Alkermes PlcNASDAQ: ALKS

Alkermes to Present New Data on Alixorexton and LUMRYZ® (sodium oxybate) at Sleep Europe 2026, Underscoring Leadership in Sleep Medicine Research

· Issued by Alkermes Plc via Business Wire

DUBLIN--(BUSINESS WIRE)--Alkermes plc (Nasdaq: ALKS) today announced plans to present two oral presentations and six posters from its industry-leading portfolio of sleep medicine research at the European Sleep Research Society’s (ESRS) 28th Congress, Sleep Europe 2026, taking place Oct. 20-23, 2026 in Maastricht, the Netherlands. The company will present new data related to LUMRYZ® (sodium oxybate) extended-release oral suspension, now part of Alkermes’ sleep portfolio following the acquisition of Avadel Pharmaceuticals plc, and alixorexton, Alkermes’ novel, investigational, oral, selective orexin 2 receptor (OX2R) agonist in development for the treatment of narcolepsy type 1 (NT1), narcolepsy type 2 (NT2) and idiopathic hypersomnia (IH).

In an oral presentation, the company will present findings from the Vibrance‑1 phase 2 study of alixorexton in adults with NT1, which were recently published in The Lancet Neurology. The presentation will also include data from the open-label, long-term extension study evaluating the safety and durability of effect in participants with NT1 and NT2 who received alixorexton for up to nine months of treatment.

“I am pleased to present results from the Vibrance-1 phase 2 study and long-term extension evaluating alixorexton in patients with narcolepsy type 1 and type 2 at Sleep Europe. Together, these results further characterize the potential of alixorexton in narcolepsy and provide evidence supporting sustained clinical benefit with longer-term treatment,” said Giuseppe Plazzi, M.D., Ph.D., Neurologist, Director of the Narcolepsy Center at the IRCCS of the Neurological Sciences of Bologna and Professor of Childhood Neuropsychiatry at the University of Modena and Reggio Emilia.

In a separate oral presentation and corresponding poster presentation within the “Impactful Clinical Trial” session, the company will share detailed results from the phase 3 REVITALYZ study evaluating the investigational use of LUMRYZ in adults with IH. The Company previously announced positive topline results for this study.

“I am honored to present results from the REVITALYZ phase 3 trial evaluating LUMRYZ in adults with idiopathic hypersomnia, a chronic neurological disorder for which there are limited treatment options. It is an exciting time in sleep medicine, and the research being presented at Sleep Europe 2026 underscores the significant scientific progress we are seeing across narcolepsy and idiopathic hypersomnia,” said Richard Bogan, M.D., FCCP, FAASM, Principal of Bogan Sleep Consultants, LLC and Associate Clinical Professor at the University of South Carolina School of Medicine.

Additional highlights to be shared in poster presentations at Sleep Europe 2026 include:

  • Results from an interim analysis of the ongoing open-label, long-term extension (LTE) study evaluating the safety and maintenance of effect of alixorexton in adults with NT1 and NT2 at week 24 of the LTE, approximately nine months after the first dose for participants treated with alixorexton in the randomized double-blind period of the Vibrance-1 and Vibrance-2 phase 2 studies;
  • Exploratory findings from the Vibrance-2 phase 2 study evaluating the impact of alixorexton compared to placebo on patient-reported measures of cognition and fatigue in adults with NT2;
  • Detailed study designs and methods for the Brilliance Studies, a phase 3 clinical trial program evaluating the safety and efficacy of alixorexton compared to placebo in adults with NT1 and NT2; and
  • Findings from REFRESH, a prospective multicenter, real-world study in adults with narcolepsy, including patients who switched to LUMRYZ from a twice-nightly oxybate and patients new to oxybate treatment or returning to oxybate treatment after previously discontinuing a twice-nightly oxybate.

“The breadth of data being presented by Alkermes at Sleep Europe 2026 reflects both the strength of our research programs and our leadership in the field of sleep medicine. We look forward to sharing detailed findings from the REVITALYZ phase 3 study of LUMRYZ in patients with idiopathic hypersomnia, as well as initial data from our long-term extension study evaluating the durability of effect of alixorexton in patients with narcolepsy type 1 and type 2,” said Craig Hopkinson, M.D. (MBChB), Chief Medical Officer and Executive Vice President, Research & Development at Alkermes. “Through our ongoing investment in scientific innovation across narcolepsy type 1, narcolepsy type 2 and idiopathic hypersomnia, we aim to help advance differentiated treatment approaches and address the diverse needs of people living with these serious neurological conditions.”

