WARNING

Sodium oxybate, also known as gamma-hydroxybutyrate (GHB), is a central nervous system depressant used medically to treat narcolepsy-associated cataplexy and excessive daytime sleepiness. However, it carries several risks, including:

• Addiction: Sodium oxybate has a high potential for abuse and addiction, leading to dependence and withdrawal symptoms upon discontinuation.
• Respiratory depression: High doses or concurrent use with other depressants like alcohol or opioids can lead to severe respiratory depression, which can be fatal.
• Central nervous system depression: Sodium oxybate can impair cognitive and motor function, leading to dizziness, confusion, and impaired judgment.
• Cardiovascular effects: It can cause changes in heart rate and blood pressure, potentially leading to cardiovascular complications.
• Gastrointestinal effects: Nausea, vomiting, and diarrhea are common side effects of sodium oxybate.
• Potential for overdose: Due to its potency and rapid onset of action, overdoses can occur easily, leading to coma, respiratory arrest, and death.
• Interactions with other drugs: Sodium oxybate can interact dangerously with other substances, especially alcohol and other central nervous system depressants, increasing the risk of adverse effects.

Because of these risks, sodium oxybate is tightly controlled and typically only prescribed under close medical supervision, with strict monitoring for adverse effects. It’s crucial for patients to follow their healthcare provider’s instructions carefully and to be aware of the potential dangers associated with its use.

Why is this medication prescribed?

Sodium oxybate, also known as gamma-hydroxybutyrate (GHB), is prescribed for the treatment of two main conditions:

• Narcolepsy: Sodium oxybate is approved for the treatment of cataplexy and excessive daytime sleepiness associated with narcolepsy. Narcolepsy is a chronic neurological disorder characterized by excessive daytime sleepiness and sudden loss of muscle tone (cataplexy).
• Fibromyalgia: In some cases, sodium oxybate may also be prescribed off-label for the management of fibromyalgia, a disorder characterized by widespread musculoskeletal pain, fatigue, and other symptoms.

How should this medicine be used?

Here are some general guidelines for its use:

• Dosage: The dosage of sodium oxybate varies depending on the individual’s condition, response to treatment, and other factors. It is typically taken in two doses: one at bedtime and the second 2.5 to 4 hours later during the night.
• Administration: Sodium oxybate is usually taken orally in the form of an oral solution. It should be taken on an empty stomach at least 2 hours after eating.
• Titration: The initial dosage of sodium oxybate is usually low and gradually increased over time to minimize side effects and maximize effectiveness. This process is called titration and is typically done under the supervision of a healthcare provider.
• Safety precautions: Sodium oxybate has a high potential for abuse and addiction, so it’s essential to store it securely and take it only as prescribed. It should not be used with alcohol or other central nervous system depressants.
• Monitoring: Regular follow-up appointments with the prescribing healthcare provider are important to monitor the individual’s response to treatment, adjust the dosage if needed, and address any concerns or side effects.
• Discontinuation: Sodium oxybate should not be stopped suddenly without consulting a healthcare provider, as this can lead to withdrawal symptoms. It should be discontinued gradually under medical supervision if needed.

Overall, sodium oxybate can be an effective treatment for narcolepsy and, in some cases, fibromyalgia when used appropriately under the guidance of a healthcare professional.

Other uses for this medicine

Regarding other uses for sodium oxybate, it’s primarily prescribed for narcolepsy due to its effectiveness in managing symptoms such as excessive daytime sleepiness and cataplexy (sudden loss of muscle tone). It’s not commonly used for other conditions. However, in some cases, healthcare providers may prescribe it off-label for conditions such as fibromyalgia or chronic pain, although the evidence supporting its efficacy for these conditions is limited.

What special precautions should I follow?

As for special precautions to follow when using sodium oxybate, here are some key points:

• Strict adherence to prescribed dosage: Take sodium oxybate exactly as prescribed by your healthcare provider. Do not increase or decrease the dosage without consulting them first.
• Avoid alcohol and other CNS depressants: Do not consume alcohol or other drugs that depress the central nervous system while taking sodium oxybate, as this can increase the risk of severe respiratory depression, coma, or death.
• Storage: Store sodium oxybate securely in a locked container to prevent unauthorized access, as it has a high potential for abuse.
• Driving and operating machinery: Sodium oxybate can impair cognitive and motor function, so avoid driving, operating heavy machinery, or engaging in activities that require mental alertness until you know how it affects you.
• Pregnancy and breastfeeding: Inform your healthcare provider if you are pregnant, planning to become pregnant, or breastfeeding, as the safety of sodium oxybate during pregnancy and lactation has not been established.
• Medical conditions: Inform your healthcare provider about any medical conditions you have, especially breathing problems, kidney disease, liver disease, psychiatric disorders, or a history of substance abuse, as sodium oxybate may not be suitable or may require special monitoring in these cases.

