A pregnant patient with narcolepsy whose excessive daytime sleepiness has not been adequately controlled through nonpharmacologic strategies alone. Managing narcolepsy during pregnancy requires close collaboration with the patient's obstetrician.
The first-line strategy involved discontinuing narcolepsy pharmacotherapy before conception — including early discontinuation of modafinil — along with compensatory nonpharmacologic measures such as scheduled napping and extended sleep time.
When residual sleepiness is not adequately controlled by these nonpharmacologic measures, escalation to the next protocol step is indicated.
When nonpharmacologic measures prove insufficient, a pharmacologic approach using a stimulant-class agent may be considered. Stimulants are the most commonly used option in this clinical setting, and management is carefully structured and minimised in relation to the stage of pregnancy.
Full regimen details, sequencing, clinical decision points, and monitoring guidance are available in the complete protocol.
Goal: Reduction in excessive daytime sleepinessDOI: 10.9740/mhc.2025.12.258
When managing narcolepsy in a patient who is pregnant or plans to become pregnant, collaboration with the patient's obstetrician is essential.
In clinical practice, stimulants are the most commonly used option in pregnancy; whereas use during the third trimester can result in neonate withdrawal symptoms, there does not appear to be an association with congenital or cardiovascular defects.
When the degree of sleepiness became unacceptable, methylphenidate was initiated.
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