Details of Alkermes’ presentations at Sleep Europe 2026 are as follows:

REVITALYZ: A Phase 3, Double-Blind, Placebo-Controlled, Randomised Withdrawal Trial of Extended-Release Sodium Oxybate for Idiopathic Hypersomnia

  • Presenter: Richard Bogan, M.D., FCCP, FAASM, Principal of Bogan Sleep Consultants, LLC and Associate Clinical Professor at the University of South Carolina School of Medicine
  • Presentation Date: The oral presentation is scheduled to occur on Friday, Oct. 23, 2026 from 12:10–12:30 CEST as part of the “Impactful Clinical Trial Session 1.” The corresponding poster (F314) will be presented on Friday, Oct. 23, 2026 from 12:30–13:30 CEST.

Phase 2 and Long-term Extension Results from Treatment With the Orexin 2 Receptor Agonist Alixorexton Demonstrated Clinically Meaningful Improvements in Symptoms of Narcolepsy Type 1 and 2

  • Presenter: Giuseppe Plazzi, M.D., Ph.D., Head of the Sleep Center at the Institute of Neurological Sciences of Bologna, Italy and Chair of Child Neurology at the University of Modena and Reggio Emilia
  • Presentation Date: The oral presentation is scheduled to occur on Friday, Oct. 23, 2026 from 15:55–16:15 CEST as part of the “Hot Topics in Sleep Science and Medicine” session.

Long-Term Safety, Tolerability, and Durability of Alixorexton: Interim Results from a Phase 2/3 Extension Study in Narcolepsy

  • Poster ID: F304
  • Presenter: Yves Dauvilliers, M.D., Ph.D., Professor of Neurology and Physiology, and Director of the Sleep-Wake Disorders Center at the University of Montpellier, France, and Coordinator of the French National Reference Center for Rare Diseases dedicated to narcolepsy and hypersomnia
  • Presentation Date: The poster will be presented on Friday, Oct. 23, 2026 from 12:30–13:30 CEST.

Participant-Reported Cognitive Functioning and Fatigue in Participants with Narcolepsy Type 2 Treated With Alixorexton, an Orexin 2 Receptor Agonist, in the Vibrance-2 Study

  • Poster ID: W339
  • Presenter: Richard Bogan, M.D., FCCP, FAASM, Principal of Bogan Sleep Consultants, LLC and Associate Clinical Professor at the University of South Carolina School of Medicine
  • Presentation Date: The poster will be presented on Wednesday, Oct. 21, 2026 from 12:30–13:30 CEST.

Study Design for 2 Phase 3, Randomised, Double-Blind, Placebo-Controlled Studies Evaluating Alixorexton in Patients With Narcolepsy Type 1: The Brilliance NT1 Studies

  • Poster ID: W338
  • Presenter: Julie Himes, M.D., Alkermes
  • Presentation Date: Presentation Date: The poster will be presented on Wednesday, Oct. 21, 2026 from 12:30–13:30 CEST.

Study Design for a Phase 3, Randomised, Double-Blind, Placebo-Controlled Study Evaluating Alixorexton in Patients With Narcolepsy Type 2: The Brilliance NT2 Study

  • Poster ID: W337
  • Presenter: Juan Chavez, M.D., Alkermes
  • Presentation Date: The poster will be presented on Wednesday, Oct. 21, 2026 from 12:30–13:30 CEST.

Real-World Experience of Once-Nightly Sodium Oxybate Treatment in People With Narcolepsy: Final Results From REFRESH

  • Poster ID: T340
  • Presenter: Jeremy McConnell, M.D., Florida Sleep Specialists
  • Presentation Date: The poster will be presented on Thursday, Oct. 22, 2026 from 12:30–13:30 CEST.

About Alixorexton
Alixorexton (formerly referred to as ALKS 2680) is a novel, investigational, oral, selective orexin 2 receptor (OX2R) agonist in development for the treatment of narcolepsy type 1 (NT1), narcolepsy type 2 (NT2) and idiopathic hypersomnia (IH). Orexin, a neuropeptide produced in the lateral hypothalamus, is considered to be the master regulator of wakefulness due to its activation of multiple, downstream wake-promoting pathways that project widely throughout the brain.1 Targeting the orexin system may address excessive daytime sleepiness across hypersomnolence disorders, whether or not orexin deficiency is the underlying cause of disease.2 Once-daily oral administration of alixorexton was previously evaluated in a phase 1 study in healthy volunteers and patients with NT1, NT2 and IH, and in Vibrance-1 and Vibrance-2, phase 2 studies in patients with NT1 and NT2, respectively. Alixorexton is currently being evaluated in the phase 3 Brilliance Studies in patients with NT1 and NT2, and in the phase 2 Vibrance-3 study in patients with IH. The U.S. Food and Drug Administration (FDA) has granted alixorexton Breakthrough Therapy designation for the treatment of NT1 and Orphan Drug Designation (ODD) for the treatment of IH. The European Commission has granted ODD to alixorexton for the treatment of narcolepsy.

