Key takeaways:
Xywav is prescription-only medication that’s FDA approved to treat narcolepsy and idiopathic hypersomnia. It’s a combination of calcium, magnesium, potassium, and sodium oxybates.
Common Xywav side effects include gastrointestinal problems, such as nausea and diarrhea. Headaches, dizziness, and decreased appetite can also occur, along with increased sweating.
In rare cases, serious Xywav side effects can occur. These include mood changes, suicidal thoughts and behaviors, and hallucinations. Unusual sleep behaviors, breathing problems, and dependence and misuse are also possible.
Narcolepsy and idiopathic hypersomnia are health conditions that involve excessive sleepiness during the day. A medication called Xywav is FDA approved to help treat these conditions. It’s a combination of calcium, magnesium, potassium, and sodium oxybates. And it comes as an oral solution that you take at bedtime.
Xywav can help people stay awake during the day and sleep well at night. But like all medications, Xywav has risks. Usually, Xywav side effects are mild and go away on their own. But severe side effects can also occur. Knowing what to watch out for can help keep you safe.
Xywav side effects at a glance
Mild Xywav side effects can often be managed at home. On the other hand, rare but serious side effects may require medical attention.
Common or mild side effects
Less common but serious side effects
Mood and behavior changes, including anxiety, depression, and hallucinations
Suicidal thoughts and behaviors
Slowed breathing
Sleepwalking or other unusual activities while asleep (parasomnias)
Dependence and misuse
Below, we’ll dive deeper into nine Xywav side effects and tips on how to manage them.
1. Gastrointestinal side effects
Gastrointestinal (GI) side effects, such as nausea, vomiting, and diarrhea, are common with Xywav. These side effects are part of the reason you’ll likely start with a lower dosage. If you’re tolerating Xywav well, your prescriber may increase your dosage.
Since Xywav is typically taken before bedtime, you’ll likely fall asleep before any nausea or GI discomfort hits. But if you’re experiencing nausea, some strategies that may help are staying hydrated and eating smaller (but more frequent) meals. For diarrhea, try avoiding fatty, fried, and spicy foods.
But if your GI symptoms don’t improve, tell your prescriber. They may recommend over-the-counter (OTC) medications for nausea or diarrhea. If OTC options don’t help, there are prescription medications that may provide a short-term solution. Additionally, your prescriber may consider lowering your Xywav dosage.
2. Headaches
Headaches were commonly reported in Xywav clinical studies, affecting about 1 in 5 people. Older adults may be more likely to experience this side effect. Fortunately, there are several ways to prevent or manage headaches while taking Xywav.
Staying hydrated, managing stress, and getting enough sleep may help reduce headache frequency. Poor sleep can contribute to headaches, so tell your prescriber if you’re not sleeping well while taking Xywav.
If headaches continue while taking Xywav, talk to your healthcare team. They can help rule out other potential causes and recommend other tips or treatments for relief.
3. Dizziness
Dizziness is another possible Xywav side effect. Since Xywav is taken at bedtime, this side effect may not cause major problems for some people. But it’s important to be careful if you need to get out of bed during the night.
Xywav can also cause daytime dizziness. If this happens, take precautions to reduce your risk of falls and injuries. This may include removing tripping hazards from walkways, using nonslip mats in the bathroom, and keeping everyday items on shelves that are easy to reach.
Drinking water or eating a small snack may help relieve mild dizziness. But tell your prescriber if dizziness becomes severe, worsens, or doesn’t improve over time.
Good to know: Xywav can also decrease alertness and coordination. Avoid activities that require focus, such as driving a car or climbing a ladder, for at least 6 hours after taking a dose, especially when first starting treatment.
4. Decreased appetite
Decreased appetite is another possible Xywav side effect, and it may lead to weight loss in some people. Tell your prescriber if you notice unexpected weight loss or a reduced appetite while taking Xywav.
To help maintain your nutrition, your healthcare team may recommend eating smaller meals more often throughout the day and choosing nutrient-dense foods, such as smoothies, nut butters, and avocados. In some cases, they may recommend lowering your Xywav dosage or switching you to a different medication.
5. Mood changes
Some people taking Xywav have reported feeling more irritable, anxious, or depressed. More seriously, hallucinations, confusion, and suicidal thoughts and behaviors have also been reported.
If you have a history of depression or another mental health condition, tell your prescriber before taking Xywav. They may want to monitor you more closely for mood or behavior changes. And if you notice you feel more depressed, anxious, or confused while taking Xywav, tell your prescriber right away.
If you or someone you know is having thoughts of suicide, you’re not alone, and help is available. Call the National Suicide Prevention Lifeline at 988, or text “HOME” to 741-741 to reach the Crisis Text Line.
6. Increased sweating
Xywav can cause increased sweating (hyperhidrosis) in some people. This can happen during the day or at night. If you notice that you’re sweating more than usual while taking Xywav, try using an OTC antiperspirant. And try wearing cool, loose clothing to bed to decrease sweating at night.
Hyperhidrosis usually isn’t dangerous, but it can affect your quality of life. If you’re experiencing increased sweating, tell your prescriber. They may start by ruling out other conditions and medications that could be contributing to the problem. If they think Xywav is the likely cause of your symptoms, they may suggest taking medication to help with sweating, reducing your Xywav dosage, or even stopping treatment entirely.
