307 Therapeutic Potential of Opioids in Narcolepsy Type 1 Table 1: Systematic literature review results Name (year) Type of study Type of opioid Subject groups Outcome Remarks Harper [131] Case report Codeine N=1 Narcolepsy with cataplexy Patient report (up to 240 mg codeine for 11 years followed by pentazocine): Full remission of all narcolepsy symptoms (sleepiness, cataplexy, hypnagogic hallucinations and sleep paralysis) Opioid indication was the combination of pain and Crohn’s disease Fry et al [130] Open label trial, RCT and case series Codeine Case series: N=27 Narcolepsy with cataplexy Open label: N=5 Narcolepsy with cataplexy RCT: N=8 Narcolepsy with cataplexy Case series (30-180 mg codeine): 18/27 people continued codeine until publication (usage 10-33 months) and 9/27 discontinued (usage < 6 weeks). 7/27 discontinued because of lack of efficacy, and 2/27 because of worsening of pre-existing depression and skin rash. 18/27 individuals self-reported improvement of EDS and amnestic episodes. Open label (150 mg codeine for 2 weeks): Self-reported improvement of EDS (5/5 participants), decrease of cataplexy attack frequency (3/5 subjects) and periods of amnestic automatic behaviour (2/5 participants). Insignificant increase in MWT sleep latency. RCT (randomised crossover 1 week codeine and 1 week placebo): Significant decrease in reported number of naps during the codeine week compared to placebo, but not in objective sleepiness measures (i.e., PSG and EEG-measured daytime alertness within a laboratory environment). Opioid was initiated for its effects on narcolepsy symptom severity. Stimulants were discontinued for at least 1 and 2 weeks for the open label study and RCT, respectively. No details were provided on the extent of self-reported improvement in the 3 study components. Codeine dosage in the RCT was not mentioned. 10
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