By following these precautions and working closely with your healthcare provider, you can minimize the risks associated with sodium oxybate use and maximize its potential benefits for your specific condition.

What special dietary instructions should I follow?

Regarding special dietary instructions for sodium oxybate:

• Empty stomach: Sodium oxybate should be taken on an empty stomach at least 2 hours after eating. Avoid consuming food or beverages, especially those containing protein, before taking sodium oxybate.
• High-fat meals: High-fat meals may delay the absorption of sodium oxybate and reduce its effectiveness. Try to avoid consuming large amounts of fatty foods before taking sodium oxybate.

What should I do if I forget a dose?

If you forget a dose of sodium oxybate, take it as soon as you remember, unless it is almost time for your next scheduled dose. In that case, skip the missed dose and continue with your regular dosing schedule. Do not take a double dose to make up for a missed one. If you are unsure about what to do, consult your healthcare provider or pharmacist for guidance.

What side effects can this medication cause?

Sodium oxybate, like any medication, can cause side effects, although not everyone experiences them. Common side effects of sodium oxybate may include:

• Nausea and vomiting: These gastrointestinal symptoms are among the most common side effects of sodium oxybate.
• Dizziness: Sodium oxybate can cause dizziness, which may impair your ability to perform tasks such as driving or operating machinery.
• Headache: Some individuals may experience headaches while taking sodium oxybate.
• Sleep disturbances: Sodium oxybate is a central nervous system depressant and may affect sleep patterns, leading to insomnia or disrupted sleep.
• Fatigue: Despite being used to treat excessive daytime sleepiness, some individuals may experience fatigue as a side effect of sodium oxybate.
• Drowsiness: While sodium oxybate is often taken at night to improve sleep, excessive drowsiness can occur, especially if the dosage is too high.
• Tremors: Shaking or tremors may occur as a side effect of sodium oxybate.
• Sweating: Some individuals may experience increased sweating while taking sodium oxybate.
• Decreased appetite: Sodium oxybate can sometimes reduce appetite, leading to weight loss in some cases.
• Mood changes: Changes in mood, including depression, anxiety, or agitation, have been reported as side effects of sodium oxybate.
• Muscle pain: Some individuals may experience muscle pain or weakness while taking sodium oxybate.

It’s important to note that more serious side effects can occur, although they are less common. These may include respiratory depression, hallucinations, confusion, memory problems, and allergic reactions. If you experience any concerning or severe side effects while taking sodium oxybate, it’s essential to contact your healthcare provider promptly. They can evaluate your symptoms and determine the appropriate course of action.

What should I know about storage and disposal of this medication?

Storage:

• Keep in a secure location: Store sodium oxybate in a locked cabinet or container to prevent unauthorized access, as it has a high potential for abuse and addiction.
• Controlled temperature: Store sodium oxybate at room temperature away from heat, moisture, and direct light.
• Out of reach of children and pets: Ensure that sodium oxybate is stored out of the reach of children and pets, as even small doses can be dangerous or fatal.
• Keep the container tightly closed: Close the container tightly after each use to prevent spills or accidental ingestion.

Disposal:

• Follow disposal instructions: Dispose of unused or expired sodium oxybate as instructed by your healthcare provider or pharmacist. Do not flush medications down the toilet unless specifically instructed to do so.
• Drug take-back programs: Many communities offer drug take-back programs or special disposal facilities for medications. Check with your local pharmacy, law enforcement agency, or healthcare provider for information on safe disposal options in your area.

In case of emergency/overdose

In case of emergency or overdose of sodium oxybate:

• Seek medical help immediately: If you suspect an overdose of sodium oxybate or experience symptoms such as severe drowsiness, difficulty breathing, loss of consciousness, or seizures, seek emergency medical attention right away.
• Contact poison control: You can also contact your local poison control center at 1-800-222-1222 for guidance on what to do in case of an overdose.

What other information should I know?

• Avoid alcohol and other CNS depressants: Do not consume alcohol or other drugs that depress the central nervous system while taking sodium oxybate, as this can increase the risk of respiratory depression, coma, or death.
• Follow dosage instructions: Take sodium oxybate exactly as prescribed by your healthcare provider. Do not increase or decrease the dosage without consulting them first.
• Keep appointments: Attend all scheduled follow-up appointments with your healthcare provider to monitor your response to treatment and adjust the dosage if needed.
• Inform healthcare providers: Inform other healthcare providers, including dentists and emergency medical personnel, that you are taking sodium oxybate before undergoing any medical procedures or receiving emergency treatment.
• Do not share medication: Do not share sodium oxybate with others, even if they have similar symptoms or conditions. Sharing prescription medication is illegal and can be dangerous.

By following these guidelines and staying informed about the safe use, storage, and disposal of sodium oxybate, you can help minimize the risks associated with this medication and ensure its effectiveness in treating your condition.