7. Unusual sleep behaviors
Xywav can cause unusual sleep behaviors, such as sleepwalking, sleep talking, and abnormal dreams. Eating while asleep is also possible. In some cases, you may not be able to remember these events.
Tell your prescriber right away if you’ve been experiencing unusual sleep behaviors. Parasomnias, such as sleepwalking, can be dangerous and lead to injury. Your prescriber may recommend lowering your Xywav dosage. Or they may switch you to another medication.
Additionally, Xywav can cause some people to have trouble sleeping at night. To help improve your chances of getting a good night’s sleep with Xywav, make sure you have good sleep hygiene habits, such as:
Having a consistent bedtime routine
Keeping your bedroom cool and dark
Exercising in the morning or afternoon
Avoiding using your phone or watching TV an hour before bedtime
8. Breathing problems
Xywav is part of a group of medications called central nervous system (CNS) depressants. These medications slow down brain activity and can cause sleepiness, drowsiness, and confusion. They can also slow down breathing, even when taken as prescribed. Combining Xywav with other CNS depressants can further increase the risk of dangerously slowed breathing.
To help lower your risk of breathing problems while taking Xywav:
Tell your prescriber if you already have breathing problems, such as sleep apnea, before starting Xywav.
Avoid combining Xywav with alcohol and other CNS depressants, such as opioids and benzodiazepines.
Share an updated list of all prescription and OTC medications, supplements, and substances you use with your healthcare team. They can check for interactions.
Because of the risk of breathing problems, Xywav is obtainable only through a Risk Evaluation and Mitigation Strategy (REMS) program. This type of program helps ensure the medication is prescribed and used safely.
9. Dependence and misuse
Xywav is a controlled substance, meaning that it carries a risk of dependence and misuse. Controlled substances have restrictions on how they’re prescribed and administered. The potential for misuse with Xywav is another reason it’s available only through a REMS program.
The active ingredient in Xywav is related to a substance called gamma-hydroxybutyrate (GHB). GHB is an illegal drug that carries a risk of misuse. Xywav is usually considered safe when taken as prescribed, but it may not be the best option if you have a history of substance use disorder.
If you’re prescribed Xywav, carefully follow your prescriber’s instructions on how to take it. If you find yourself taking more Xywav than recommended, tell your prescriber right away.
If you or someone you know struggles with substance use, help is available. Call SAMHSA’s National Helpline at 1-800-662-4357 to learn about resources in your area.
Frequently asked questions
Xywav leaves the body relatively quickly. Most of the medication is cleared within about 5 hours after a dose. But its effects on alertness, coordination, and thinking can last longer. Because of this, you should avoid activities that require full attention, such as driving, for at least 6 hours after taking Xywav.
Xywav contains significantly less sodium than Xyrem, a related medication. Depending on your prescribed dose, Xywav contains about 87 mg to 131 mg of sodium per night. This lower sodium content may be beneficial for people who need to limit their sodium intake.
Xywav is a liquid medication taken by mouth, usually once or twice nightly. It should be taken on an empty stomach, at least 2 hours after eating. You’ll prepare each dose using the provided measuring device and dilute it with water before taking it. Since Xywav works quickly, you should take it while already in bed and ready to sleep.
Xywav leaves the body relatively quickly. Most of the medication is cleared within about 5 hours after a dose. But its effects on alertness, coordination, and thinking can last longer. Because of this, you should avoid activities that require full attention, such as driving, for at least 6 hours after taking Xywav.
Xywav contains significantly less sodium than Xyrem, a related medication. Depending on your prescribed dose, Xywav contains about 87 mg to 131 mg of sodium per night. This lower sodium content may be beneficial for people who need to limit their sodium intake.
Xywav is a liquid medication taken by mouth, usually once or twice nightly. It should be taken on an empty stomach, at least 2 hours after eating. You’ll prepare each dose using the provided measuring device and dilute it with water before taking it. Since Xywav works quickly, you should take it while already in bed and ready to sleep.
The bottom line
Xywav (a combination of calcium, magnesium, potassium, and sodium oxybates) treats narcolepsy and idiopathic hypersomnia. Common Xywav side effects include gastrointestinal problems, such as nausea and diarrhea. It can also cause headaches, dizziness, and a decreased appetite.
In rare cases, serious side effects can occur. These include mood and behavior changes, slowed breathing, and unusual sleep behaviors. Xywav can also cause dependence and misuse. Seek immediate medical attention if you’re having symptoms that seem severe, such as trouble breathing, hallucinations, or extreme confusion, while taking Xywav.
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References
Chen, C., et al. (2021). Pharmacokinetics, bioavailability, and bioequivalence of lower-sodium oxybate in healthy participants in two open-label, randomized, crossover studies. Clinical and Translational Science.
Jazz Pharmaceuticals. (2023). Xywav- calcium, magnesium, potassium, and sodium oxybates solution [package insert]. DailyMed.
Wallace, D. M., et al. (2011). Sodium oxybate-induced sleep driving and sleep-related eating disorder. Journal of Clinical Sleep Medicine.
