If you have narcolepsy, your doctor may suggest Xyrem as a treatment option for symptoms of this condition.

Xyrem is a medication prescribed to treat the following narcolepsy symptoms in adults and some children:

For more information, see the “Is Xyrem used for narcolepsy?” section below.

Xyrem basics

Xyrem contains the active drug sodium oxybate. An active drug is an ingredient that makes a medication work. It belongs to a group of drugs called central nervous system (CNS) depressants.

Xyrem comes as a liquid solution that you swallow. It’s not available as a generic drug.

This article discusses Xyrem’s side effects, use for narcolepsy, dosages, and more.

Like most drugs, Xyrem may cause mild or serious side effects. The lists below describe some of the more common side effects that Xyrem may cause. These lists don’t include all possible side effects.

Keep in mind that side effects of a drug can depend on:

  • your age
  • other health conditions you have
  • other medications you take

Your doctor or pharmacist can tell you more about the potential side effects of Xyrem. They can also suggest ways to help reduce side effects.

Mild side effects

Here’s a short list of some of the mild side effects that Xyrem can cause. To learn about other mild side effects, talk with your doctor or pharmacist, or read Xyrem’s prescribing information.

Mild side effects of Xyrem that have been reported include:

In addition, the following mild side effects have been reported in children using Xyrem:

Mild side effects of many drugs may go away within a few days to a couple of weeks. But if they become bothersome, talk with your doctor or pharmacist.

Serious side effects

Serious side effects from Xyrem can occur, but they aren’t common. If you have serious side effects from Xyrem, call your doctor right away. But if you think you’re having a medical emergency, you should call 911 or your local emergency number.

Serious side effects of Xyrem that have been reported include:

* For more information about risk of misuse, see the “Can Xyrem be misused?” section below.
† For more information about this side effect, see the “Side effect focus” section below.

Suicide prevention

If you think someone is at immediate risk of self-harm or hurting another person:

  • Call 911 or your local emergency number.
  • Stay with the person until help arrives.
  • Remove any guns, knives, medications, or other things that may cause harm.
  • Listen, but don’t judge, argue, threaten, or yell.

If you or someone you know is considering suicide, get help from a crisis or suicide prevention hotline. Try the National Suicide Prevention Lifeline at 800-273-8255.

Side effect focus

Learn more about some of the side effects Xyrem may cause.

Boxed warnings

Xyrem has boxed warnings. A boxed warning is a serious warning from the Food and Drug Administration (FDA).

Risk of misuse. It’s possible to misuse Xyrem. (Misuse is sometimes called abuse.) Misuse of Xyrem can result in serious side effects, including coma or trouble breathing. In rare cases, it can even be fatal.

To learn more, see the “Can Xyrem be misused?” section below.

Risk of CNS depression. Xyrem depresses (slows down) activity in your CNS. This is called CNS depression. Even when you take Xyrem at doses prescribed by your doctor, the drug will cause this side effect. CNS depression can impair your motor skills, judgment, and thinking.

Due to the risk of CNS depression, you should not take Xyrem with alcohol. And you should not take Xyrem together with drugs called sedative hypnotics. These are a type of medication prescribed to treat certain sleep disorders.

In addition, combining Xyrem with other CNS depressants can lead to serious side effects, such as:

In rare cases, taking Xyrem with other CNS depressants may be fatal.

For more about sedative hypnotics and CNS depressants, see the “What should be considered before taking Xyrem?” section below.

What might help

Due to the risks of misuse and CNS depression, only certain healthcare professionals with special certification may prescribe Xyrem. And only a specially licensed pharmacy may fill Xyrem prescriptions.

These restrictions apply to Xyrem because the drug is prescribed under a program called a risk evaluation and mitigation strategy (REMS). The Food and Drug Administration (FDA) can require certain drugs to have a REMS so that they’re prescribed only when their benefits outweigh their risks. To learn more, see the “Can Xyrem be misused?” section below.

Due to Xyrem’s effects on the CNS, certain activities can be dangerous after you take a dose of this drug. You should wait at least 6 hours after a dose before taking part in activities that require you to be fully awake. Examples include driving a car and operating machinery.

Breathing problems, including sleep apnea

Treatment with Xyrem can cause breathing problems, including sleep apnea. If you have existing breathing problems or sleep apnea, taking Xyrem may worsen your condition.

Certain people may be at higher risk of breathing problems if they take Xyrem, including:

  • people with obesity
  • males*
  • females* who have gone through menopause and aren’t taking hormone replacement therapy

With sleep apnea, your breathing stops and restarts while you’re sleeping. This side effect was rare in studies of Xyrem. But a few people in these studies had to stop taking Xyrem due to this side effect.

