If you have a certain kind of sleep disorder, your doctor may suggest treatment with Xywav.
Xywav is a prescription drug that’s used to treat idiopathic hypersomnia in adults.
It’s also prescribed to treat the following symptoms of narcolepsy in adults and some children:
- excessive daytime sleepiness
Xywav contains the following active drugs. An active drug is the ingredient that makes a medication work.
- calcium oxybate
- magnesium oxybate
- potassium oxybate
- sodium oxybate
Xywav belongs to a group of drugs called central nervous system depressants. This drug comes as a liquid solution that you swallow. It’s not available as a generic drug.
Keep reading to learn more about Xywav, including information about side effects, cost, and more.
Find answers to some commonly asked questions about Xywav.
Is Xywav an alternative to Xyrem?
Though Xywav and Xyrem are very similar, they’re also different in a few ways.
Both Xywav and Xyrem are used to treat cataplexy and excessive daytime sleepiness due to narcolepsy in adults and some children. But Xywav may also be used to treat idiopathic hypersomnia (IH) in adults.
Xywav and Xyrem both contain sodium oxybate as an active drug. But Xywav also contains the active drugs calcium oxybate, magnesium oxybate, and potassium oxybate. This means Xywav has less sodium (salt) than Xyrem. So it may be a safer option for people who are limiting their salt intake.
If you’d like to learn more about how Xywav compares with Xyrem, talk with your doctor or pharmacist.
How does Xywav work?
How a drug works is referred to as its mechanism of action.
Xywav’s mechanism of action for treating narcolepsy symptoms and IH isn’t known. It’s thought that it improves sleep quality by affecting certain chemicals in the brain.
Is Xywav a controlled substance?
Yes, Xywav is a controlled substance. This means that certain laws in the United States control how Xywav is prescribed to help prevent possible misuse (sometimes called abuse). Misuse occurs when a person uses a drug in a way other than how it’s prescribed. Misusing Xywav can lead to serious side effects, including trouble breathing or coma.
Xywav is considered a Schedule III controlled substance. A Schedule III substance has an approved medical use, but it also has risks of misuse, dependence, and tolerance. With dependence, the body needs a drug to function as it usually would. Tolerance means the body gets used to a drug and needs a higher dose for the same effect.
In addition, distribution of Xywav is restricted through a program called a risk evaluation and mitigation strategy (REMS). As a result, the drug is available only from certain prescribers and a specially certified pharmacy. The Food and Drug Administration (FDA) requires certain medications to have a REMS to help manage serious risks associated with those medications.
To learn more, see the “Can Xywav be misused?” section below.
Like most drugs, Xywav may cause mild or serious side effects. The lists below describe some of the more common side effects that Xywav 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 Xywav. 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 Xywav can cause. To learn about other mild side effects, talk with your doctor or pharmacist, or read Xywav’s prescribing information.
Mild side effects of Xywav that have been reported include:
- decreased appetite
- trouble sleeping
- dry mouth
- anxiety or agitation
- weakness or lack of energy
- muscle spasms or tremor
- nausea or vomiting
- sweating more than usual, including night sweats
- weight loss*
* For more information about this side effect, see the “Side effect focus” section below.
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 Xywav can occur, but they aren’t common. If you have serious side effects from Xywav, call your doctor right away. But if you think you’re having a medical emergency, call 911 or your local emergency number.
Serious side effects of Xywav that have been reported include:
- breathing problems, such as sleep apnea
- aggression or paranoia
- panic attack
- psychosis (loss of contact with reality)
- suicidal thoughts or actions
- boxed warnings:
- risk of central nervous system depression*
- risk of misuse†
- abnormal dreams or unusual behaviors during sleep*
- allergic reaction*
* For more information about this side effect, see the “Side effect focus” section below.
† For more information about the risk of misuse, see the “Can Xywav be misused?” section below.
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 Xywav may cause.
Risk of CNS depression. Xywav works by depressing (slowing down) activity in your CNS. This is known as CNS depression, and it can happen with Xywav even when it’s taken as directed. CNS depression can impair your judgment, thinking, and motor skills.
Due to the risk of CNS depression, you should not take Xywav with alcohol. You also should not take it with drugs called sedative hypnotics. These are medications prescribed for certain sleep disorders.
Taking other CNS depressants with Xywav may cause serious side effects, including:
- low blood pressure
- trouble breathing
In rare instances, taking CNS depressants with Xywav may be fatal.
