Alcohol, Opioids, and More: 8 Xywav Interactions to Watch For

If you have narcolepsy or another condition of excessive daytime sleepiness, such as idiopathic hypersomnia (IH), you may be wondering about medications to manage your symptoms. A medication called Xywav is one option. It’s a liquid solution that contains four active ingredients that are all a form of oxybate.

Oxybate is a central nervous system (CNS) depressant. This means it slows down your brain activity. It’s not fully understood how Xywav works. But it helps you sleep at night so that you feel more rested and awake during the day.

Like most medications, Xywav can have drug interactions. Typically, these interactions occur because these medications have similar side effects. Here, we’ll cover 8 Xywav interactions and how to prevent or manage them.

1. Benzodiazepines

CNS depressants like Xywav can cause drowsiness, confusion, and trouble with coordination. In fact, Xywav has a boxed warning for CNS depression. A boxed warning is the highest warning the FDA can give to a medication.

This is why it’s best to avoid combining Xywav with other CNS depressants. This includes benzodiazepines, such as alprazolam (Xanax), clonazepam (Klonopin), and lorazepam (Ativan). Like Xywav, these medications slow down brain activity and cause drowsiness and dizziness. These side effects can worsen if benzodiazepines and Xywav are taken together. In severe cases, fainting, slowed breathing, and overdose can occur.

Additionally, benzodiazepines may increase daytime sleepiness if you take them during the day. This can make your narcolepsy or IH worse. In most cases, it’s best to avoid this combination. But if both medications are necessary, your prescriber may lower the dose of one or both medications. If you experience excessive sleepiness or dizziness, or if you faint or fall at any point, tell your prescriber immediately.

Xywav and benzodiazepines are both controlled substances. These are medications that have a risk of dependence and misuse. To minimize your risk, take your medication exactly as prescribed.

2. Opioids

Opioids are typically used to treat pain that can’t be treated by nonopioid medications. Like Xywav, they’re CNS depressants and controlled substances. Common opioid medications include tramadol (ConZip, Qdolo) and Percocet (oxycodone / acetaminophen).

Opioids and Xywav have some similar side effects, including drowsiness and dizziness. So taking opioids with Xywav increases the risk of severe sedation. It may also lead to low blood pressure, slowed breathing, and overdose, which can be life-threatening.

Additionally, taking opioids during the day can increase daytime drowsiness. This can make your narcolepsy or IH worse.

If you’re taking opioids, tell your prescriber before starting Xywav. They may recommend stopping your opioids. Or they may prescribe a decreased dose. If you have pain that warrants short-term opioid use, your prescriber may recommend stopping Xywav until your opioid treatment is complete.

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• Xywav side effects. Common side effects of Xywav include dizziness and drowsiness. This can affect your ability to drive. Rarely, Xywav may also lead to dependence and misuse.

• How to take Xywav. Xywav is taken at night as a single dose. Your prescriber may recommend taking an additional dose a few hours later.

• How Xywav works. The active ingredient in Xywav helps slow down brain activity and cause drowsiness. Still, it’s not 100% clear how Xywav works for narcolepsy and idiopathic hypersomnia.

3. Alcohol

You shouldn’t drink alcohol if you take Xywav. Combining these substances can cause severe sedation, coordination problems, and trouble remembering events.

Before starting Xywav, be honest with your prescriber if you drink alcohol. If you feel you’re unable to stop drinking, tell them. They may talk to you about resources and medications that may help decrease how much you drink.

If you or someone you know struggles with substance use, help is available. Call the Substance Abuse and Mental Health Services Administration’s National Helpline at 1-800-662-4357 to learn about resources in your area.

4. Sleep medications

Several medications treat insomnia (trouble sleeping) by helping you fall asleep and stay asleep. Some are by prescription, while others are over the counter (OTC). Prescription examples include the “Z-drugs,” such as eszopiclone (Lunesta), zaleplon (Sonata), and zolpidem (Ambien, Intermezzo, Edluar). OTC examples include antihistamines, such as diphenhydramine (ZzzQuil) and doxylamine (Unisom).

Many of these medications are also considered CNS depressants. And they have some similar side effects to Xywav, such as drowsiness and dizziness. They’re also controlled substances that can lead to dependence and misuse.

Like Xywav, these sleep medications are meant to be taken at night. Taking them with Xywav can lead to excessive sleepiness and daytime drowsiness the next day. This may make your narcolepsy or IH worse. And it can lead to falls and injuries.