Symptoms of sleep apnea can include:

  • choking or gasping during sleep
  • having a headache upon waking up
  • snoring
  • feeling tired after sleeping

* In this article, we use the terms “male” and “female” to refer to someone’s sex assigned at birth. For information about the difference between sex and gender, see this article.

What might help

If you notice symptoms of sleep apnea or breathing problems while taking Xyrem, talk with your doctor. You should also contact your doctor if you have an existing breathing problem that worsens while you’re taking Xyrem. They can best advise you on whether it’s safe for you to continue using Xyrem. They can also recommend another treatment for your condition that may be better.

Abnormal dreams or unusual behaviors during sleep

Taking Xyrem may cause you to have abnormal dreams or unusual behaviors during sleep. These were among Xyrem’s most common side effects in studies.

Examples of unusual behaviors during sleep that the studies reported include:

  • sleepwalking
  • performing tasks, such as chores, in your sleep
  • eating in your sleep
  • talking in your sleep

For some people, these behaviors have led to injury.

What might help

While you’re taking Xyrem, notify your doctor right away if you notice abnormal dreams or unusual behaviors during sleep. They’ll likely want to examine your symptoms further. Your doctor may recommend that you stop taking Xyrem and can discuss alternative treatments with you.

Allergic reaction

Some people may have an allergic reaction to Xyrem. While allergic reaction wasn’t reported in studies of the drug, it has occurred in rare cases since the drug became available on the market.

Symptoms of a mild allergic reaction can include:

A more severe allergic reaction is rare but possible. Symptoms of a severe allergic reaction can include swelling under your skin, typically in your eyelids, lips, hands, or feet. They can also include swelling of your tongue, mouth, or throat, which can cause trouble breathing.

Call your doctor right away if you have an allergic reaction to Xyrem. But if you think you’re having a medical emergency, call 911 or your local emergency number.

Find answers to some commonly asked questions about Xyrem.

Is Xyrem used to treat insomnia, idiopathic hypersomnia, or fibromyalgia?

Xyrem is not approved by the Food and Drug Administration (FDA) to treat these conditions. Insomnia is a sleep disorder that causes difficulty falling or staying asleep. Idiopathic hypersomnia is a condition that causes you to feel excessive sleepiness during the day. And fibromyalgia is a condition that causes pain and a lack of energy.

But doctors may prescribe Xyrem off-label to treat these conditions. Off-label drug use means that a drug that’s been approved by the FDA for one purpose is used for a different purpose that has not been approved.

If you’d like to learn more about off-label uses of Xyrem, talk with your doctor or pharmacist.

Will Xyrem make me feel high? Does it have a risk of addiction or withdrawal?

Xyrem is unlikely to make you feel high. Feelings of euphoria weren’t reported in studies of the drug.

Xyrem does have a risk of addiction and dependence, which may cause withdrawal. To learn more, see the “Can Xyrem be misused?” section below.

If you have concerns about addiction and withdrawal caused by Xyrem, talk with your doctor.

What is a controlled substance, and does Xyrem fall in this category?

Yes, Xyrem is a controlled substance. Certain laws control the use of Xyrem to prevent possible misuse. Misuse occurs when a person uses a drug in a way other than how it’s prescribed. Misusing Xyrem can lead to serious side effects, including trouble breathing or coma. It can even be fatal in rare cases.

Xyrem is considered a Schedule III controlled substance. This type of controlled substance has an approved medical use but also has risks of misuse, dependence, and tolerance. With dependence, the body needs a drug to function normally. Tolerance means the body gets used to a drug and needs a higher dose for the same effect.

In addition, Xyrem is available only through certain prescribers and a specialty pharmacy. These restrictions apply to Xyrem because the drug is prescribed under a program called a risk evaluation and mitigation strategy (REMS). The FDA can require certain drugs to have a REMS so that they’re prescribed only when their benefits outweigh their risks.

To learn more about Xyrem and risk of misuse, see the “Can Xyrem be misused?” section below.

What is Xyrem’s half-life? Does it affect whether Xyrem shows up on a drug test?

A drug’s half-life is how long it takes for a person’s body to get rid of half a dose. Xyrem has a half-life of about 30 to 60 minutes. It takes a drug roughly four to five times its half-life to be mostly removed from the body. But this does not mean that the drug will no longer be detectable on a drug test.