To see a list of sedative hypnotics and CNS depressants, see the “What should be considered before taking Xywav?” section below.
Risk of misuse. Xywav has a risk of misuse. (Misuse is where a drug is used in a way other than how it’s prescribed). Misusing Xywav can lead to serious side effects, including trouble breathing or coma. In rare cases, it can be fatal.
To learn more, see the “Can Xywav be misused?” section below.
What might help
After taking a Xywav dose, you should avoid dangerous activities or any activity that requires you to be fully awake for at least 6 hours. Examples include driving a car or operating machinery.
Due to the risk of CNS depression and misuse, distribution of Xywav is restricted through a program called a risk evaluation and mitigation strategy (REMS). This means the drug is available only from certain prescribers and a specially certified pharmacy. The FDA requires certain medications to have a REMS to help manage serious risks associated with those medications.
For more information about either of Xywav’s boxed warnings, talk with your doctor or pharmacist.
Treatment with Xywav may cause weight loss. But in studies of the drug, this side effect wasn’t common among adults. It occurred more often in children who took the drug.
Decreased appetite is one of Xywav’s more common side effects. Decreased appetite can lead to weight loss.
What might help
If you have weight loss that bothers you while taking Xywav, talk with your doctor. They can suggest ways to reach or maintain a weight that is healthy for you.
Abnormal dreams or unusual behaviors during sleep
As a result of taking Xywav, you may experience abnormal dreams or unusual behaviors during sleep. These side effects were somewhat common in studies of the drug.
Unusual behaviors during sleep that were reported in these studies include:
- performing other tasks, such as chores
Some people have been injured as a result of these sleep behaviors.
What might help
While taking Xywav, if you have abnormal dreams or unusual behaviors during sleep, tell your doctor. They can recommend ways to help treat this side effect.
Your doctor may suggest stopping treatment with Xywav. If this is the case, they can recommend alternatives to treat your condition.
Some people may have an allergic reaction to Xywav. While it doesn’t appear allergic reactions were reported in studies of Xywav, they have happened since it 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, usually 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 Xywav. But if you think you’re having a medical emergency, call 911 or your local emergency number.
Costs of prescription drugs can vary depending on many factors. These factors include what your insurance plan covers and which pharmacy you use. To find current prices for Xywav in your area, visit WellRx.com.
You may wonder how the cost of Xywav compares with alternatives such as Xyrem. Xywav may be more expensive than Xyrem. To learn more about the price you may pay for either medication, talk with your doctor or insurance company.
For information about how Xyrem and Xywav are alike and different, see the “What are some frequently asked questions about Xywav?” section above.
If you have questions about how to pay for your prescription, talk with your doctor or pharmacist. You can also visit the Xywav manufacturer’s website to see if it has support options.
To learn more about saving money on prescriptions, check out this article.
Xywav is used to treat idiopathic hypersomnia (IH) in adults. For some people with hypersomnia, it’s possible to identify its cause, such as another medication or condition. Idiopathic means there’s no clear cause for the hypersomnia.
People with IH experience excessive daytime sleepiness (EDS), which is an overwhelming, sudden urge to sleep. This happens even after a good night’s sleep. With EDS, you may frequently feel tired and have trouble concentrating or completing tasks. This, in turn, can affect how you function at work or school.
Xywav’s mechanism of action for treating IH is not known. (“Mechanism of action” means how a drug works.) It’s thought that the drug helps improve sleep quality by affecting certain chemicals in the brain.
Xywav is used to treat the following symptoms of narcolepsy in adults and children ages 7 years and older:
- cataplexy, which is an unexpected, temporary loss of muscle control
- excessive daytime sleepiness (EDS), which is an overwhelming, sudden urge to sleep that makes it hard to function during the day
Narcolepsy affects the nervous system, resulting in abnormal sleep. EDS and “sleep attacks” (falling asleep suddenly without warning) are the main symptoms of narcolepsy.
Some people with narcolepsy also have cataplexy as a symptom. (Cataplexy is an unexpected, temporary loss of muscle control.)
How Xywav works to treat narcolepsy symptoms isn’t known. It’s thought that the drug improves sleep quality by affecting certain chemicals in the brain.
Your doctor will recommend the dosage of Xywav that’s right for you. Below are commonly prescribed dosages, but always take the dosage your doctor prescribes.
Xywav comes as a liquid solution that you swallow.
You may take one dose of Xywav immediately before going to bed. Or your doctor may suggest that you follow this dosing schedule:
- Take one dose immediately before going to bed.
