Xywav Dosages: Your GoodRx Guide
Xywav is a medication that can help with symptoms related to narcolepsy and idiopathic hypersomnia. Xywav dosages are based on your specific needs.
Xywav
Used for Idiopathic Hypersomnia, Narcolepsy
Used for Idiopathic Hypersomnia, Narcolepsy
Xywav is a prescription medication that contains calcium, magnesium, potassium, and sodium oxybates. It treats cataplexy (sudden muscle weakness from strong emotions) and excessive daytime sleepiness in people ages 7 years and older with narcolepsy. It can also treat idiopathic hypersomnia (IH) in adults. Xywav works in the brain as a central nervous system (CNS) depressant to help with these sleep conditions. The medication is an oral solution that's taken by mouth, usually twice each night. Some adults with IH can take it once at night instead. Side effects can include headache, nausea, and dizziness.
What is Xywav?
What is Xywav used for?
- Cataplexy (sudden muscle weakness from strong emotions) or excessive daytime sleepiness (EDS) in people with narcolepsy
- Idiopathic hypersomnia (IH) in adults
How Xywav works
Xywav is a central nervous system (CNS) depressant. It's not exactly known how the medication works for narcolepsy and IH.
But it's thought to boost the effects of gamma-aminobutyric acid (GABA) in areas of the brain that control sleep and wakefulness. GABA is a natural chemical in the brain that has a calming effect. By boosting GABA at night, Xywav can help you get better quality sleep so you feel more rested the next day.
When does Xywav start working?Time passed since treatment started:
Drug facts
| Common Brands | Xywav |
|---|---|
| Drug Class | CNS depressant |
| Controlled Substance Classification | Schedule III |
| Generic Status | No lower-cost generic available |
| Availability | Prescription only |
More on Xywav essentials
Risks and warnings for Xywav
Xywav can cause some serious health issues. This risk may be even higher for certain groups. If this worries you, talk to your doctor or pharmacist about other options.
Extreme sleepiness and dangerously slow breathing (respiratory depression)
- Risk factors: Taking medications that can slow the body down and cause slow breathing | Drinking alcohol | Medical conditions that cause breathing problems (e.g., COPD, asthma, sleep apnea)
Xywav is a central nervous system (CNS) depressant. This means it slows your brain function. This can make you less alert. It can also slow your breathing. This can happen at recommended Xywav doses and can be very dangerous.
Don't take Xywav with other CNS depressants. They include opioid medications, benzodiazepines, and muscle relaxants. It can also include any other medication that cause sleepiness. Taking these medications with Xywav can cause serious breathing problems, low blood pressure, extreme sleepiness, or even death.
Also tell your prescriber if you have any breathing problems, like obstructive sleep apnea. These medical conditions can raise the risk of breathing problems while taking Xywav.
Don't drive or use dangerous machines until you know how Xywav affects you. Be aware of it affects your concentration, judgment, thinking, and motor skills. Wait at least 6 hours after taking it before doing anything that needs your full attention or coordination.
Potential for misuse
- Risk factors: History of substance use disorder
Xywav is a controlled substance. It has a risk of misuse (when a medication is purposefully used for a non-medical reason). Misusing Xywav can raise the risk of serious and possibly life-threatening side effects. This can include seizures, very slowed breathing, changes in how alert you are, coma, and death. Misuse can also sometimes lead to addiction.
To lower the risk of misuse and addiction, take Xywav exactly as prescribed. Don't change the dose or how often you take it without talking to your prescriber first. Speak with your care team if you're concerned about this risk.
Only available through the Xywav REMS program
Xywav has risks of misuse, extreme sleepiness, and slowed breathing. These can all lead to dangerous consequences. are all potentially life-threatening. Because of these risks, the FDA has a requirement for Xywav to be only available through a Risk Evaluation and Mitigation Strategy (REMS) program. This safety program is called the Xywav REMS Program.
Your prescriber will help sign you up for the Xywav REMS program. Your prescriber and the pharmacy you get Xywav from must also enroll. This helps make sure you and everyone involved in your care understand the dangers of the medication.
