pitolisant pitolisant pitolisant, sold under the brand name wakix among others, is a medication for the treatment of excessive daytime sleepiness in adults with narcolepsy. it is a histamine 3 (h3) receptor antagonist/inverse agonist. it represents the first commercially available medication in its class. pitolisant enhances the activity of histaminergic neurons in the brain that function to improve a person's wakefulness. pitolisantclinical datatrade nameswakix, ozawadeother namestiprolisant; ciproxidine; bf2.649ahfs/drugs.commonographmedlineplusa619055license data eu ema: by inn us dailymed: pitolisant routes ofadministrationby mouthdrug classhistamine h3 receptor inverse agonistsatc coden07xx11 (who) legal statuslegal status ca: ℞-only us: ℞-only eu: rx-only identifiers iupac name 1-propyl]piperidine cas number362665-56-3 nhcl: 903576-44-3 npubchem cid9948102drugbankdb11642hcl: dbsalt002888chemspider8123714 yhcl: 9726467unii4bc83l4piyhcl: yv33ch63hi ykeggd10749 nhcl: d11490 nchebichebi:134709 ychemblchembl462605 ycomptox dashboard (epa)dtxsid30957654 chemical and physical dataformulac17h26clnomolar mass295.85 g·mol−13d model (jsmol)interactive image smiles c1ccn(cc1)cccocccc2=cc=c(c=c2)cl inchi inchi=1s/c17h26clno/c18-17-9-7-16(8-10-17)6-4-14-20-15-5-13-19-11-2-1-3-12-19/h7-10h,1-6,11-15h2 ykey:nnachaucxxvjsp-uhfffaoysa-n y ny (what is this?) (verify) the most common side effects include difficulty sleeping, nausea, and feeling worried. the u.s. food and drug administration (fda) considers it to be a first-in-class medication. medical uses pitolisant (wakix) is used in adults for the treatment of narcolepsy. narcolepsy is a chronic sleep disorder that causes overwhelming daytime drowsiness. pitolisant (ozawade) is indicated to improve alertness and reduce excessive daytime sleepiness in adults with obstructive sleep apnea. side effects the most common side effects include insomnia (difficulty sleeping), headache, nausea (feeling sick), anxiety, irritability, dizziness, depression, tremor, sleep disorders, tiredness, vomiting, vertigo (a spinning sensation) and dyspepsia (heartburn). serious but rare side effects are abnormal loss of weight and spontaneous abortion. pharmacology pitolisant is an inverse agonist of the histamine 3 (h3) autoreceptor. the h3 autoreceptors regulate histaminergic activity in the central nervous system (and to a lesser extent, the peripheral nervous system) by inhibiting histamine synthesis and release upon binding to endogenous histamine. by preventing the binding of endogenous histamine at the h3, as well as producing a response opposite to that of endogenous histamine at the receptor (inverse agonism) pitolisant enhances histaminergic activity in the brain. history pitolisant was developed by jean-charles schwartz, walter schunack, and colleagues after the former discovered the h3 receptor. it was the first h3 receptor inverse agonist to be tested in humans or introduced for clinical use. it is marketed in the european union by bioprojet pharma. it was approved for medical use in the european union in march 2016. the fda approved pitolisant for excessive daytime sleepiness in participants with narcolepsy based primarily on evidence from two trials (trial 1/nct01067222, trial 2/nct01638403). an additional trial (trial 3/nct01800045), in which participants with a different type of narcolepsy were exposed to the same dose of pitolisant, was used to add data for evaluation of side effects. the trials were conducted in europe and south america. the two primary trials enrolled adults with narcolepsy and excessive daytime sleepiness. participants received pitolisant, placebo, or an approved drug for narcolepsy for eight weeks. for participants receiving pitolisant, the dose could be increased during the first three weeks but had to remain the same for the next five weeks. neither the participants nor the healthcare providers knew which treatment was being given during the trial. the benefit of pitolisant was evaluated by comparing changes in daytime sleepiness during the trial between pitolisant- and placebo-treated participants. to measure the daytime sleepiness, the investigators used a scale called the epworth sleepiness scale (ess). the ess asks participants to rate the likelihood that they would fall asleep while doing eight daily activities (such as sitting and reading or watching television). participants rate each item from zero (would never doze) to three (high chance of dozing). pitolisant was approved by the u.s. food and drug administration (fda) in august 2019. it was granted orphan drug designation for the treatment of narcolepsy, fast track designation for the treatment of excessive daytime sleepiness and cataplexy in people with narcolepsy, and breakthrough therapy designation for the treatment of cataplexy in people with narcolepsy.