Pitolisant

How it works

By blocking presynaptic H3 autoreceptors it increases the synthesis and release of histamine and other wake-promoting neurotransmitters in the brain, enhancing wakefulness.

Prescribing in practice

• It can prolong the QT interval, so caution and ECG consideration are needed with cardiac disease, electrolyte disturbance, or other QT-prolonging drugs.
• It is taken once daily in the morning and titrated upward, with dose adjustment required in hepatic and renal impairment.
• It may reduce the effectiveness of hormonal contraceptives, so an alternative method should be used during and for some weeks after treatment.

Monitoring

Monitor for QT prolongation where risk factors exist, along with insomnia, anxiety, headache and gastrointestinal effects.

Counselling the patient

• Take it once a day in the morning to avoid disturbing your sleep.
• Use a reliable non-hormonal contraceptive method, as it can stop the pill working.
• Report palpitations, fainting, or persistent anxiety to your team.

Evidence & guidelines

The HARMONY trials demonstrated reductions in daytime sleepiness and cataplexy, and NICE recommends it as an option for narcolepsy with or without cataplexy.