About LUMRYZ® (sodium oxybate) for extended-release oral suspension
LUMRYZ (sodium oxybate) for extended-release oral suspension is a central nervous system depressant indicated for the treatment of cataplexy or excessive daytime sleepiness (EDS) in patients 7 years of age and older with narcolepsy. LUMRYZ is not currently approved by regulatory authorities for the treatment of idiopathic hypersomnia (IH). Pursuant to the terms of a previously disclosed settlement and license agreement, Alkermes may not market, offer for sale, take orders for, distribute, promote, or provide patient support services with respect to LUMRYZ for IH before March 1, 2028, even if LUMRYZ were to receive FDA approval for IH prior to that date.

IMPORTANT SAFETY INFORMATION

WARNING: CENTRAL NERVOUS SYSTEM (CNS) DEPRESSION and ABUSE AND MISUSE

Central Nervous System Depression
LUMRYZ® (sodium oxybate) is a CNS depressant. Clinically significant respiratory depression and obtundation may occur in patients treated with LUMRYZ at recommended doses. Many patients who received LUMRYZ during clinical trials in narcolepsy were receiving CNS stimulants.

Abuse and Misuse
LUMRYZ (sodium oxybate) is the sodium salt of gamma-hydroxybutyrate (GHB). Abuse or misuse of illicit GHB, either alone or in combination with other CNS depressants, is associated with CNS adverse reactions, including seizure, respiratory depression, decreased consciousness, coma, and death.

Because of the risks of CNS depression and abuse and misuse, LUMRYZ is available only through a restricted program under a Risk Evaluation and Mitigation Strategy (REMS) called the LUMRYZ REMS. 

CONTRAINDICATIONS
LUMRYZ is contraindicated for use in:

  • combination with sedative hypnotics or alcohol
  • patients with succinic semialdehyde dehydrogenase deficiency

WARNINGS AND PRECAUTIONS
Central Nervous System Depression
The concurrent use of LUMRYZ with other CNS depressants, including but not limited to opioid analgesics, benzodiazepines, sedating antidepressants or antipsychotics, sedating antiepileptic drugs, general anesthetics, muscle relaxants, and/or illicit CNS depressants, may increase the risk of respiratory depression, hypotension, profound sedation, syncope, and death. If use of these CNS depressants in combination with LUMRYZ is required, dose reduction or discontinuation of one or more CNS depressants (including LUMRYZ) should be considered. In addition, if short-term use of an opioid (eg, post- or perioperative) is required, interruption of treatment with LUMRYZ should be considered.

After first initiating treatment and until certain that LUMRYZ does not affect them adversely (eg, impair judgment, thinking, or motor skills), caution patients against engaging in hazardous activities requiring complete mental alertness or motor coordination such as operating hazardous machinery, including automobiles or airplanes. Also caution patients against engaging in these hazardous activities for at least six (6) hours after taking LUMRYZ. Patients should be queried about CNS depression-related events upon initiation of LUMRYZ therapy and periodically thereafter.

Abuse and Misuse
LUMRYZ is a Schedule III controlled substance. The active ingredient of LUMRYZ, sodium oxybate, is the sodium salt of gamma-hydroxybutyrate (GHB), a Schedule I controlled substance. Abuse of illicit GHB, either alone or in combination with other CNS depressants, is associated with CNS adverse reactions, including seizure, respiratory depression, decreases in the level of consciousness, coma, and death. The rapid onset of sedation, coupled with the amnestic features of GHB, particularly when combined with alcohol, has proven to be dangerous for the voluntary and involuntary user (eg, assault victim). Physicians should carefully evaluate patients for a history of drug abuse and follow such patients closely.

LUMRYZ REMS
LUMRYZ is available only through a restricted distribution program called the LUMRYZ REMS because of the risks of central nervous system depression and abuse and misuse.

Notable requirements of the LUMRYZ REMS include the following:

  • Healthcare providers who prescribe LUMRYZ are specially certified.
  • LUMRYZ will be dispensed only by pharmacies that are specially certified.
  • LUMRYZ will be dispensed and shipped only to patients who are enrolled in the LUMRYZ REMS with documentation of safe use conditions.

Further information is available at www.LUMRYZREMS.com or by calling 1-877-453-1029.

Respiratory Depression and Sleep-Disordered Breathing
LUMRYZ may impair respiratory drive, especially in patients with compromised respiratory function. In overdoses of oxybate with illicit use of GHB, life-threatening respiratory depression has been reported. Increased apnea and reduced oxygenation may occur with LUMRYZ administration. A significant increase in the number of central apneas and clinically significant oxygen desaturation may occur in patients with obstructive sleep apnea treated with LUMRYZ. Prescribers should be aware that sleep-related breathing disorders tend to be more prevalent in obese patients, in men, in postmenopausal women not on hormone replacement therapy, and among patients with narcolepsy.

