Jeffrey Panko NP Psychiatry · Patient education
Sodium oxybate
Xyrem / Lumryz / Separate mixed-salt oxybate formulations
A guide for adults taking sodium oxybate.
Follow the directions on your prescription and your provider's recommendations.
Formulations: Xyrem is an immediate-release liquid generally taken twice nightly. Lumryz is an extended-release suspension taken once nightly. Xywav has its own dosing plan. Access is through restricted distribution programs.
What it is used for
Sodium oxybate treats cataplexy and excessive daytime sleepiness in narcolepsy. Xywav, a different mixed-salt oxybate formulation, also has an adult idiopathic-hypersomnia indication. Instructions differ by formulation.
How it works
Oxybate depresses central nervous-system activity, with actions involving GABA-B signaling. It changes nighttime sleep and can improve daytime symptoms, but can dangerously suppress breathing.
What to expect over time
Benefit is reviewed over weeks while the dose is adjusted. Track cataplexy, daytime sleepiness, breathing symptoms, and nighttime behavior.
Taking your medication
- Use the exact measuring, mixing, and timing instructions supplied by your pharmacy. Take at least two hours after eating.
- Take while in bed and lie down immediately. For twice-nightly treatment, the second dose is usually 2½–4 hours later.
- If the second dose is missed, skip it. Never take two doses together or add a second Lumryz dose.
- Do not drive or perform hazardous tasks for at least six hours after a dose and until fully alert.
When to get help
Emergency symptoms. Call 911 for slow or stopped breathing, inability to wake, collapse, or a seizure. A dosing error needs immediate Poison Control or emergency advice.
Prompt medical advice. Contact your provider promptly for sleepwalking, new depression, confusion, falls, or witnessed breathing pauses.
If you feel unsafe or have thoughts of self-harm, call 911 or go to an emergency department.
Possible side effects
- Nausea, vomiting, or dizziness
- Bedwetting or sweating
- Sleepwalking or other unusual nighttime behavior
- Confusion or daytime sleepiness
Keeping track of treatment
Some side effects resolve with time; others may require a change of medication. Discuss persistent or bothersome side effects with your provider.
The program should review breathing, mood, falls, misuse risk, and adherence. Sodium-containing formulations add a substantial sodium load that matters with hypertension, heart failure, or kidney disease.
If you take too much
For a suspected overdose, call Poison Control at 1-800-222-1222 immediately, even if you feel well. Call 911 for a seizure, collapse, trouble breathing, or inability to wake.
Before you start
Do not use with alcohol or sedative-hypnotics, or with succinic semialdehyde dehydrogenase deficiency. Discuss sleep apnea, lung disease, depression, substance use, and liver disease.
Discuss pregnancy, pregnancy plans, and breastfeeding with your provider. Treatment decisions should consider both the medication and the condition being treated.
Medicines and interactions
Review all your medications with your provider, including over-the-counter medicines and supplements. Have new medications checked before taking them.
Opioids, benzodiazepines, muscle relaxants, and other sedatives can cause life-threatening additive respiratory depression. Any temporary interruption for surgery or pain treatment needs instructions.
Divalproex can raise oxybate exposure and require dose adjustment. Do not substitute formulations yourself.
Everyday tips
Prepare only as directed and keep doses secure from other people.
Use the supplied measuring equipment, never a kitchen spoon.
Your questions answered
Can I use a sleeping pill with it?
Sedative-hypnotics and alcohol are contraindicated. Review all other sedating medicines before treatment.
Can I use one formulation’s instructions for another?
No. Once-nightly and twice-nightly schedules differ, as do mixing and dose instructions.
Storage and safety
Store securely in the original container under the formulation’s temperature and mixed-dose instructions. Keep it locked away from children, pets, and anyone for whom it was not prescribed.
Sources
About this information
Educational handout; does not replace your prescription or provider's recommendations.
Educational inclusion does not mean this medication or its indications are treated at this practice. Review the guide for your exact product with your prescriber or pharmacist.