What is sodium oxybate (GHB) used for in narcolepsy and what are safety concerns?

• A. Used for cataplexy/narcolepsy in select patients; sedative at night; potential for abuse; tightly regulated with monitoring.
• B. Cures narcolepsy.
• C. Over-the-counter sleep aid.
• D. Used for insomnia as a first-line therapy.

Answer: (A)

Sodium oxybate is used in narcolepsy with cataplexy for a specific subset of patients because it helps normalize nighttime sleep and, as a result, reduces daytime sleepiness and the frequency/severity of cataplexy episodes. It works as a central nervous system depressant at night, so it is taken in two doses (before bedtime and a later dose during the night) to sustain benefits across the sleep period. Because of its potential for abuse and dependence, it is tightly regulated and requires monitoring through a restricted access program to prevent misuse. It is not a cure, not an over-the-counter sleep aid, and not a first-line therapy for insomnia. Safety concerns include risk of abuse and dependence, sedation and respiratory depression—especially if alcohol or other sedatives are used—along with possible sleep-related complex behaviors like sleepwalking, amnesia, or engaging in activities during sleep. The formulation also carries a high sodium load, which can affect blood pressure and fluid balance, so caution is needed in patients with cardiovascular or renal issues.