Sodium oxybate is a central nervous system depressant—the sodium salt of gamma-hydroxybutyric acid (GHB)—approved by the FDA to treat excessive daytime sleepiness and cataplexy in patients aged 7 and older with narcolepsy, as well as idiopathic hypersomnia in adults via specific formulations.
Sodium oxybate is a prescription CNS depressant used to treat cataplexy and excessive daytime sleepiness in patients with narcolepsy aged 7 years and older.
Xyrem: Immediate-release sodium oxybate oral solution; taken twice nightly (first at bedtime, second 2.5 to 4 hours later).
Both are taken at least 2 hours after eating, while in bed, with the patient lying down immediately afterward.
Their administration instructions differ and are not interchangeable.
XYWAV: Low-sodium oxybate containing calcium, magnesium, potassium, and sodium oxybates (reduces sodium content by about 90%); approved for narcolepsy and idiopathic hypersomnia.
Despite being sedating at night, it improves daytime symptoms by improving disrupted nocturnal sleep.
LUMRYZ: Extended-release sodium oxybate oral suspension; taken once at bedtime.
High risk of central nervous system depression, abuse, and misuse because it is a GHB derivative (classified as a Schedule III controlled substance).
Dangerous Interactions: Never mix with alcohol, sedatives, or other CNS depressants, which can cause severe respiratory depression, low blood pressure, coma, or death.
Activity Restrictions include: Do not drive, operate heavy machinery, or perform hazardous tasks for at least 6 hours after taking a dose.
REMS Program: Must be dispensed through restricted Risk Evaluation and Mitigation Strategy (REMS) programs.
Common Side Effects
Nausea and vomiting Dizziness and headache Bedwetting (enuresis) Changes in weight or appetite Sleepwalking or complex sleep behaviors Depression Suicidality Sleep disordered breathing
Its precise therapeutic mechanism is not fully established; effects are thought to involve GABA-B signaling.
Oxybate consolidates nocturnal sleep and increases slow-wave sleep, helping reduce both daytime sleepiness and cataplexy.
It is not a conventional stimulant.
Respiratory and CNS depression: potentially serious, including at prescribed doses.
Alcohol and sedative-hypnotics are contraindicated; opioids and other CNS depressants increase risk.
Abuse and misuse: prescription sodium oxybate is a Schedule III controlled substance and is dispensed through restricted REMS programs. Illicit GHB is associated with overdose, coma, and death.
Sodium oxybate supplies approximately 1,640 mg of sodium—clinically relevant in hypertension, heart failure, or renal disease.
Xywav is a different formulation containing calcium, magnesium, potassium, and sodium oxybates; it provides approximately 92% less sodium and also has an adult idiopathic-hypersomnia indication.