Xyrem may show up on a drug test. This is because Xyrem is a form of gamma-hydroxybutyrate (GHB), which is an illegal drug. Be sure to bring your doctor’s prescription or note whenever you’re having a drug test. This can prove that you’re using Xyrem under the supervision of a doctor.

Can Xyrem cause long-term side effects?

It’s not known if Xyrem causes long-term side effects.

Certain side effects reported in studies of the drug are considered long-term conditions when they occur in people who aren’t taking Xyrem. Examples include depression and psychosis (loss of contact with reality). But it’s not known if these side effects are long term or whether they go away if you stop taking Xyrem.

Talk with your doctor or pharmacist if you’d like to learn more about Xyrem and its long-term side effects.

Does Xyrem cause weight gain?

No, Xyrem doesn’t cause weight gain. This side effect wasn’t reported in studies of the drug. In fact, weight loss was reported by some children taking Xyrem in these studies.

If you’re concerned about weight changes while taking Xyrem, talk with your doctor.

Xyrem is a medication prescribed to treat the following symptoms of narcolepsy:

  • Excessive daytime sleepiness (EDS). EDS is a sudden, overwhelming urge to sleep. It can make completing activities and tasks during the day difficult.
  • Cataplexy. With cataplexy, muscles can weaken or go completely limp without warning.

For this purpose, Xyrem may be used in adults and children ages 7 years and older.

Narcolepsy is a nervous system condition that causes abnormal sleep patterns. In addition to EDS and cataplexy, people with narcolepsy sometimes have “sleep attacks” (suddenly falling asleep). These can happen at any time, with no warning.

How Xyrem treats narcolepsy isn’t known. It’s thought that the drug affects certain chemicals in the brain, which helps to improve sleep quality and treat narcolepsy symptoms.

Your doctor will recommend the dosage of Xyrem that’s right for you. Below are commonly used dosages, but always take the dosage your doctor prescribes.

Form

Xyrem comes as a liquid solution that you swallow.

Recommended dosages

The recommended dosing schedule for Xyrem is as follows:

  1. Take one dose immediately before you go to bed.
  2. Take a second dose 2.5 to 4 hours later.

Questions about Xyrem’s dosage

Below are some common questions about Xyrem’s dosage.

  • What if I miss a dose of Xyrem? If you miss a Xyrem dose, skip the missed dose. You should never take two or more doses of Xyrem at one time.
  • Will I need to take Xyrem long term? If you and your doctor agree Xyrem is safe and working for you, you’ll likely take it long term.
  • How long does Xyrem take to work? Most people fall asleep within 15 minutes of taking a dose of Xyrem. Some fall asleep within 5 minutes of taking a dose.

Before you begin treatment with Xyrem, it’s important to discuss certain aspects of your health with your doctor. These include any medical conditions you have and any medications you take. This information helps them determine whether Xyrem is the right treatment option for you.

Interactions

Taking a medication with certain vaccines, foods, and other things can affect how the medication works. These effects are called interactions.

Before taking Xyrem, be sure to tell your doctor about all medications you take, including prescription and over-the-counter types. Also, describe any vitamins, herbs, or supplements you use. Your doctor or pharmacist can tell you about any interactions these items may cause with Xyrem.

Interactions with drugs or supplements

Xyrem can interact with several types of drugs. These drugs include:

Note: Because of possible interactions, your doctor will likely recommend that you don’t take Xyrem with certain drugs listed above.

Boxed warnings

Xyrem has boxed warnings. These are serious warnings from the Food and Drug Administration (FDA).

Xyrem’s boxed warnings include:

  • Risk of misuse. It’s possible to misuse Xyrem. (Misuse is sometimes called abuse.) Misuse of Xyrem can result in serious side effects, including coma or trouble breathing. It can even be fatal in rare cases. To learn more, see the “Can Xyrem be misused?” section below.
  • Risk of CNS depression. Xyrem depresses (slows down) activity in your CNS. This effect is called CNS depression. Even when you take Xyrem at doses prescribed by your doctor, the drug causes this side effect. CNS depression can impair your motor skills, judgment, and thinking. For more information, see the “What are Xyrem’s side effects?” section above.

Other warnings

Xyrem may not be right for you if you have certain medical conditions or other factors that affect your health. Talk with your doctor about your health history before you take Xyrem. Factors to consider include those discussed below.

Succinic semialdehyde dehydrogenase deficiency. Having a rare brain disorder called succinic semialdehyde dehydrogenase deficiency can cause Xyrem levels to build up in the body. This could result in serious side effects. As a result, having this disorder is considered a contraindication to taking Xyrem. This means that your doctor will not prescribe Xyrem if you have this disorder due to the risk of harm. Your doctor can suggest safer treatments for you instead.

