sodium oxybate

Adjunctive therapy

Brands: Xyrem

Last reviewed 2025-12-30

Reviewed by PsychMed Editorial Team.

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Quick answers

What is sodium oxybate?
Sodium oxybate (brand Xyrem) is a nighttime medication indicated for cataplexy or excessive daytime sleepiness (EDS) in patients 7 years of age and older with narcolepsy (label).
What is Xyrem?
Xyrem is a brand name for sodium oxybate.
What is Xyrem (sodium oxybate) used for?
Label indications include: Treatment of cataplexy or excessive daytime sleepiness (EDS) in patients 7 years of age and older with narcolepsy; REMS-restricted (label).
What drug class is Xyrem (sodium oxybate)?
Nighttime CNS depressant (sodium oxybate; oxybate/GHB) indicated for cataplexy and excessive daytime sleepiness in narcolepsy (patients 7+); Schedule III with boxed warning for CNS depression and abuse/misuse, and dispensed under a REMS due to risk of respiratory depression and misuse.
What strengths does Xyrem (sodium oxybate) come in?
Oral solution: 0.5 g/mL (label).

Snapshot

Class: Adjunctive therapy
Common US brands: Xyrem
Therapeutic drug monitoring not routinely recommended.
Last reviewed: 2025-12-30

Label indications

Treatment of cataplexy or excessive daytime sleepiness (EDS) in patients 7 years of age and older with narcolepsy; REMS-restricted (label).

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Clinical Highlights

Sodium oxybate (brand Xyrem) is a nighttime medication indicated for cataplexy or excessive daytime sleepiness (EDS) in patients 7 years of age and older with narcolepsy (label). It is a CNS depressant and a Schedule III controlled substance. It has a boxed warning for CNS depression and abuse/misuse and is dispensed only through a REMS due to risk of respiratory depression and misuse (label).

Practical use requires nightly planning: dosing is split into two doses (bedtime and 2.5 to 4 hours later), and many patients fall asleep quickly after dosing; fall risk and safe storage are common counseling priorities (label/clinical).
Alcohol and other sedatives increase risk of respiratory depression and are generally avoided; interaction review is especially important in polypharmacy and in patients with substance use risk (label/clinical).
The compare view, sodium oxybate evidence feed, and sodium oxybate print page help compare wake-promoting approaches and implementation constraints.

Dosing & Formulations

Oral solution concentration: 0.5 g/mL; dosing is prescribed in grams per night and split into two doses (label). Adults: start 4.5 g per night (2.25 g at bedtime and 2.25 g 2.5 to 4 hours later). Titrate by 1.5 g per night at weekly intervals to an effective range of 6–9 g per night; doses above 9 g have not been studied and are not ordinarily administered (label).

Food reduces absorption; the first dose is taken at least 2 hours after eating (label).
Both doses are prepared before bedtime and each dose is diluted with water in pharmacy-provided containers; the second dose is taken 2.5 to 4 hours after the first (label).

Monitoring & Risks

CNS and respiratory depression risk is the core safety concern; risk is higher with sedatives, alcohol, or underlying respiratory compromise (label/clinical). Sudden sleep onset after dosing can lead to falls and injuries; safe nighttime environment planning is clinically important (label/clinical).

Misuse/diversion risk is addressed through REMS enrollment, safe storage, and clinical monitoring, particularly in patients with substance use disorders (label/clinical).
Hepatic impairment prolongs half-life and increases exposure; lower starting doses are used and monitoring is emphasized (label).

Drug Interactions

Alcohol and sedative-hypnotics are generally avoided due to additive CNS depression and respiratory depression risk (label). Concomitant divalproex/valproate increases oxybate exposure; an initial dose reduction of at least 20% is recommended with close monitoring (label).

Other CNS depressants (benzodiazepines, opioids, some antipsychotics, sedating antidepressants) can increase sedation and respiratory risk; careful review is a routine safety step (label/clinical).

Practice Notes

Implementation is often the limiting factor: split-night dosing, safe storage, and avoidance of alcohol/sedatives require structured counseling and follow-up (clinical). In serious mental illness, clinicians often coordinate dosing plans with sleep timing, housing stability, and co-medications to reduce fall risk and ensure adherence (clinical).

When insomnia or nocturnal confusion worsens, reassessment of dosing, timing, and interacting sedatives is often prioritized before adding additional hypnotics (clinical).

References

XYREM (sodium oxybate) oral solution prescribing information — DailyMed (2025)
Treatment of central disorders of hypersomnolence: an American Academy of Sleep Medicine clinical practice guideline — Journal of Clinical Sleep Medicine (2021)
Treatment OF Central Disorders OF Hypersomnolence: AN American Academy OF Sleep Medicine Systematic Review, Meta Analysis, AND Grade Assessment — Journal of Clinical Sleep Medicine (2021)
Sodium oxybate improves excessive daytime sleepiness in narcolepsy — Sleep (2006)