Sodium oxybate Disease Interactions

A variety of abnormal thinking and behavior changes have been reported to occur in association with the use of most anxiolytics, sedatives and hypnotics. Some of these changes include decreased inhibition, aggressiveness, agitation, and hallucinations. These drugs can cause or exacerbate mental depression and cause suicidal behavior and ideation. Therapy with these drugs should be administered cautiously in patients with a history of depression or other psychiatric disorders. Patients should be monitored for any changes in mood or behavior. It may be prudent to refrain from dispensing large quantities of medication to these patients.

Sodium oxybate should not be used with alcohol. This drug should be used with caution in patients with history of drug or alcohol abuse. The inappropriate use of this drug alone or in combination with other CNS depressants is associated with CNS adverse reaction including seizures, respiratory depression, decreases in the levels of consciousness, coma and death. Because illicit use and abuse has been reported, physicians should evaluate carefully their patients for history of drug or alcohol abuse and should follow such patients closely, observing them for signs of misuse.

Some hypnotic drugs can have an anticholinergic effect and should be used with caution in patients with glaucoma, and trouble urinating due to retention or enlarged prostate.

In general, anxiolytics, sedatives and hypnotics are extensively metabolized by the liver. Their plasma clearance may be decreased and their half-life prolonged in patients with impaired hepatic function. Therapy with these drugs should be administered cautiously in patients with liver disease (some are not recommended in severe liver impairment), and the dosage should be adjusted accordingly. Laboratory testing is recommended prior and during treatment.

Sodium oxybate has a high content of salt, and it should be used with caution in patients sensitive to salt intake such as patients with heart failure, hypertension, or renal impairment.

The use of sodium oxybate may impair the respiratory drive especially in patients with compromised respiratory function. Sodium oxybate should be used cautiously in patients with sleep apnea and sleep-related breathing disorders as there have been reports of increased central apneas and clinically relevant desaturation. Prescribers should be aware that sleep-related disorders tend to be more prevalent in obese patients, postmenopausal women not receiving hormone replacement therapy and also among patients with narcolepsy.