Depression and Suicidality
Depression, and suicidal ideation and behavior, can occur in patients treated with LUMRYZ. In an adult clinical trial in patients with narcolepsy (n=212), there were no suicide attempts, but one patient with a history of depression and anxiety developed suicidal ideation in the LUMRYZ-treated group. In a clinical trial in pediatric narcolepsy patients administered immediate-release sodium oxybate, one patient experienced suicidal ideation and two patients reported depression. The emergence of depression in patients treated with LUMRYZ requires careful and immediate evaluation. Patients with a previous history of a depressive illness and/or a suicide attempt should be monitored carefully for the emergence of depressive symptoms while taking LUMRYZ.

Other Behavioral or Psychiatric Adverse Reactions
Other behavioral and psychiatric adverse reactions can occur in patients taking LUMRYZ. During adult clinical trials in patients with narcolepsy administered LUMRYZ, 2% of 107 patients treated with LUMRYZ experienced a confusional state. No patients treated with LUMRYZ discontinued treatment because of confusion. Anxiety occurred in 7.5% of 107 patients treated with LUMRYZ in the adult trial in patients with narcolepsy. Other psychiatric reactions reported in adult clinical trials in patients with narcolepsy administered LUMRYZ included irritability, emotional disorder, panic attack, agitation, delirium, and obsessive thoughts. Other neuropsychiatric reactions reported in adult clinical trials in patients with narcolepsy administered immediate-release sodium oxybate and in the postmarketing setting for immediate-release sodium oxybate include hallucinations, paranoia, psychosis, aggression, and agitation. In a clinical trial in pediatric patients administered immediate-release sodium oxybate, neuropsychiatric reactions including acute psychosis, confusion, and anxiety were reported. The emergence or increase in the occurrence of behavioral or psychiatric events in patients taking LUMRYZ should be carefully monitored.

Parasomnias
Parasomnias can occur in patients taking LUMRYZ. Sleepwalking, defined as confused behavior occurring at night and at times associated with wandering, was reported in 3% of 107 adult patients with narcolepsy treated with LUMRYZ. No patients treated with LUMRYZ discontinued due to sleepwalking. Episodes of sleepwalking should be fully evaluated and appropriate interventions considered.

Use in Patients Sensitive to High Sodium Intake
LUMRYZ has a high sodium content. In patients sensitive to sodium intake (eg, those with heart failure, hypertension, or renal impairment), consider the amount of daily sodium intake in each dose of LUMRYZ.

MOST COMMON ADVERSE REACTIONS
Most common adverse reactions (incidence ≥5% and greater than placebo) reported for any dose of LUMRYZ in a trial of adults with narcolepsy were nausea, dizziness, enuresis, headache, and vomiting. Similarly, in a trial of pediatric narcolepsy patients receiving immediate-release sodium oxybate, the most commonly observed adverse reactions (incidence ≥5%) were nausea, enuresis, vomiting, headache, decreased weight, decreased appetite, dizziness, and sleepwalking.

ADDITIONAL ADVERSE REACTIONS
Additional adverse reactions that occurred in ≥2% of adult patients with narcolepsy treated with LUMRYZ and were more frequent in the LUMRYZ treatment group than with placebo were vomiting, nausea, decreased weight, decreased appetite, dizziness, somnolence, headache, enuresis, anxiety, and somnambulism.

DRUG INTERACTIONS
LUMRYZ is contraindicated for use in combination with alcohol or sedative hypnotics. Use of other CNS depressants may potentiate the CNS-depressant effects of LUMRYZ.

PREGNANCY AND LACTATION
There are no adequate data on the developmental risk associated with the use of sodium oxybate in pregnant women. LUMRYZ should be used during pregnancy only if the potential benefit justifies the potential risk to the fetus. GHB is excreted in human milk after oral administration of sodium oxybate. There is insufficient information on the risk to a breastfed infant, and there is insufficient information on milk production in nursing mothers. The developmental and health benefits of breastfeeding should be considered along with the mother’s clinical need for LUMRYZ and any potential adverse effects on the breastfed infant from LUMRYZ or from the underlying maternal condition.

PEDIATRIC USE
LUMRYZ has not been studied in a pediatric clinical trial for narcolepsy. The safety and effectiveness of LUMRYZ in the treatment of cataplexy or excessive daytime sleepiness in pediatric patients 7 years of age and older with narcolepsy is supported by evidence from a double-blind, placebo-controlled, randomized-withdrawal study of immediate-release sodium oxybate. Safety and effectiveness of LUMRYZ in pediatric patients below the age of 7 years have not been established.

