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Improvement in Cataplexy and Daytime Somnolence in Narcoleptic Patients with Venlafaxine XR Administration
Rafael J Selin-Pascual M.D
Narcoleptic patients have been treated with stimulants for sleep attacks as well as day-
time somnolence,without effects on cataplexy,while this symptoms has been treated
with antidepressants,that do not improve daytime somnolence or sleep attacks.
Venlafaxine inhibits the reuptake of norepinephrine,serotonin,and to lesser extent
dopamine,and also suppressed REM sleep.Because some of the symptoms of nar-
colepsy may be related to REM sleep deregulation,venlafaxine was studied in this sleep
disorder.Six narcoleptic patients were studied,they were drug-free and all of them had
daytime somnolence and cataplexy attacks.They underwent the following sleep proce-
dure:one acclimatization night,one baseline night,followed by multiple sleep latency
test.After two days of the sleep protocol,patients received 150 mg of venlafaxine XR
at 08:00 h.Two venlafaxine sleep nights recordings were performed.Patients were fol-
lowed for two months with weekly visits for clinical evaluation.Sleep log and analog-
visual scale for alertness and somnolence were performed on each visit.Venlafaxine XR
was increase by the end of the first month to 300 mg/day.Sleep recordings showed that
during venlafaxine XR two days acute administration the following findings:increase in
wake time and sleep stage 1,while REM sleep time was reduced.No changes were
observed in the rest of sleep architecture variables.Cataplexy attacks were reduced
since the first week of venlafaxine administration.Daytime somnolence was reduced
also,but until the 7th week and with 300 mg/day of venlafaxine XR administration.Side
effects were mild and they were nausea,hiporexia and anxiety.Venlafaxine XR admin-
istration improved cataplexy with mild effect on somnolence,that could be explained
because at low doses venlafaxine XR acts like selective serotonin reuptake inhibitor and
only at high doses the effects on the norepinephrine reuptake is observed.Double blind
protocols with venlafaxine are needed in order to determine the utility of venlafaxine XR
in narcolepsy.(Sleep and Hypnosis 2002;4(1):22-25)
| Keywords: Narcolepsy, enlafaxine XR, REM sleep, cataplexy |
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