Changes in behavior or thoughts, including depression and suicidal thoughts
- Risk factors: History of mental health conditions
Some people who take Xywav can have behavior changes. This has included confusion, hallucinations (seeing things that aren't real), or paranoia.
Some people taking this medication have also had symptoms of depression. Some people taking a similar medication, Xyrem, had suicidal thoughts.
Watch for signs of depression or other unusual thoughts or behavior while taking Xywav. If you or those around you notice these changes, talk to your prescriber. If you start having thoughts of hurting yourself, get medical help right away. You can also call or text the Suicide and Crisis Line at 988.
Unusual sleep behavior
Some people taking Xywav can have unusual sleep behaviors (or parasomnias). Examples include talking, eating, or doing other strange things in your sleep. It can also include sleepwalking. Some unusual sleep behaviors can raise your risk of getting yourself hurt.
Make sure your family and loved ones know about this side effect so they can watch out for your safety. Tell your prescriber if you've sleepwalked or wandered throughout the night.
Side effects of Xywav
The following side effects may get better over time as your body gets used to the medication. Let your healthcare provider know immediately if you continue to experience these symptoms or if they worsen over time.
Common Side Effects
Adults with IH:
- Nausea (21%)
- Headache (16%)
- Anxiety (12%)
- Dizziness (12%)
- Trouble sleeping (9%)
- Sweating (8%)
- Low appetite (8%)
Adults with narcolepsy:
- Headache (20%)
- Nausea (13%)
- Dizziness (10%)
- Low appetite (8%)
Children with narcolepsy:
- Nausea (20%)
- Bed-wetting (19%)
- Vomiting (18%)
- Headache (17%)
- Weight loss (13%)
- Low appetite (9%)
- Dizziness (8%)
Less Common Side Effects
- Parasomnia (unusual sleep behavior)
- Sleepiness
- Low energy
- Dry mouth
- Diarrhea
Xywav serious side effects
Contact your healthcare provider immediately if you experience any of the following.
- Dangerously slow breathing: trouble breathing; slow or shallow breathing; bluish-colored lips, fingers, or toes
- Depression
- Suicidal thoughts or behavior
- Sleepwalking
When do Xywav possible side effects begin and end?
Time passed since treatment started:
M
H
D
W
M
Nausea
Headache
Dizziness
Dry mouth
Risk of very slow breathing
Seek immediate medical care if you experience this side effect.
If a line continues to the right, you'll likely keep experiencing this side effect once it starts.
More on Xywav side effects
The following Xywav side effects have also been reported
Side effects that you should report to your care team as soon as possible:
- Allergic reactions—skin rash, itching, hives, swelling of the face, lips, tongue, or throat
- CNS depression—slow or shallow breathing, shortness of breath, feeling faint, dizziness, confusion, trouble staying awake
- Mood and behavior changes—anxiety, nervousness, confusion, hallucinations, irritability, hostility, thoughts of suicide or self-harm, worsening mood, feelings of depression
- Sleep apnea—loud snoring, gasping or choking during sleep, daytime sleepiness
- Sleepwalking
Side effects that usually do not require medical attention (report these to your care team if they continue or are bothersome):
- Bedwetting
- Dizziness
- Headache
- Loss of appetite
- Nausea
- Vomiting
Pros and cons of Xywav
Pros
- Works well to lessen cataplexy attacks and daytime sleepiness in people with narcolepsy
- Approved for children as young as 7 years old with narcolepsy
- Helps lessen daytime sleepiness in adults with idiopathic hypersomnia
- Lower sodium content (has 92% less sodium than Xyrem)
Cons
- Is a controlled substance, so there are special requirements to get the prescription filled
- Need to prepare your doses before taking and also take at least 2 hours after food
- Can cause most people to fall asleep within 5 to 15 minutes, so need to be ready for bed when you take it
- Need to wake up in the middle of the night to take a second dose if you take it twice each night
Pharmacist tips for Xywav
- Take Xywav at least 2 hours after eating. Food can lower how much medication gets absorbed into your body. This means that it might not work as well for you.
- Make sure you're in bed when you take Xywav. Most people fall asleep about 5 to 15 minutes after taking it. Being in bed when you take the medication is a good idea in case you suddenly fall asleep afterwards. Avoid getting out of bed after you take the medication because you might fall and hurt yourself.
