Methylphenidate and narcolepsy: new indication. When modafinil fails

(1) Narcolepsy (daytime bouts of drowsiness) is sometimes associated with cataplexy, and can be incapacitating. The best-assessed treatment is modafinil, which has no demonstrated efficacy on cataplexy. (2) After many years of off-license use in the treatment of narcolepsy, methylphenidate is now licensed for this indication in France. (3) According to the results of our literature search, which includes a clinical expert report from Novartis Pharma, the file on methylphenidate in narcolepsy is mainly based on "clinical experience": only three case series, totalling fewer than 200 patients, have been published. (4) These non comparative studies suggest an effect of high dose methylphenidate on daytime drowsiness and cataplexy. (5) The adverse effects of methylphenidate are those of amphetamine psychostimulants, i.e. mainly neuropsychological disorders, cardiovascular effects, loss of appetite and a limited risk of excessive use by some patients.