolisant may help reduce daytime sleepiness in people with IH. It has not been approved for use in those with IH.
• Solriamfetol (Sunosi®) – A newer type of wake-promoting agent. This drug is approved for narcolepsy and sleep apnea. However, it has not been fully studied for use in people with IH.
• Flumazenil (Romazicon®)– This drug blocks the sleepy chemicals in the brain. For IH, doctors may prescribe it if other drugs have not worked. You must get it from a special compounding pharmacy.
• Clarithromycin (Biaxin®, Biaxin XL®) – This is an antibiotic. It can help some people feel more awake. It may be used for people with hypersomnia if other drugs are not effective.

What are the possible side effects?

Side effects can vary depending on the specific drug you are taking. Common side effects of wake-promoting agents include:^2-4

• Headache
• Nausea
• Nervousness or anxiety
• Dizziness
• Trouble sleeping (insomnia)
• Dry mouth
• Fast or irregular heartbeat

Some side effects are more serious. These are rare. You should stop taking the drug and get medical help right away if you have:^2-4

• Skin rash, hives, or peeling skin
• Swelling of the face, eyes, lips, or tongue
• Trouble swallowing or breathing
• Chest pain
• Mental health changes

These are not all the possible side effects of wake-promoting agents. Talk to your doctor about what to expect when taking wake-promoting agents. You should also call your doctor if you have any changes that concern you when taking wake-promoting agents.

Other things to know

It is important to use these drugs safely. They can interact with other drugs you take. One interaction involves birth control. Modafinil, armodafinil, and pitolisant can make hormonal birth control less effective. This includes pills, patches, and rings. Talk to your doctor about using other forms of birth control while taking these drugs.^3,4

You should also be careful with alcohol. It is best to avoid alcohol while taking these drugs. Alcohol can change how the drug works in your body.^3,4

Tell your doctor if you have heart or liver problems. You may need a lower dose.^3,4

Wake-promoting drugs are controlled substances. This means there is a small risk of abuse or dependence. Always follow your doctor's dosage instructions exactly.^3,4

Before beginning treatment for idiopathic hypersomnia, tell your doctor about all your health conditions and any other drugs, vitamins, or supplements you take. This includes over-the-counter drugs.