Dosing & Drug Interactions

Dosing WAKIX With Other Medications

Some medications have clinically important drug interactions with WAKIX

Choose from the drop-down menu or from the drug categories below.

This tool is not intended to provide an exhaustive list of drug interactions with WAKIX, and some drugs may have other interactions and/or safety considerations. Before prescribing, always consult the Full Prescribing Information for WAKIX as well as for concomitant medications.

Strong CYP2D6 Inhibitors

Dosage Modifications for Concomitant Use With Strong CYP2D6 Inhibitors

Concomitant administration of WAKIX with strong CYP2D6 inhibitors increases WAKIX exposure by 2.2-fold

Examples¹:

Bupropion, Paroxetine

Initiating WAKIX in adult patients on strong CYP2D6 inhibitors

Dosing recommendation for WAKIX with strong CYP2D6 inhibitors in adult patients graphic

Initiating WAKIX in pediatric patients (6 years and older) on strong CYP2D6 inhibitors

Dosing recommendation for WAKIX with strong CYP2D6 inhibitors in pediatric patients less than 40 kg graphic

Dosing recommendation for WAKIX with strong CYP2D6 inhibitors in pediatric patients 40 kg or above graphic

Initiating strong CYP2D6 inhibitors in patients on a stable dose of WAKIX

For adult and pediatric patients on a stable dose of WAKIX: Reduce the WAKIX dose by half upon initiating strong CYP2D6 inhibitors

Strong CYP3A4 Inducers

Dosage Modifications for Concomitant Use With Strong CYP3A4 Inducers

Concomitant use of WAKIX with strong CYP3A4 inducers decreases WAKIX exposure by 50%

Examples¹:

Carbamazepine, Phenytoin, Rifampin

Initiating strong CYP3A4 inducers in patients on a stable dose of WAKIX

Assess for loss of efficacy of WAKIX after initiation of a strong CYP3A4 inducer

Discontinuing concomitant strong CYP3A4 inducers in patients on a stable dose of WAKIX

If concomitant dosing of a strong CYP3A4 inducer is discontinued, decrease WAKIX dosage by half

Centrally Acting H₁ Receptor Antagonists

Examples:

Certain antihistamines²: Diphenhydramine, Pheniramine maleate, Promethazine
Certain tri- or tetracyclic antidepressants: Clomipramine,³ Imipramine,³ Mirtazapine^3,4

Concomitant use of WAKIX with centrally acting histamine 1 (H₁) receptor antagonists may reduce the effectiveness of WAKIX

Avoid use of centrally acting H₁ receptor antagonists

Drugs Known to Prolong the QT Interval

Examples⁵:

Class 1A antiarrhythmics: Disopyramide, Procainamide, Quinidine
Class 3 antiarrhythmics: Amiodarone, Sotalol
Certain antipsychotics: Chlorpromazine, Thioridazine, Ziprasidone
Certain antibiotics: Moxifloxacin

Concomitant use of WAKIX with drugs that prolong the QT interval may add to the QT effects of WAKIX and increase the risk of cardiac arrhythmia

Avoid use of WAKIX in combination with other drugs known to prolong the QT interval

Sensitive CYP3A4 Substrates

Examples:

Cyclosporine,⁶ Hormonal contraceptives, Midazolam¹

Concomitant use of WAKIX with sensitive CYP3A4 substrates may reduce the effectiveness of sensitive CYP3A4 substrates

The effectiveness of hormonal contraceptives may be reduced during treatment with WAKIX and for 21 days after discontinuing therapy

Patients using hormonal contraception should be advised to use an alternative non-hormonal contraceptive method during treatment with WAKIX and for at least 21 days after discontinuation of WAKIX

Dosage Modifications for Concomitant Use With Strong CYP2D6 Inhibitors

Concomitant administration of WAKIX with strong CYP2D6 inhibitors increases WAKIX exposure by 2.2-fold

Examples¹:
Bupropion, Paroxetine

Initiating WAKIX in adult patients on strong CYP2D6 inhibitors

Dosing recommendation for WAKIX with strong CYP2D6 inhibitors in adult patients graphic

Initiating WAKIX in pediatric patients (6 years and older) on strong CYP2D6 inhibitors