GERIATRIC USE
Dose selection for an elderly patient should be cautious, usually starting at the low end of the dosing range, reflecting the greater frequency of decreased hepatic, renal, or cardiac function, and of concomitant disease or other drug therapy.

HEPATIC IMPAIRMENT
LUMRYZ should not be initiated in patients with hepatic impairment because appropriate dosage adjustments for initiation cannot be made with the available dosage strengths. Patients with hepatic impairment who have been titrated to a maintenance dosage of another oxybate product can be switched to LUMRYZ if the appropriate dosage strength is available.

DEPENDENCE AND TOLERANCE
There have been case reports of withdrawal, ranging from mild to severe, following discontinuation of illicit use of GHB at frequent repeated doses (18 g to 250 g per day) in excess of the recommended dosage range. Signs and symptoms of GHB withdrawal following abrupt discontinuation included insomnia, restlessness, anxiety, psychosis, lethargy, nausea, tremor, sweating, muscle cramps, tachycardia, headache, dizziness, rebound fatigue and sleepiness, confusion, and, particularly in the case of severe withdrawal, visual hallucinations, agitation, and delirium. These symptoms generally abated in three (3) to fourteen (14) days. In cases of severe withdrawal, hospitalization may be required. The discontinuation effects of LUMRYZ have not been systematically evaluated in controlled clinical trials.

Tolerance to LUMRYZ has not been systematically studied in controlled clinical trials. There have been some case reports of symptoms of tolerance developing after illicit use at dosages far in excess of the recommended LUMRYZ dosage regimen.

Please see full Prescribing Information, including BOXED Warning.

About Alkermes plc
Alkermes plc (Nasdaq: ALKS), a mid-cap growth and value equity, is a global biopharmaceutical company that seeks to develop innovative medicines in the field of neuroscience. The company has a portfolio of proprietary commercial products for the treatment of alcohol dependence, opioid dependence, schizophrenia, bipolar I disorder and narcolepsy. Alkermes’ pipeline includes late-stage clinical candidates in development for narcolepsy and idiopathic hypersomnia, and orexin 2 receptor agonists in early clinical development for other neurological disorders, including attention-deficit hyperactivity disorder (ADHD) and fatigue associated with multiple sclerosis and Parkinson’s disease. Headquartered in Ireland, Alkermes also has a corporate office and research and development center in Massachusetts and a manufacturing facility in Ohio. For more information, please visit Alkermes’ website at www.alkermes.com.

Note Regarding Forward-Looking Statements
Certain statements set forth in this press release constitute “forward-looking statements” within the meaning of the Private Securities Litigation Reform Act of 1995, as amended, including, but not limited to, statements concerning: the potential therapeutic and commercial value of alixorexton and LUMRYZ. The company cautions that forward-looking statements are inherently uncertain. Although the company believes that such statements are based on reasonable assumptions within the bounds of its knowledge of its business and operations, the forward-looking statements are neither promises nor guarantees and they are necessarily subject to a high degree of uncertainty and risk. Actual performance and results may differ materially from those expressed or implied in the forward-looking statements due to various risks and uncertainties. These risks and uncertainties include, among others: clinical results for alixorexton and LUMRYZ may not be predictive of results of future stages of ongoing clinical studies, future clinical studies or real-world results; alixorexton or LUMRYZ may be shown to be ineffective or unsafe; the FDA may not agree with the company’s regulatory strategies or components of its development program for alixorexton or LUMRYZ in IH, including clinical trial designs, conduct and methodologies; clinical studies for alixorexton may not be initiated or completed on expected timelines or at all; potential changes in the cost, scope and duration of the alixorexton development program; and those risks and uncertainties described under the heading “Risk Factors” in the company’s Annual Report on Form 10-K for the year ended Dec. 31, 2025 and in subsequent filings made by the company with the U.S. Securities and Exchange Commission (SEC), which are available on the SEC’s website at www.sec.gov. Existing and prospective investors are cautioned not to place undue reliance on these forward-looking statements, which speak only as of the date hereof. Except as required by law, the company disclaims any intention or responsibility for updating or revising any forward-looking statements contained in this press release.

LUMRYZ® is a registered trademark, and REVITALYZ℠ is a service mark, of Flamel Ireland Limited, an affiliate of Alkermes plc.