- Take a second dose 2.5 to 4 hours later.
Questions about Xywav’s dosage
Below are some common questions about Xywav’s dosage.
- What if I miss a dose of Xywav? If you miss a Xywav dose, simply skip the missed dose. Never take more than one dose of Xywav to make up for a missed dose.
- Will I need to take Xywav long term? If you and your doctor agree Xywav is safe and working for you, you’ll likely take it long term.
- How long does Xywav take to work? Xywav works very quickly. Most people fall asleep within 5 to 15 minutes of taking a dose.
Before you begin treatment with Xywav, 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 Xywav is a good treatment option for you.
Taking a medication with certain vaccines, foods, and other things can affect how the medication works. These effects are called interactions.
Before taking Xywav, be sure to tell your doctor about all medications you take, including prescription and over-the-counter kinds. Also, describe any vitamins, herbs, or supplements you use. Your doctor or pharmacist can tell you about any interactions these items may cause with Xywav.
Interactions with drugs or supplements
Xywav can interact with several kinds of drugs. These drugs include:
- sedative hypnotic medications, such as:
- ramelteon (Rozerem)
- eszopiclone (Lunesta)
- zaleplon (Sonata)
- central nervous system depressants, such as:
- benzodiazepines, including alprazolam (Xanax)
- muscle relaxers, including cyclobenzaprine (Fexmid, Amrix)
- certain pain medications, including oxycodone (Oxaydo, OxyContin) and fentanyl (Actiq, Fentora)
- certain antidepressants, including doxepin (Silenor) and trazodone
- the antipsychotic drug clozapine (Clozaril)
This list does not contain all kinds of drugs that may interact with Xywav. Your doctor or pharmacist can tell you more about these interactions and any others that may occur with Xywav.
Note: Because of possible interactions, your doctor will likely recommend that you do not take Xywav with certain drugs listed above.
Boxed warnings for Xywav include:
- Risk of central nervous system depression. Xywav works by depressing (slowing down) activity in your central nervous system (CNS). This is known as CNS depression, and it can happen with Xywav even when it’s taken as directed. CNS depression can impair your judgment, thinking, and motor skills. For more information, see the “What are Xywav’s side effects?” section above.
- Risk of misuse. Xywav has a risk of misuse. Misusing Xywav can lead to serious side effects, including trouble breathing or coma. In rare cases, it can even be fatal. To learn more, see the “Can Xywav be misused?” section below.
Xywav 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 Xywav. Factors to consider include those in the list below.
- Succinic semialdehyde dehydrogenase deficiency. If you have succinic semialdehyde dehydrogenase deficiency, a rare brain disorder, your doctor will not prescribe Xywav to you. This condition can result in the level of Xywav building up in your body, which may cause serious side effects. Your doctor can suggest safer treatment options for your condition instead of Xywav.
- Breathing or lung problems. Xywav can lower your breathing rate and cause other breathing issues, including respiratory depression. If you have existing breathing or lung problems, you may have a higher risk of this side effect with Xywav. Let your doctor know if you have such problems. This can help them determine whether Xywav is a safe treatment option for you.
- Sleep apnea. Xywav can cause sleep apnea. For people who already have this condition, taking Xywav could worsen it. If you have sleep apnea, let your doctor know so they can determine whether Xywav is safe for you to take.
- Depression. Xywav can cause depression or depressed mood and can worsen this condition in people who already have it. If you have depression, tell your doctor. This can help them determine whether Xywav is a safe treatment option for you.
- Suicidal thoughts or actions. In rare cases, Xywav has caused suicidal thoughts or actions. Be sure to talk with your doctor if you have or have had suicidal thoughts or behaviors. Taking Xywav could worsen these feelings. Your doctor will discuss with you whether Xywav is safe for you to take.
- Liver problems. If you have liver problems, your body may have issues breaking down Xywav after you take a dose. This can result in the level of Xywav building up in your body, which may cause serious side effects. Tell your doctor about any liver problems you have. This can help them determine whether Xywav is a safe treatment option for you.
- Allergic reaction. If you’ve had an allergic reaction to Xywav or any of its ingredients, your doctor will likely not prescribe Xywav. Ask them what other medications are better options for you.
Xywav and alcohol
You should not drink alcohol during Xywav treatment.
Xywav works by depressing (slowing down) activity in your central nervous system (CNS). This is known as CNS depression,* and it can impair your judgment, thinking, and motor skills. Like Xywav, alcohol is a CNS depressant. So drinking alcohol while taking Xywav can increase the risk of serious side effects from CNS depression.
