Always take Xyrem exactly as your doctor has told you to. You should check with your doctor or pharmacist if you are not sure.
The usual starting dose is 4.5 g/day, given as two equally divided doses of 2.25 g/dose. Your doctor may gradually increase your dose up to a maximum of 9 g/day given as two equally divided doses of 4.5 g/dose.
Take Xyrem orally two times each night. Take the first dose upon getting into bed and the second dose 2.5 to 4 hours later. You may need to set an alarm clock to make sure you wake up to take the second dose. Food decreases the amount of Xyrem that is absorbed by your body. Therefore, it is best to take Xyrem at set times well after a meal (two-three hours). Prepare both doses before bedtime.
If you stop taking Xyrem for more than 14 consecutive days you should consult your doctor as you should restart taking Xyrem at a reduced dose.
Instructions on how to dilute Xyrem
The following instructions explain how to prepare Xyrem. Please read the instructions carefully and follow them step by step.
To help you, the Xyrem carton contains 1 bottle of medicine, a measuring syringe and two dosing cups with child-resistant caps.
1. Remove the bottle cap by pushing down while turning the cap anticlockwise (to the left). After removing the cap, set the bottle upright on a table-top. There is a plastic covered foil seal on the top of the bottle, which must be removed before using the bottle for the first time. While holding the bottle in its upright position, insert the press-in-bottle-adaptor into the neck of the bottle. This needs only to be done the first time that the bottle is opened. The adaptor can then be left in the bottle for all subsequent uses
2. Next, insert the tip of the measuring syringe into the centre opening of the bottle and press down firmly (See Figure 1).
Figure 1
3. While holding the bottle and syringe with one hand, draw up the prescribed dose with the other hand by pulling on the plunger. NOTE: Medicine will not flow into the syringe unless you keep the bottle in its upright position (See Figure 2).
Figure 2
4. Remove the syringe from the centre opening of the bottle. Empty the medicine from the syringe into one of the dosing cups provided by pushing on the plunger (See Figure 3). Repeat this step for the second dosing cup. Then add about 60 ml of water to each dosing cup (60 ml is about 4 tablespoons).
Figure 3
5. Place the caps provided on the dosing cups and turn each cap clockwise (to the right) until it clicks and locks into its child-resistant position (See Figure 4). Rinse out the syringe with water.
Figure 4
6. Just before going to sleep, place your second dose near your bed. You may need to set an alarm so you wake up to take your second dose no earlier than 2.5 hours and no later than 4 hours after your first dose. Remove the cap from the first dosing cup by pressing down on the child-resistant locking tab and turning the cap anticlockwise (to the left). Drink all of the first dose while sitting in bed, recap the cup, and then lie down right away.
7. When you wake up 2.5 to 4 hours later, remove the cap from the second dosing cup. While sitting in bed, drink all of the second dose right before lying down to continue sleeping. Recap the second cup.
If you have the impression that the effect of Xyrem is too strong or too weak, talk to your doctor or pharmacist.
If you take more Xyrem than you should
Symptoms of Xyrem overdose may include agitation, confusion, impaired movement, impaired breathing, blurred vision, profuse sweating, headache, vomiting, decreased consciousness leading to coma and seizures. If you take more Xyrem than you were told to take, or take it by accident, get emergency medical help right away. You should take the labelled medicine bottle with you, even if it is empty.
If you forget to take Xyrem
If you forget to take the first dose, take it as soon as you remember and then continue as before. If you miss the second dose, skip that dose and do not take Xyrem again until the next night. Do not take a double dose to make up for forgotten individual doses.
If you stop taking Xyrem
You should continue to take Xyrem for as long as instructed by your doctor. You may find that your cataplexy attacks return if your medicine is stopped and you may experience insomnia, headache, anxiety, dizziness, sleeping problems, sleepiness, hallucination and abnormal thinking.
If you have any further questions on the use of this product, ask your doctor or pharmacist.