Dosing recommendation for WAKIX with strong CYP2D6 inhibitors in pediatric patients less than 40 kg graphic

Dosing recommendation for WAKIX with strong CYP2D6 inhibitors in pediatric patients 40 kg or above graphic

Initiating strong CYP2D6 inhibitors in patients on a stable dose of WAKIX

For adult and pediatric patients on a stable dose of WAKIX: Reduce the WAKIX dose by half upon initiating strong CYP2D6 inhibitors

Dosage Modifications for Concomitant Use With Strong CYP3A4 Inducers

Concomitant use of WAKIX with strong CYP3A4 inducers decreases WAKIX exposure by 50%

Examples¹:
Carbamazepine, Phenytoin, Rifampin

Initiating strong CYP3A4 inducers in patients on a stable dose of WAKIX

Assess for loss of efficacy of WAKIX after initiation of a strong CYP3A4 inducer

Dosing recommendation for WAKIX with strong CYP3A4 inducers graphic

Discontinuing concomitant strong CYP3A4 inducers in patients on a stable dose of WAKIX

If concomitant dosing of a strong CYP3A4 inducer is discontinued, decrease WAKIX dosage by half

Examples:
Certain antihistamines²: Diphenhydramine, Pheniramine maleate, Promethazine
Certain tri- or tetracyclic antidepressants: Clomipramine,³ Imipramine,³ Mirtazapine^3,4

Concomitant use of WAKIX with centrally acting histamine 1 (H₁) receptor antagonists may reduce the effectiveness of WAKIX

Avoid use of centrally acting H₁ receptor antagonists

Examples⁵:
Class 1A antiarrhythmics: Disopyramide, Procainamide, Quinidine
Class 3 antiarrhythmics: Amiodarone, Sotalol
Certain antipsychotics: Chlorpromazine, Thioridazine, Ziprasidone
Certain antibiotics: Moxifloxacin

Concomitant use of WAKIX with drugs that prolong the QT interval may add to the QT effects of WAKIX and increase the risk of cardiac arrhythmia

Avoid use of WAKIX in combination with other drugs known to prolong the QT interval

Examples:
Cyclosporine,⁶ Hormonal contraceptives, Midazolam¹

Concomitant use of WAKIX with sensitive CYP3A4 substrates may reduce the effectiveness of sensitive CYP3A4 substrates

The effectiveness of hormonal contraceptives may be reduced during treatment with WAKIX and for 21 days after discontinuing therapy

Patients using hormonal contraception should be advised to use an alternative non-hormonal contraceptive method during treatment with WAKIX and for at least 21 days after discontinuation of WAKIX

Starting patients on WAKIX »

Important Safety Information

Contraindications

WAKIX is contraindicated in patients with known hypersensitivity to pitolisant or any component of the formulation. Anaphylaxis has been reported. WAKIX is also contraindicated in patients with severe hepatic impairment.

WAKIX is indicated for the treatment of excessive daytime sleepiness (EDS) or cataplexy in patients 6 years of age and older with narcolepsy.

Important Safety Information

Contraindications

Important Safety Information

Contraindications

Warnings and Precautions

WAKIX prolongs the QT interval. Avoid use of WAKIX in patients with known QT prolongation or in combination with other drugs known to prolong the QT interval. Avoid use in patients with a history of cardiac arrhythmias, as well as other circumstances that may increase the risk of the occurrence of torsade de pointes or sudden death, including symptomatic bradycardia, hypokalemia or hypomagnesemia, and the presence of congenital prolongation of the QT interval.

The risk of QT prolongation may be greater in patients with higher concentrations of pitolisant (e.g., patients with hepatic or renal impairment). Monitor patients with hepatic or renal impairment for increased QTc. Dosage modification is recommended in patients with moderate hepatic impairment and moderate or severe renal impairment. WAKIX is contraindicated in patients with severe hepatic impairment and not recommended in patients with end-stage renal disease (ESRD).

