If use of these CNS depressants in combination with XYREM is required, dose reduction or discontinuation of one or more CNS depressants (including XYREM) should be considered. The concurrent use of XYREM with other CNS depressants, including but not limited to opioid analgesics, benzodiazepines, sedating antidepressants or antipsychotics, sedating anti-epileptic drugs, general anesthetics, muscle relaxants, and/or illicit CNS depressants, may increase the risk of respiratory depression, hypotension, profound sedation, syncope, and death. WARNINGS AND PRECAUTIONS Central Nervous System Depression patients with succinic semialdehyde dehydrogenase deficiency.combination with sedative hypnotics or alcohol. 1ĬONTRAINDICATIONS XYREM is contraindicated for use in: The hypersomnolence and/or MSLT findings are not better explained by other causes such as insufficient sleep, obstructive sleep apnea, delayed sleep phase disorder, or the effect of medication or substances or their withdrawal.If the CSF hypocretin-1 concentration is tested at a later stage and found to be either 110 pg/mL or less, or less than one-third of mean values obtained in normal subjects with the same assay, then the disorder should be reclassified as narcolepsy type 1.Cerebrospinal fluid (CSF) hypocretin-1 concentration is either not measured, or found to be either greater than 110 pg/mL, or greater than one-third of mean values obtained in normal subjects with the same standardized assay.If cataplexy develops later, then the disorder should be reclassified as narcolepsy type 1.A SOREMP (within 15 min of sleep onset) on the preceding nocturnal polysomnogram (PSG) may replace one of the SOREMPs on the MSLT.A mean sleep latency of 8 minutes or less and at least 2 sleep onset rapid eye movement periods (SOREMPs) are found on a multiple sleep latency test (MSLT).The patient has daily periods of irrepressible need to sleep or lapses into daytime sleep, occurring for at least 3 months.The following criteria should be met for narcolepsy type 2 patients. How narcolepsy type 2 is diagnosed according to the American Academy of Sleep Medicine (AASM) ICSD-3 criteria.
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