Suicidal thoughts. In rare cases, Xyrem has caused suicidal thoughts or actions as a side effect. If you have or have had suicidal thoughts or behaviors, talk with your doctor before you begin taking Xyrem. Taking Xyrem could worsen these feelings. Your doctor can determine whether Xyrem is safe for you to take. For guidance on suicide prevention, see “Suicide prevention” above.

Depression. Depression or depressed mood are possible side effects of Xyrem. If you have depression, tell your doctor. Taking Xyrem could worsen your condition. Your doctor can determine whether Xyrem is safe for you to take.

Heart failure or high blood pressure. Xyrem contains a high amount of sodium. In people who have heart failure or high blood pressure, the drug may worsen their condition. For more information, see the “Ask a Pharmacist” section below.

Breathing or lung problems. Xyrem can cause lung-related side effects, such as decreased breathing rate and respiratory depression. If you have existing lung problems, you may have a higher risk of these side effects with Xyrem. Tell your doctor about any lung problems you have. This will help them determine whether Xyrem is safe for you to take.

Sleep apnea. Xyrem may cause sleep apnea. Taking Xyrem can worsen this condition in people who already have it. If you have sleep apnea, talk with your doctor. They can let you know whether Xyrem is safe for you to take.

Liver problems. If you have liver problems, your body may have trouble breaking down Xyrem after you take a dose. This can cause Xyrem levels to build up in your body, which may result in serious side effects. Before starting Xyrem treatment, tell your doctor about any liver problems you have. This will help them determine whether Xyrem is safe for you to take.

Allergic reaction. If you’ve had an allergic reaction to Xyrem or any of its ingredients, your doctor will likely not prescribe Xyrem. Ask them what other medications are better options for you.

Xyrem and alcohol

You should not take Xyrem with alcohol.

Xyrem works by depressing (slowing down) your central nervous system (CNS). This effect is referred to as CNS depression. CNS depression can impair your motor skills, thinking, and judgment.

Alcohol also depresses your CNS. As a result, combining alcohol and Xyrem can lead to serious side effects. These include trouble breathing or coma. In rare cases, it can be fatal.

If you’d like to drink alcohol, let your doctor know. They can suggest treatments for your narcolepsy symptoms other than Xyrem.

Pregnancy and breastfeeding

It’s not known whether it’s safe to take Xyrem while pregnant or breastfeeding.

If you’re pregnant or breastfeeding, or planning to become pregnant or breastfeed, talk with your doctor. They’ll discuss safe options for treating your narcolepsy symptoms.

Xyrem and Provigil (modafinil) may be prescribed to treat narcolepsy symptoms in adults. Xyrem may also be prescribed for this use in some children.

Provigil is a type of stimulant medication. It works by exciting your nervous system to release chemicals that make you feel more energetic. Xyrem isn’t a stimulant, so it works in a different way.

To find out more about these two medications, see this detailed comparison. Also, check with your doctor about which drug is right for your condition.

Don’t take more Xyrem than your doctor prescribes. Using more than this can lead to serious side effects.

Symptoms of overdose

In studies of Xyrem, there were only two reports of overdose. So it’s not clear exactly what the symptoms of Xyrem overdose are.

But Xyrem’s active drug, sodium oxybate, is a form of gamma-hydroxybutyrate (GHB). So it’s thought to cause overdose symptoms similar to those reported with GHB, which is an illegal drug.

Symptoms of GHB overdose include:

What to do in case you take too much Xyrem

Call your doctor if you think you’ve taken too much Xyrem. You can also call 800-222-1222 to reach the American Association of Poison Control Centers or use its online resource. But if you have severe symptoms, immediately call 911 or your local emergency number. Or go to the nearest emergency room.

Your doctor will explain how you should take Xyrem. They will also explain how much to take and how often. Be sure to follow your doctor’s instructions for administration of this drug.

Taking Xyrem

Xyrem comes as a liquid solution that you swallow.

Taking Xyrem with other drugs

Your doctor may suggest using Xyrem with other drugs to treat excessive daytime sleepiness resulting from narcolepsy. Examples include:

If you have questions about taking other drugs with Xyrem to treat symptoms of narcolepsy, talk with your doctor.

Should I take Xyrem with food?

No, you shouldn’t take Xyrem with food. You should wait at least 2 hours after eating before taking a dose of Xyrem.

Questions for your doctor

You may have questions about Xyrem and your treatment plan. It’s important to discuss all your concerns with your doctor.