Z-drugs shouldn’t be taken with Xywav. And it’s best to avoid combining Xywav with other sleep medications. This includes OTC options such as diphenhydramine.

There are several other sleep medications. So before starting Xywav, give your prescriber and pharmacist a list of the medications you take. Include prescription medications and OTC products. They can check for possible interactions with other sleep medications.

5. Muscle relaxers

Muscle relaxers are medications that treat muscle spasms and muscle pain. Common examples include cyclobenzaprine (Amrix), methocarbamol (Robaxin), and carisoprodol (Soma).

Muscle relaxers can cause drowsiness, dizziness, and trouble with coordination. So taking them with Xywav may make these side effects more likely and worse. In severe cases, it can lead to severely low blood pressure, slowed breathing, and overdose.

During Xywav treatment, tell your prescriber all the medications you take. This means you should alert them if you’re prescribed a muscle relaxer after you’ve started Xywav. If you need a muscle relaxer for only a short time, your prescriber may recommend stopping Xywav during this time.

6. Seizure medications, such as topiramate

Seizure medications often work by slowing down the brain, which can lead to dizziness and drowsiness. Examples include gabapentin (Neurontin), topiramate (Topamax), and levetiracetam (Keppra).

Ask your prescriber or pharmacist before taking seizure medications with Xywav. They can look for interactions. Not all seizure medications cause drowsiness. But if you take one that does, your prescriber can tell you how to proceed. Often, your seizure medication is vital. So stopping it may not be an option. In that case, your prescriber can help you weigh the risks and benefits of taking Xywav.

7. Some antidepressants and antipsychotics, such as Lexapro

Antidepressants treat several health conditions, including depression and anxiety. These are widely used and can interact with several other medications, including Xywav. This is because several antidepressants can cause drowsiness and dizziness. Taking them with Xywav can make these effects more likely and more intense. Antidepressants that can cause these effects include amitriptyline, escitalopram (Lexapro), and paroxetine (Paxil).

Antipsychotics are another group of medications that treat mental health conditions. These include bipolar disorder, schizophrenia, and sometimes depression. Like antidepressants, several antipsychotics can cause drowsiness. Common antipsychotics that cause sleepiness include quetiapine (Seroquel), olanzapine (Zyprexa), and clozapine (Clozaril). Taking them with Xywav can increase the risk of these effects and make them more severe.

Not all antidepressants and antipsychotics cause drowsiness. But if you take one of these medications, ask your prescriber before starting Xywav. They can tell you if there’s a potential interaction and what to do about it.

8. Depakote (divalproex)

Depakote (divalproex sodium) is a medication that treats several health conditions. These include seizures and bipolar disorder. If you’re prescribed Depakote and Xywav, your prescriber may recommend a low Xywav dosage. They’ll also monitor you more closely for side effects.

The reason is because Depakote can lead to increased levels of oxybate, the active ingredient in Xywav. So this medication can cause extreme tiredness, dizziness, and confusion. It can also affect your memory.

Additionally, Depakote can cause drowsiness, which may be worse if you take it with Xywav. Make sure you tell your prescriber if you take Depakote before starting Xywav. And if you’re already taking Xywav, and Depakote is recommended to you by another healthcare professional, make sure your Xywav prescriber knows.

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Written by:

Nicole E. Cieri-Hutcherson, PharmD, BCPS, NCMP

Nicole E. Cieri-Hutcherson, PharmD, BCPS, NCMP, has over a decade of experience as a pharmacist, professor, and researcher. She was a full-time clinical professor in the pharmacy practice department at D’Youville School of Pharmacy before subsequently joining the faculty of the pharmacy practice department at the University at Buffalo School of Pharmacy and Pharmaceutical Sciences.

Edited by:

Amy B. Gragnolati, PharmD, BCPS

Amy Gragnolati, PharmD, BCPS, is a pharmacy editor for GoodRx. Amy currently holds her pharmacist license in Georgia and California.

Reviewed by:

Alex Brewer, PharmD, MBA

Alex Brewer, PharmD, MBA, is a licensed pharmacist specializing in chronic disease and health and wellness. Upon completing his residency, he worked in the managed care field, conducting medication therapy management and adherence counseling sessions with Medicaid, Medicare, and private insurance patients, before transitioning to a career in medical writing.

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