- You have to prepare your Xywav dose(s) before you take the medication. Even though the medication is already a liquid, you still have to mix your dose with water before taking it. Be sure you know how much of the oral solution you need to draw up and how much water to mix it with. Ask your prescriber if you're not sure.
- If you take Xywav twice each night: Prepare both doses before you go to sleep. That way, they're both ready when you need to take them. Take the first dose right before bed. Then, take your second dose of the night 2.5 to 4 hours after that. Set an alarm so you wake up to take your second dose. If you miss the second dose, skip it and take your usual dose the next night. Don't take two Xywav doses at the same time because it can cause serious side effects.
- How to prepare Xywav: Have all your supplies ready. This includes the Xywav bottle, provided syringe, empty pharmacy container, and 1/4 cup (60 mL) of water. Draw up your prescribed dose using the syringe. Transfer the medication from the syringe into the clean, empty container. Then, pour the 1/4 cup (60 mL) of water into the container and mix well. Cap the container and place at your bedside if you're not taking the medication right away.
- Take your prepared Xywav dose(s) within 24 hours. Empty the prepared dose down the sink drain if it's been more than 24 hours and you still haven't taken it.
- Don't drive or do anything that requires concentration within 6 hours of taking Xywav. This medication can make you fall asleep quickly or make you feel dizzy. Be sure to wait at least 6 hours after taking to do anything that needs your focus.
- Don't drink alcohol or take other sedatives with Xywav. This can make side effects like sleepiness and dizziness more intense. It can also raise the risk of slow breathing, which can be dangerous. Talk to your prescriber about all your medications to make sure they're safe to take together.
- Tell your prescriber or care team if you have any mood or behavior changes, like depression or confusion. Also tell them about any unusual sleep behaviors like sleepwalking at any time. Your prescriber can discuss steps on how to manage these side effects. They might recommend changing your treatment plan, if needed.
- Store the Xywav oral solution and any prepared doses at room temperature (68ºF to 77ºF). Keep the cap tightly closed and keep out of reach of children.
More on Xywav tips
Xywav dosage
Typical dosage for Xywav
-
Narcolepsy
- Ages 18 years and older: The typical starting dose is 2.25 grams by mouth at bedtime, then another 2.25 grams taken 2.5 to 4 hours later. Your prescriber will raise your dose every week to the recommended dose. The recommended dose is 6 to 9 grams per night, split into two doses (one time at bedtime and again 2.5 to 4 hours later).
- Ages 7 to under 18 years old: The prescriber will choose the dose based on your child's body weight. The dose is taken by mouth twice per night (once at bedtime and again 2.5 to 4 hours later). Your child will first start at a low dose. Then, the prescriber will raise the dose every week to a maximum dose of 6 to 9 grams per night, split into two doses.
-
Idiopathic hypersomnia (IH)
- Ages 18 years and older: The dose depends on whether you take Xywav once or twice per night.
- Once per night: The typical starting dose is up to 3 grams by mouth once every night. Your prescriber will raise your dose every week to the recommended dose of 6 grams once per night.
- Twice per night: The typical starting dose is up to 2.25 grams by mouth twice every night (once at bedtime and then again 2.5 to 4 hours later). Your prescriber will raise your dose every week to the recommended dose. The recommended dose is 9 grams per night, split into two doses (one time at bedtime and again 2.5 to 4 hours later).
- Ages 18 years and older: The dose depends on whether you take Xywav once or twice per night.
Your dose might be lower if you have liver problems. Your dose might also be lower if you also take divalproex (Depakote).
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Xywav contraindications
Contraindications are specific health conditions or situations in which a person should not take a medication due to safety concerns. If you have any of the following conditions or if any of the following apply to you, let your healthcare provider know because Xywav will not be safe for you to take.
- Take other sedative hypnotics (e.g., sleep medications)
- Drink alcohol
- A rare condition called succinic semialdehyde dehydrogenase deficiency
What are alternatives to Xywav?
There are a number of medications that your doctor can prescribe in place of Xywav. Compare a few possible alternatives below.
News about Xywav