1 Buysse, D. Diagnosis and assessment of sleep and circadian rhythm disorders. Journal of Psychiatric Practice. 2005; 11(2):102-115

2 Ten-Blanco M, Flores A, Cristino L, Pereda-Perez I. Targeting the orexin/hypocretin system for the treatment of neuropsychiatric and neurodegenerative diseases: From animal to clinical studies. Frontiers in Neuroendocrinology. 2023;69(101066). https://www.sciencedirect.com/science/article/pii/S0091302223000146

Attached document

Contents
  1. HIGHLIGHTS OF PRESCRIBING INFORMATION · page 1
  2. WARNING: CENTRAL NERVOUS SYSTEM (CNS) DEPRESSION AND ABUSE AND MISUSE · page 1
  3. Abuse and Misuse · page 1
  4. _________________ RECENT MAJOR CHANGES _________________ · page 1
  5. __________________INDICATIONS AND USAGE _________________ · page 1
  6. _______________DOSAGE AND ADMINISTRATION ______________ · page 1
  7. Important Administration Information · page 1
  8. _____________ DOSAGE FORMS AND STRENGTHS______________ · page 1
  9. ___________________ CONTRAINDICATIONS ___________________ · page 1
  10. _______________ _______________ WARNINGS AND PRECAUTIONS · page 1
  11. ___________________ ADVERSE REACTIONS ___________________ · page 1
  12. ______________ _______________ USE IN SPECIFIC POPULATIONS · page 1
  13. FULL PRESCRIBING INFORMATION: CONTENTS* · page 1
  14. WARNING: CENTRAL NERVOUS SYSTEM (CNS) DEPRESSION · page 1
  15. 1 INDICATIONS AND USAGE · page 1
  16. 2 DOSAGE AND ADMINISTRATION · page 1
  17. 3 DOSAGE FORMS AND STRENGTHS · page 1
  18. 5 WARNINGS AND PRECAUTIONS · page 1
  19. 6 ADVERSE REACTIONS · page 1
  20. DRUG INTERACTIONS · page 1
  21. USE IN SPECIFIC POPULATIONS · page 1
  22. 8.6 Hepatic Impairment 9 DRUG ABUSE AND DEPENDENCE · page 1
  23. 10 OVERDOSAGE 10.1 Human Experience · page 1
  24. 1 INDICATIONS AND USAGE · page 3
  25. 2 DOSAGE AND ADMINISTRATION · page 3
  26. 2.1 Adult Dosing Information · page 3
  27. 2.2 Pediatric Dosing Information · page 3
  28. Pediatric Patients 7 years and Older Weighing at least 45 kg · page 3
  29. Pediatric Patients 7 years and Older Weighing Less than 45 kg · page 4
  30. 2.3 Important Administration Instructions · page 4
  31. 2.4 Switching Patients from Immediate-Release Sodium Oxybate · page 4
  32. 3 DOSAGE FORMS AND STRENGTHS · page 4
  33. 4 CONTRAINDICATIONS · page 4
  34. 5 WARNINGS AND PRECAUTIONS · page 5
  35. 5.1 Central Nervous System Depression · page 5
  36. 5.2 Abuse and Misuse · page 5
  37. 5.3 LUMRYZ REMS · page 6
  38. 5.4 Respiratory Depression and Sleep-Disordered Breathing · page 6
  39. 5.5 Depression and Suicidality · page 7
  40. 5.6 Other Behavioral or Psychiatric Adverse Reactions · page 8
  41. 5.7 Parasomnias · page 8
  42. 5.8 Use in Patients Sensitive to High Sodium Intake · page 9
  43. 6 ADVERSE REACTIONS · page 9
  44. 6.1 Clinical Trials Experience · page 10
  45. Adult Patients · page 10
  46. Adverse Reactions Leading to Treatment Discontinuation · page 10
  47. Most Common Adverse Reactions · page 10
  48. Dose-Response Information · page 10
  49. Pediatric Patients (7 Years of Age and Older) · page 11
  50. Adverse Reactions Leading to Treatment Discontinuation · page 11
  51. Adverse Reactions in the Pediatric Clinical Trial · page 11
  52. 6.2 Postmarketing Experience · page 12
  53. 7 DRUG INTERACTIONS · page 12
  54. 7.1 Alcohol, Sedative Hypnotics, and CNS Depressants · page 12
  55. 8 USE IN SPECIFIC POPULATIONS · page 12
  56. 8.1 Pregnancy · page 12
  57. Risk Summary · page 12
  58. Clinical Considerations · page 12
  59. Labor or Delivery · page 12
  60. Data · page 13
  61. Animal Data · page 13
  62. 8.2 Lactation · page 13
  63. Risk Summary · page 13
  64. 8.4 Pediatric Use · page 13
  65. Juvenile Animal Toxicity Data · page 13
  66. 8.5 Geriatric Use · page 14
  67. 8.6 Hepatic Impairment · page 14
  68. 9 DRUG ABUSE AND DEPENDENCE · page 14
  69. 9.1 Controlled Substance · page 14
  70. 9.2 Abuse · page 14
  71. 9.3 Dependence · page 15
  72. Dependence · page 15
  73. Tolerance · page 15
  74. 10 OVERDOSAGE · page 16
  75. 10.1 Human Experience · page 16
  76. 10.2 Signs and Symptoms · page 16
  77. 10.3 Recommended Treatment of Overdose · page 16
  78. 10.4 Poison Control Center · page 17
  79. 11 DESCRIPTION · page 17
  80. 12 CLINICAL PHARMACOLOGY · page 17
  81. 12.1 Mechanism of Action · page 17
  82. 12.3 Pharmacokinetics · page 17
  83. Absorption · page 18
  84. Effect of Food · page 18
  85. Effect of Ethanol · page 18
  86. Effect of Water Temperature · page 18
  87. Effect of Water Flavoring · page 18
  88. Distribution · page 18
  89. Elimination · page 18
  90. Metabolism · page 18
  91. Excretion · page 19
  92. Specific Population · page 19
  93. Geriatric Patients · page 19
  94. Pediatric Patients · page 19
  95. Male and Female Patients · page 19
  96. Racial or Ethnic Groups · page 19
  97. Patients with Renal Impairment · page 19
  98. Patients with Hepatic Impairment · page 19
  99. Drug Interaction Studies · page 20
  100. 13 NONCLINICAL TOXICOLOGY · page 20
  101. 13.1 Carcinogenesis, Mutagenesis, Impairment of Fertility · page 20
  102. Carcinogenesis · page 20