Here are a few tips that might help guide your discussion:

  • Before your appointment, write down questions such as:
    • How will Xyrem affect my body, mood, or lifestyle?
  • Bring someone with you to your appointment if doing so will help you feel more comfortable.
  • If you don’t understand something related to your condition or treatment, ask your doctor to explain it to you.

Remember, your doctor and other healthcare professionals are available to help you. And they want you to get the best care possible. So, don’t be afraid to ask questions or offer feedback on your treatment.

Costs of prescription drugs can vary depending on many factors. These factors include what your insurance plan covers and which pharmacy you use.

If you have questions about how to pay for your prescription, talk with your doctor or pharmacist. You can also visit the Xyrem manufacturer’s website to see if it has support options.

And to learn more about saving money on prescriptions, check out this article.

Xyrem has a boxed warning about the risk of misuse.* Boxed warnings are serious warnings from the Food and Drug Administration (FDA).

With misuse, a person uses a drug in a way other than how it is prescribed. This can include taking more of a drug than a doctor instructed or taking a drug that’s prescribed to someone else. Xyrem misuse can result in serious side effects. This can include coma or trouble breathing. In rare cases, it can be fatal.

Xyrem is considered a Schedule III controlled substance. This type of controlled substance has an approved medical use but also has risks of misuse, dependence, and tolerance. With dependence, the body needs a drug to function normally. Tolerance means the body gets used to a drug and needs a higher dose for the same effect.

Before you begin treatment with Xyrem, tell your doctor if you have a history of substance use disorder. You may have a higher risk of dependence with Xyrem, which could increase your risk of misuse.

* Xyrem also has a boxed warning about risk of central nervous system depression. For more information about this side effect, see the “What are Xyrem’s side effects?” section above.

About the Xyrem REMS program

Because of Xyrem’s risk of misuse, only certain healthcare professionals with special certification may prescribe Xyrem. And only a specially licensed pharmacy may fill Xyrem prescriptions. You won’t be able to pick up Xyrem at your local pharmacy.

These restrictions apply to Xyrem because the drug is prescribed under a program called a risk evaluation and mitigation strategy (REMS). The FDA can require certain drugs to have a REMS so that they’re prescribed only when their benefits outweigh their risks.

Before your doctor can prescribe Xyrem, you must enroll in the Xyrem REMS program. You’ll need to complete documentation that you’re using the drug safely and only as your doctor instructs you to.

If you’d like to learn more about the Xyrem REMS program, talk with your doctor or pharmacist. You can also get information about the program by visiting the Xyrem REMS website or calling 866-997-3688.

If you’re considering treatment with Xyrem, ask your doctor questions about taking this drug. Knowing more about Xyrem can help you feel comfortable about the risks and benefits of this medication. Here are a few to help you get started:

  • What should I know about treatments for narcolepsy other than Xyrem?
  • Do I need to restrict my salt intake while taking Xyrem?
  • How will I know if it’s safe for me to drive while using Xyrem?
  • My job requires routine drug screening. Will Xyrem show up on a drug test?

You may also be interested in learning more about:

Q:

If I have heart failure, what should I know about taking Xyrem?

Anonymous

A:

It’s important to note that Xyrem has a high salt content. If you have heart failure, your doctor may suggest limiting your daily salt intake. This can help with symptoms of heart failure, including water retention. It can also help lower blood pressure.

The following lists how much salt is in certain Xyrem doses.

  • Xyrem 3 grams (g) has 550 milligrams (mg) of salt.
  • Xyrem 4.5 g has 820 mg of salt.
  • Xyrem 6 g has 1,100 mg of salt.
  • Xyrem 7.5 g has 1,400 mg of salt.
  • Xyrem 9 g has 1,640 mg of salt.

If your salt intake is a concern, your doctor may suggest Xywav (calcium, magnesium, potassium, and sodium oxybates) for treating your narcolepsy symptoms. This drug works similarly to Xyrem but contains a lower amount of salt per dose.

For more information about heart failure and Xyrem, talk with your doctor.

The Healthline Pharmacist TeamAnswers represent the opinions of our medical experts. All content is strictly informational and should not be considered medical advice.
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Disclaimer: Healthline has made every effort to make certain that all information is factually correct, comprehensive, and up to date. However, this article should not be used as a substitute for the knowledge and expertise of a licensed healthcare professional. You should always consult your doctor or another healthcare professional before taking any medication. The drug information contained herein is subject to change and is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. The absence of warnings or other information for a given drug does not indicate that the drug or drug combination is safe, effective, or appropriate for all patients or all specific uses.