What is Xyrem Uses, warnings & interactions
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Xyrem (sodium oxybate) is a legal prescription form of the street drug gamma hydroxybutyrate (GHB) that is manufactured by Jazz Pharmaceuticals, Inc. It was approved in 2002 by the U.S. Food and Drug Administration (FDA) to treat narcolepsy and sudden episodes of muscle weakness. It is considered a Schedule III controlled substance as it has a high potential for abuse.
If your doctor has prescribed Xyrem to you, you may want to know more about what it is and how it works. Here we’ll explain what Xyrem is used for, how it works, its side effects, and more.
What is Xyrem used for?
Xyrem is a central nervous system depressant that is approved in the treatment of cataplexy (sudden muscle weakness while awake) or excessive daytime sleepiness (EDS) in patients 7 years of age and older with narcolepsy. Xyrem is available only from a certified pharmacy under a special program called Xyrem REMS Program. Your doctor must be registered in the program to prescribe Xyrem.
How does Xyrem work?
Xyrem increases how long you spend in REM sleep. This helps decrease symptoms of narcolepsy while you are awake. It is thought to act on GHB and GABA-B receptors to help regulate sleep cycles, emotion, and memory.
What are the most commonly prescribed doses of Xyrem?
- 0.5g/ml oral solution
Before taking Xyrem
Before beginning Xyrem, tell your doctor about your medical conditions, including:
- History of substance abuse.
- Sleep disorders such as sleep apnea (short periods of not breathing while asleep)
- Lung problems or breathing problems
- Depression or other mental disorders
- Liver or kidney problems
- Salt restriction
- Heart failure or high blood pressure
- Are pregnant, plan on becoming pregnant, or are breastfeeding
How to take Xyrem
- Read the Full Prescribing Information, Drug Information, and Medication Guide that comes with Xyrem.
- Take Xyrem exactly as your doctor prescribes it. Do not change your dose or stop taking this medication without talking with them first.
- Xyrem can cause you to fall asleep quickly without feeling drowsy. Most people fall asleep within 15 minutes of taking this medication while some fall asleep within 5 minutes.
- Xyrem is taken as 2 divided doses at bedtime. You take the first dose of Xyrem at least 2 hours after eating while you are already in bed. You should lie down immediately after taking Xyrem. The second dose of Xyrem is taken 2.5 to 4 hours later. If you miss the second dose of Xyrem, skip it and wait until the next night to take Xyrem.
You should not take Xyrem if you drink alcohol or take sedative hypnotics. You should also avoid Xyrem if you have a rare disorder called succinic semialdehyde dehydrogenase deficiency.
- You should be extremely careful using Xyrem with other CNS depressants as it increases the risk of serious side effects.
- When first starting Xyrem, use caution when performing hazardous activities that require concentration and focus within the first 6 hours of dosing until you know how it will affect you.
- Adult patients and caregivers of pediatric patients should notify the doctor if they notice an increase in suicidal thoughts and behaviors.
- Monitor and evaluate episodes of sleepwalking.
- Use with caution in patients with high blood pressure, heart failure, or kidney dysfunction.
Xyrem drug interactions
When Xyrem is taken with other medications, it may change the way they work or increase the frequency and severity of side effects. You should discuss with your doctor whether any of the prescription drugs, over-the-counter medications, vitamins, and herbal supplements you take may interact with this medication, including:
- Divalproex sodium
- Other CNS depressants such as antidepressants, benzodiazepines, sleep medicines, opioids, seizure medications, and muscle relaxers
Xyrem side effects
Some common side effects of Xyrem include:
- Loss of appetite
- Weight loss
- Dry mouth
Xyrem can sometimes cause more serious side effects, including:
- Serious allergic reactions (hives, angioedema, and shortness of breath)
- Increased risk of suicidal thoughts and behaviors
- Mental/mood changes such as anxiety, hallucinations, and psychosis
- Worsening symptoms of hypertension and heart failure
Contact your healthcare professional for medical advice about any possible side effects you experience while taking Xyrem. You can report your adverse reactions to the FDA at 1-800-FDA-1088 or www.fda.gov/medwatch.
Your doctor can prescribe other medications if Xyrem is not right for you. They will vary by factors such as side effects and cost. Some FDA-approved alternatives to Xyrem include:
- Wakix (pitolisant)
- Xywav (calcium/magnesium/potassium/sodium oxybates)
- Sunosi (solriamfetol)
- Provigil (modafinil)
- Nuvigil (armodafinil)
Can you take Xyrem while you are pregnant or breastfeeding?
Based on animal studies, there is a risk of fetal harm if Xyrem is used while pregnant. Xyrem should be only used in pregnant women if the possible benefits outweigh the possible risks to the fetus. GHB is found in breast milk when Xyrem is taken by mouth. There is no information on the risk to a breastfed infant or on milk production in nursing mothers. You should always discuss the risks and benefits of any medication with your healthcare provider if you are pregnant, plan on becoming pregnant, or are breastfeeding.
Will you have withdrawal symptoms if you suddenly stop taking Xyrem?
Yes, you should not suddenly stop taking Xyrem as it may cause you to have withdrawal symptoms. Cataplexy (sudden muscle weakness) attacks may return as well as other symptoms such as insomnia, headache, hallucinations, dizziness, and anxiety.
Can you drink alcohol while taking Xyrem?
No, Xyrem is a CNS depressant so you should not drink alcohol while taking this medication. It can increase your chance of side effects such as confusion as well as serious, life-threatening effects such as trouble breathing (respiratory depression).
Is Xyrem a narcotic?
Xyrem is not a narcotic, but it is a controlled substance that has a high potential for abuse. Before prescribing this medication, your healthcare provider will screen you for alcohol or substance abuse and other medical conditions that may prohibit the use of Xyrem.
What is the cost of Xyrem?
The average cost for 180ml of Xyrem 0.5g/ml is around $5,800.
How should you store Xyrem?
You should store Xyrem in its original bottle before mixing it with water. After mixing, store it in a container with a child-resistant cap for up to 24 hours. Keep Xyrem at room temperature between 68°F to 77°F (20°C to 25°C). After taking Xyrem, pour any remaining medication down the drain, cross out the label on the bottle, and place the bottle in the trash.
Is there a generic for Xyrem?
Currently, there is no generic Xyrem available on the market. However, you can still save on brand-name drugs like Xyrem through NiceRx if eligible for assistance.