Page 1

HIGHLIGHTS OF PRESCRIBING INFORMATION

These highlights do not include all the information needed to use LUMRYZ® safely and effectively. See full prescribing information for LUMRYZ.

LUMRYZ (sodium oxybate) for extended-release oral suspension, CIII Initial U.S. Approval: 2002

WARNING: CENTRAL NERVOUS SYSTEM (CNS) DEPRESSION AND ABUSE AND MISUSE

See full prescribing information for complete boxed warning. Central Nervous System Depression

• LUMRYZ is a CNS depressant, and respiratory depression can occur with LUMRYZ use (5.1, 5.4)

Abuse and Misuse

• LUMRYZ is the sodium salt of gamma-hydroxybutyrate (GHB). Abuse or misuse of illicit GHB is associated with CNS adverse reactions, including seizure, respiratory depression, decreased consciousness, coma, and death (5.2, 9.2)

LUMRYZ is available only through a restricted program called the LUMRYZ REMS (5.3)

_________________ RECENT MAJOR CHANGES _________________

Dosage and Administration (2.3) 11/2025

__________________INDICATIONS AND USAGE _________________

LUMRYZ is a central nervous system depressant indicated for the treatment of cataplexy or excessive daytime sleepiness (EDS) in patients 7 years of age and older with narcolepsy (1).

_______________DOSAGE AND ADMINISTRATION ______________

Dosing for Adults:

• Initiate dosage at 4.5 g once per night orally (2.1).

• Titrate to effect in increments of 1.5 g per night at weekly intervals (2.1).

• Recommended dosage range: 6 g to 9 g once per night orally (2.1).

Dosing for Pediatric Patients (7 Years of Age and Older):

• The recommended starting dosage, titration regimen, and maximum total nightly dosage are based on body weight (2.2)

• Pediatric patients 7 years and older weighing at least 45 kg: The recommended starting dosage is 4.5 g once per night. Increase the dosage by 1.5 g per night at weekly intervals to the maximum recommended dosage of 9 g once per night orally. The dosage may be gradually titrated based on efficacy and tolerability (2.2).

• Pediatric patients 7 years and older weighing less than 45 kg: Because the recommended starting dosage cannot be achieved with the available strengths of LUMRYZ, use another sodium oxybate product to initiate treatment (2.2).

Important Administration Information

• Prepare the dose of LUMRYZ prior to bedtime; suspend dose in approximately ⅓ cup of water (with or without calorie-free drink mix or flavored water enhancer) in the mixing cup provided (2.3).

• Allow 2 hours after eating before dosing (2.3).

• Take LUMRYZ while in bed and lie down after dosing (2.3).

_____________ DOSAGE FORMS AND STRENGTHS______________

For extended-release oral suspension: Packets of 4.5 g, 6 g, 7.5 g, or 9 g (3)

___________________ CONTRAINDICATIONS ___________________

• In combination with sedative hypnotics or alcohol (4).

• Succinic semialdehyde dehydrogenase deficiency (4).

_______________ _______________ WARNINGS AND PRECAUTIONS

• CNS depression: Use caution when considering the concurrent use of LUMRYZ with other CNS depressants (5.1).

• Caution patients against hazardous activities requiring complete mental alertness or motor coordination within the first 6 hours of dosing or after first initiating treatment until certain that LUMRYZ does not affect them adversely (5.1).

• Depression and suicidality: Monitor patients for emergent or increased depression and suicidality (5.5).

• Confusion/Anxiety: Monitor for impaired motor/cognitive function (5.6).