For more information about alcohol and Xywav, talk with your doctor.
* Xywav has a
Pregnancy and breastfeeding
It’s not known if it’s safe to take Xywav while pregnant or breastfeeding.
If you’re pregnant or breastfeeding, or planning to become pregnant or breastfeed, tell your doctor. They can discuss safe treatment options for your condition with you.
Your doctor will explain how you should take Xywav. They’ll also explain how much to take and how often. Be sure to follow your doctor’s instructions.
Xywav comes as a liquid solution that you swallow.
It’s important to know that Xywav works very quickly for most people. You’ll likely fall asleep within 5 to 15 minutes after taking a dose. To avoid possible injury, your doctor may suggest that you take Xywav while in bed. Or they may recommend that you get into bed right after taking a dose.
Should I take Xywav with food?
No, you should not take Xywav with food. You should wait at least 2 hours after eating before taking a dose of Xywav.
Questions for your doctor
You may have questions about Xywav 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 Xywav 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.
Xywav has a
Misuse (sometimes called abuse) occurs when a person uses a drug in a way other than how it’s prescribed. Misusing Xywav can lead to serious side effects, including trouble breathing or coma. It can even be fatal in rare cases.
Before you begin taking Xywav, it’s important to tell your doctor if you have a history of a substance use disorder. This can help them determine whether Xywav is a good treatment option for your condition.
About the Xywav REMS program
Due to the risk of misuse and central nervous system (CNS) depression,* distribution of Xywav is restricted through a program called a
The FDA requires certain medications to have a REMS to help manage serious risks associated with those medications. The REMS program ensures that Xywav is prescribed only when its benefits outweigh its risks.
Because of the REMS program, only specially certified healthcare professionals can prescribe Xywav. And only a specially certified pharmacy may dispense the drug. This means you will not be able to pick it up from your local pharmacy.
To be prescribed Xywav, you must enroll in the Xywav REMS program. You also need to complete documentation that indicates you’re taking the drug safely as your doctor prescribes.
To learn more about the Xywav REMS program, talk with your doctor or pharmacist. You can also check out the Xywav REMS website, or call 866-997-3688.
* For more information about the risk of CNS depression with Xywav, see the “What are Xywav’s side effects?” section above.
Do not take more Xywav than your doctor prescribes. Taking more than this can lead to serious side effects.
Symptoms of overdose
In studies of Xywav, overdose wasn’t reported.
But one of Xywav’s active drugs is sodium oxybate, which is a form of gamma-hydroxybutyrate (GHB). So Xywav’s overdose symptoms may be similar to those reported with GHB, which is an illegal drug.
Symptoms of GHB overdose include:
- blurry vision
- slowed breathing or trouble breathing
- slow heart rate
- loss of consciousness
What to do in case you take too much Xywav
Call your doctor if you think you’ve taken too much Xywav. 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.
If you’re considering treatment with Xywav, it’s important to talk with your doctor or pharmacist. Ask questions that help you feel comfortable with the risks and benefits of taking Xywav. Some examples to help you get started are:
- What should I know about other treatments for narcolepsy besides Xywav?
- Does my medical history place me at higher risk of side effects if I take Xywav?
- Will Xywav show up on a drug test?
- How will I know if it’s safe for me to drive while taking Xywav?
You may also be interested in learning more about treatment options for:
If I stop taking Xywav, will I have withdrawal symptoms?Anonymous
It’s possible that you’ll have withdrawal symptoms from stopping Xywav treatment. This is especially true if you stop taking the drug suddenly or your dose is reduced too quickly.
In studies, some people who suddenly stopped taking Xywav experienced symptoms including:
- sleep problems
- worsening cataplexy
- hallucinations (seeing or hearing things that aren’t real)
One of Xywav’s active drugs is sodium oxybate. It’s a form of gamma-hydroxybutyrate (GHB), which is an illegal drug. It’s thought that symptoms of withdrawal from Xywav may be similar to those experienced with GHB. Other symptoms that have been reported in people who stopped taking GHB include:
- rapid heartbeat
- muscle cramps
Because of the risk of withdrawal symptoms, it’s important that you do not stop taking Xywav without first talking with your doctor. They can instruct you on slowly lowering your dose over time until it’s safe for you to stop taking Xywav.
For more information about possible withdrawal symptoms from stopping Xywav treatment, 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.
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.