309 Therapeutic Potential of Opioids in Narcolepsy Type 1 Table 1: Continued. Name (year) Type of study Type of opioid Subject groups Outcome Remarks Donjacour et al [126] Case report Oxycodone and buprenorphine N=1 Narcolepsy with cataplexy Patient 1 (10-60 mg oxycodone for over 2 weeks followed by 60 days buprenorphine patches): Full remission of cataplexy attacks despite the presence of potential triggers when using buprenorphine (compared to at least 1 attack per week before opioid use, and 4-5 attacks per day after discontinuing). Opioid indication was a spine fracture. No information was provided on possible effects on other narcolepsy symptoms and anticataplectic effects were only present when using buprenorphine and not oxycodone. Sodium oxybate (4.5 g per night) was taken before and discontinued during and just after the period of opioid use, explaining the difference in cataplexy frequency before and after opioid use. Thannickal et al [125] Postmortem case series Morphine N=2 People with narcolepsy with cataplexy N=5 Heroin addicts People with narcolepsy (chronic morphine and no opioid treatment): The individual taking opioids was reclassified as narcolepsy without cataplexy 8 years after initiating morphine. The individual taking morphine had 16% of normal hypocretinproducing neurons, compared to the individual not taking opioids, with 3% of normal hypocretin-producing neurons. Opioid addicts (amongst others taking heroin): Opioid addicts had on average 54% more hypocretin-producing neurons than controls. Daily dosages are reported. EDS = excessive daytime sleepiness; EEG = electroencephalography; MWT = maintenance of wakefulness test; PSG = polysomnography; RCT = randomised controlled trial 10
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