Dosing & Drug Interactions

Dosing WAKIX With Other Medications

Some medications have clinically important drug interactions with WAKIX

Dosage Modifications for Concomitant Use With Strong CYP2D6 Inhibitors

Concomitant administration of WAKIX with strong CYP2D6 inhibitors increases WAKIX exposure by 2.2-fold

Initiating WAKIX in adult patients on strong CYP2D6 inhibitors

Initiating WAKIX in pediatric patients (6 years and older) on strong CYP2D6 inhibitors

Initiating strong CYP2D6 inhibitors in patients on a stable dose of WAKIX

For adult and pediatric patients on a stable dose of WAKIX: Reduce the WAKIX dose by half upon initiating strong CYP2D6 inhibitors

Dosage Modifications for Concomitant Use With Strong CYP3A4 Inducers

Concomitant use of WAKIX with strong CYP3A4 inducers decreases WAKIX exposure by 50%

Initiating strong CYP3A4 inducers in patients on a stable dose of WAKIX

Assess for loss of efficacy of WAKIX after initiation of a strong CYP3A4 inducer

Discontinuing concomitant strong CYP3A4 inducers in patients on a stable dose of WAKIX

If concomitant dosing of a strong CYP3A4 inducer is discontinued, decrease WAKIX dosage by half

Concomitant use of WAKIX with centrally acting histamine 1 (H1) receptor antagonists may reduce the effectiveness of WAKIX

Avoid use of centrally acting H1 receptor antagonists

Concomitant use of WAKIX with drugs that prolong the QT interval may add to the QT effects of WAKIX and increase the risk of cardiac arrhythmia

Avoid use of WAKIX in combination with other drugs known to prolong the QT interval

Concomitant use of WAKIX with sensitive CYP3A4 substrates may reduce the effectiveness of sensitive CYP3A4 substrates

The effectiveness of hormonal contraceptives may be reduced during treatment with WAKIX and for 21 days after discontinuing therapy

Patients using hormonal contraception should be advised to use an alternative non-hormonal contraceptive method during treatment with WAKIX and for at least 21 days after discontinuation of WAKIX

Dosage Modifications for Concomitant Use With Strong CYP2D6 Inhibitors

Concomitant administration of WAKIX with strong CYP2D6 inhibitors increases WAKIX exposure by 2.2-fold

Initiating WAKIX in adult patients on strong CYP2D6 inhibitors

Initiating WAKIX in pediatric patients (6 years and older) on strong CYP2D6 inhibitors

Initiating strong CYP2D6 inhibitors in patients on a stable dose of WAKIX

For adult and pediatric patients on a stable dose of WAKIX: Reduce the WAKIX dose by half upon initiating strong CYP2D6 inhibitors

Dosage Modifications for Concomitant Use With Strong CYP3A4 Inducers

Concomitant use of WAKIX with strong CYP3A4 inducers decreases WAKIX exposure by 50%

Initiating strong CYP3A4 inducers in patients on a stable dose of WAKIX

Assess for loss of efficacy of WAKIX after initiation of a strong CYP3A4 inducer

Discontinuing concomitant strong CYP3A4 inducers in patients on a stable dose of WAKIX

If concomitant dosing of a strong CYP3A4 inducer is discontinued, decrease WAKIX dosage by half

Concomitant use of WAKIX with centrally acting histamine 1 (H1) receptor antagonists may reduce the effectiveness of WAKIX

Avoid use of centrally acting H1 receptor antagonists

Concomitant use of WAKIX with drugs that prolong the QT interval may add to the QT effects of WAKIX and increase the risk of cardiac arrhythmia

Avoid use of WAKIX in combination with other drugs known to prolong the QT interval

Concomitant use of WAKIX with sensitive CYP3A4 substrates may reduce the effectiveness of sensitive CYP3A4 substrates

The effectiveness of hormonal contraceptives may be reduced during treatment with WAKIX and for 21 days after discontinuing therapy

Patients using hormonal contraception should be advised to use an alternative non-hormonal contraceptive method during treatment with WAKIX and for at least 21 days after discontinuation of WAKIX

Indications and Usage

Important Safety Information

Important Safety Information

Indications and Usage

Important Safety Information

References

Concomitant use of WAKIX with centrally acting histamine 1 (H₁) receptor antagonists may reduce the effectiveness of WAKIX

Avoid use of centrally acting H₁ receptor antagonists

Concomitant use of WAKIX with centrally acting histamine 1 (H₁) receptor antagonists may reduce the effectiveness of WAKIX

Avoid use of centrally acting H₁ receptor antagonists