Ch3

23 CX-516 (ampalex)

22 Mazindol

23 CX-516 (ampalex)

Caffeine, 1, the most widely used natural psychostimulant can combat drowsiness, fatigue and impaired alertness but has limited efficacy and tolerates with excessive use which also causes withdrawal headache. Concerns regarding abuse liability and cardiovascular side effects limit the use of stimulants.62 Agents currently approved for use in the treatment of narcolepsy and hypersomnia are shown in Table 2. Two new drugs, modafinil, 11, and sodium oxybate (g-hydroxybutyric acid, GHB, 12) have been approved for the treatment of narcolepsy. Sodium oxybate has also been filed for the treatment of cataplexy. The efficacy of tricyclic antidepressants (TCAs) in treating cataplectic symptoms was reported in the 1960s and monoamine oxidase inhibitors (MAOIs) were also reported effective but with serious side effect potential. These compounds were effective in suppressing REM sleep with a rapid onset of action in stark contrast to delayed time (weeks) for antidepressant efficacy. TCAs typically show anticataplectic efficacy below their antidepressant doses.63 Drugs used to treat cataplexy are: fluoxetine, 6, sodium oxybate, 12, atomoxetine, 13, venlafaxine, 14, imipramine, 15, desipramine, 16, protriptylene, 17, chlorimipramine, 18, and viloxazine, 19.

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