This series of bite-sized episodes will take you through the latest information regarding disrupted nighttime sleep and its relationship to cardiovascular risk, plus patient/clinician preferences regarding the treatment of narcolepsy with sodium oxybates.
BID Oxybate to QHS: What Clinicians and Patients Need to Know
BID Oxybate to QHS: What Clinicians and Patients Need to Know
Welcome to CME on ReachMD. This episode is part of our MinuteCME curriculum.
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This is CME on ReachMD, and I’m Dr. Michael Thorpy. Here with me today is Dr. Clete Kushida.
Let’s talk a bit about switching therapies. We know that patients with narcolepsy are often on various types of medications for their narcolepsy, and we may want to change patients from one type to another. In particular, now that we have 3 forms of oxybate, maybe we want to change patients from one form of oxybate to another. So how do you discuss this with your patients when they need to change a medication? And how do you transition them from one therapy to another?
Yes. Thanks, Michael. So one of the struggles with the patients that I see that have narcolepsy is oftentimes they have to set an alarm to wake up in the middle of the night in order to take a second dose of a sodium oxybate. And that can be a little bit challenging, especially if they’re younger patients who tend to have a large sleep debt anyway. So they’ll want to have a lot of good consolidated sleep, especially in the first half of the night. So for them to wake up after about 2 to 4 hours before they sleep can be a challenge. So that’s definitely an opportunity to be able to transition them to a once-nightly sodium oxybate, Lumryz. And by doing so, that should help to minimize their ability to have to wake up in the middle of the night to take the second dose. And in addition, there’s also the risk of, especially with older individuals, waking up in the middle of the night and then they would become a fall risk. They would also have a little bit maybe of sleep-related confusion coming out of deep sleep in order to make sure that they take the right dose. So for these reasons, having an alternative of a once-nightly sodium oxybate formulation in the form of Lumryz definitely is an advantage.
Now we had discussed earlier that also in terms of sodium content for both Xyrem as well as Lumryz, it is higher than that which is found in Xywav. So if there is a patient that has high blood pressure that’s uncontrolled, also possibility of congestive heart failure, and lastly, if they also, you know, might have hypertension-related kidney failure, those would be reasons to maybe consider a low-sodium preparation such as Xywav. But for the vast majority of patients, that should not be a major consideration, because when we’ve looked at about 20 years’ worth of data, there did not appear to be a direct link between the use of sodium oxybate and cardiovascular risk. So, you know, for the majority of people, it should not be a concern of those with narcolepsy in terms of their cardiovascular risk if they were to take Xyrem or Lumryz as opposed to Xywav.
Good. Thank you for that, Clete.
We have the 3 forms of oxybate, and in general, the dosing of it goes from 4.5 g to 6 g to 7.5, and the maximum dose is 9 g. And with the Xyrem and the Xywav, it generally is taken in 2 divided doses. However, with the Lumryz, it’s only once a night, as you said. And in general, my understanding is that patients can just change directly over to the once-nightly. So if somebody’s on 9 g of of Xyrem, if they were to change to once nightly, they would just start immediately with 9 g of the of the Lumryz. If somebody is starting, of course, from scratch, then they would need to titrate up to that dose. With the Xywav, the study showed that they could take 1 dose at night in some cases, but if you do take 1 dose at night of the Xywav, say, for example, a patient can’t often waken to take that second dose, then the maximum dose should not exceed 6 g.
Well, this was a brief but great discussion. Unfortunately, our time is up. Thank you for tuning in.
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In accordance with the ACCME Standards for Integrity and Independence, Global Learning Collaborative (GLC) requires that individuals in a position to control the content of an educational activity disclose all relevant financial relationships with any ineligible company. GLC mitigates all conflicts of interest to ensure independence, objectivity, balance, and scientific rigor in all its educational programs.
Michael J. Thorpy, MD
Director, Sleep‐Wake Disorders Center
Montefiore Medical Center
Professor of Neurology, Albert Einstein College of Medicine
Consulting/Advisory Board: Alkermes, Avadel Pharmaceuticals, Axsome, Balance Therapeutics, Eisai Pharmaceuticals, Harmony Biosciences, LLC, Idorsia Pharmaceuticals, Jazz Pharmaceuticals, NLS Pharmaceuticals, Suven Life Sciences Ltd., Takeda Pharmaceutical Co., Ltd, XW Pharma
Clete A. Kushida, MD, PhD
Professor, Division Chief
Medical Director, Sleep Medicine
Stanford University School of Medicine
Consulting Fees: XW Pharma
Research: Avadel Pharmaceuticals
Ann Marie Morse, DO
Director, Child Neurology and Pediatric Sleep Medicine
Geisinger Medical Center
Janet Weis Children’s Hospital
Consulting Fees: Alkermes, Avadel Pharmaceuticals, Jazz Pharmaceuticals, Harm Reduction Therapeutics, Takeda Pharmaceutical Co.
Research: Geisinger Health Plan, Jazz Pharmaceuticals, NIH, UCB,
Other: Damm Good Sleep, LLC
Franz H. Messerli, MD
Professor of Medicine
University of Bern
No relevant relationships reported.
- Jennifer Brutsche has nothing to disclose.
- Cindy Davidson has nothing to disclose.
- Elizabeth Lurwick has nothing to disclose.
- Andrea Mathis has nothing to disclose.
- Tim Person has nothing to disclose.
- Robert Schneider, MSW, has nothing to disclose.
- Peer Review, if applicable, Brian P. McDonough, MD, FAAFP, has nothing to disclose.
After participating in this educational activity, participants should be better able to:
- Evaluate the efficacy and safety of available sodium oxybate therapies in improving outcomes for patients with narcolepsy
- Describe the quality-of-life impact and potential cardiovascular effects of disrupted nighttime sleep on patients with narcolepsy
- Compare and contrast various federal and medical society guidelines, as well as clinical trial data, as to what constitutes appropriate sodium intake
- Define the counseling processes by which patients and clinicians can communicate about goals of treatment and implement shared decision-making as to the therapeutic management approach
This activity is designed to meet the educational needs of sleep medicine specialists, psychiatrists, and neurologists.
In support of improving patient care, Global Learning Collaborative (GLC) is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC) to provide continuing education for the healthcare team.
Global Learning Collaborative (GLC) designates this enduring activity for a maximum of 1.0 AMA PRA Category 1 Credit™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
Global Learning Collaborative (GLC) designates this activity for 1.0 nursing contact hour. Nurses should claim only the credit commensurate with the extent of their participation in the activity.
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This activity is supported by an independent educational grant from Avadel Pharmaceuticals.
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