Formulary
Sodium oxybate: Indications, Dosing, Side Effects and Interactions
A central nervous system depressant.
MedNext Academy | 3 min read
Sodium oxybate: Indications, Dosing, Side Effects and Interactions
A central nervous system depressant.
Drug action
A central nervous system depressant.
Indications and dose
**Narcolepsy with cataplexy (under expert supervision)**
- **Adult** (By Mouth): Initially 2.25 g daily, dose to be taken on retiring and 2.25 g after 2.5-4 hours, then increased in steps of 1.5 g daily in 2 divided doses, dose adjusted according to response at intervals of 1-2 weeks; dose titration should be repeated if restarting after interval of more than 14 days, maximum 9 g daily in 2 divided doses.
Cautions
Body mass index of 40 kg/m 2 or greater (higher risk of sleep apnoea); elderly; epilepsy; heart failure (high sodium content); history of depression; history of drug abuse; hypertension (high sodium content); respiratory disorders; risk of discontinuation effects including rebound cataplexy and withdrawal symptoms
Contraindications
Major depression; succinic semi-aldehyde dehydrogenase deficiency
Side effects
Common or very common Abdominal pain upper; anxiety; appetite abnormal; arthralgia; asthenia; back pain; concentration impaired; confusion; depression; diarrhoea; dizziness; dyspnoea; fall; feeling drunk; headache; hyperhidrosis; hypertension; increased risk of infection; movement disorders; muscle spasms; nasal congestion; nausea; palpitations; peripheral oedema; sedation; sensation abnormal; skin reactions; sleep disorders; sleep paralysis; snoring; taste altered; tremor; urinary disorders; vertigo; vision blurred; vomiting; weight decreased Uncommon Behaviour abnormal; faecal incontinence; hallucination; memory loss; psychosis; suicidal behaviours; thinking abnormal Frequency not known Angioedema; dehydration; delusions; dry mouth; homicidal ideation; loss of consciousness; mood altered; respiratory depression; seizure; sleep apnoea
Interactions
**Severe interactions:**
- Omeprazole The co-administration of omeprazole has no clinically significant effect on the pharmacokinetics of sodium oxybate.
**Other interactions (16):**
- The combined use of alcohol with sodium oxybate may result in potentiation of the central nervous system-depressant effects of sodium oxybate.
- Patients should be warned against the use of any alcoholic beverages in conjunction with sodium oxybate.
- Sedative hypnotics Drug interaction studies in healthy adults with sodium oxybate (single dose of 2.25 g) and lorazepam (single dose of 2 mg) and zolpidem tartrate (single dose of 5 mg) demonstrated...
- Increased sleepiness was observed after concomitant administration of sodium oxybate (2.25 g) and lorazepam (2 mg).
- Tramadol A drug interaction study in healthy adults with sodium oxybate (single dose of 2.25 g) and tramadol (single dose of 100 mg) demonstrated no pharmacokinetic/pharmacodynamic interaction.
- When higher doses up to 9 g/day of sodium oxybate are combined with higher doses of opioids (within the recommended dose range) pharmacodynamic interactions associated with symptoms of CNS...
Pregnancy
Avoid.
Hepatic impairment
Manufacturer advises caution (risk of increased exposure). Dose adjustments Manufacturer advises initial dose reduction of 50%.
Renal impairment
Consider reducing sodium intake (contains 0.18 g Na + per gram of sodium oxybate). M
Medicinal forms
Clinical governance
**Author:** MedNext Clinical Team. **Clinical reviewer:** Dr Shameer Deen, MBBS, MS, MRCS. **Sources:** BNF, Indian Pharmacopoeia, CIMS India. **Correction:** Report errors at support@mednext.academy.
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