• Parasomnias: Evaluate episodes of sleepwalking (5.7).

• High sodium content in LUMRYZ: Monitor patients with heart failure, hypertension, or impaired renal function (5.8).

___________________ ADVERSE REACTIONS ___________________

Most common adverse reactions in adults (incidence ≥ 5% and greater than placebo) reported for any dose of LUMRYZ were nausea, dizziness, enuresis, headache, and vomiting (6.1).

Most common adverse reactions for pediatric patients (≥ 5%) in a study with immediate-release sodium oxybate were nausea, enuresis, vomiting, headache, weight decreased, decreased appetite, dizziness, and sleepwalking (6.1).

To report SUSPECTED ADVERSE REACTIONS, contact Alkermes, Inc. at 1-888-828-2335 or FDA at 1-800-FDA-1088 or www.fda.gov/medwatch.

______________ _______________ USE IN SPECIFIC POPULATIONS

• Pregnancy: Based on animal data, may cause fetal harm (8.1).

• Geriatric patients: Monitor for impaired motor and/or cognitive function when taking LUMRYZ (8.5).

• Hepatic Impairment: Because of an increase in exposure, LUMRYZ should not be initiated in patients with hepatic impairment because appropriate dosage adjustments for initiation of LUMRYZ cannot be made (8.6).

See 17 for PATIENT COUNSELING INFORMATION and Medication Guide.

Revised: 08/2026

FULL PRESCRIBING INFORMATION: CONTENTS*

WARNING: CENTRAL NERVOUS SYSTEM (CNS) DEPRESSION

AND ABUSE AND MISUSE.

1 INDICATIONS AND USAGE

2 DOSAGE AND ADMINISTRATION

2.1 Adult Dosing Information

2.2 Pediatric Dosing Information

2.3 Important Administration Instructions

2.4 Switching Patients from Immediate-Release Sodium Oxybate

3 DOSAGE FORMS AND STRENGTHS

4 CONTRAINDICATIONS

5 WARNINGS AND PRECAUTIONS

5.1 Central Nervous System Depression

5.2 Abuse and Misuse

5.3 LUMRYZ REMS

5.4 Respiratory Depression and Sleep-Disordered Breathing

5.5 Depression and Suicidality

5.6 Other Behavioral or Psychiatric Adverse Reactions

5.7 Parasomnias

5.8 Use in Patients Sensitive to High Sodium Intake

6 ADVERSE REACTIONS

6.1 Clinical Trials Experience

6.2 Postmarketing Experience

DRUG INTERACTIONS

7.1 Alcohol, Sedative Hypnotics, and CNS Depressants

USE IN SPECIFIC POPULATIONS

8.1 Pregnancy

8.2 Lactation

8.4 Pediatric Use 8.5 Geriatric Use

8.6 Hepatic Impairment 9 DRUG ABUSE AND DEPENDENCE

9.1 Controlled Substance

9.2 Abuse

9.3 Dependence

10 OVERDOSAGE 10.1 Human Experience

10.2 Signs and Symptoms

10.3 Recommended Treatment of Overdose 10.4 Poison Control Center

11 DESCRIPTION

12 CLINICAL PHARMACOLOGY

12.1 Mechanism of Action

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14 CLINICAL STUDIES

14.1 Cataplexy and Excessive Daytime Sleepiness (EDS) in Adult Narcolepsy

#### 16 HOW SUPPLIED/STORAGE AND HANDLING

16.1 How Supplied 16.2 Storage 16.3 Handling and Disposal 17 PATIENT COUNSELING INFORMATION

13 NONCLINICAL TOXICOLOGY 13.1 Carcinogenesis, Mutagenesis, Impairment of Fertility

14.2 Cataplexy and Excessive Daytime Sleepiness (EDS) in Pediatric Narcolepsy

*Sections or subsections omitted from the full prescribing information are not listed.

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FULL PRESCRIBING INFORMATION

WARNING: CENTRAL NERVOUS SYSTEM (CNS) DEPRESSION AND ABUSE AND MISUSE Central Nervous System Depression LUMRYZ (sodium oxybate) is a CNS depressant. Clinically significant respiratory depression and obtundation may occur in patients treated with LUMRYZ at recommended doses [see Warnings and Precautions (5.1)]. Many patients who received sodium oxybate during clinical trials in narcolepsy were receiving central nervous system stimulants [see Clinical Trials (14)]. Abuse and Misuse LUMRYZ (sodium oxybate) is the sodium salt of gamma-hydroxybutyrate (GHB). Abuse or misuse of illicit GHB, either alone or in combination with other CNS depressants, is associated with CNS adverse reactions, including seizure, respiratory depression, decreases in the level of consciousness, coma, and death [see Warnings and Precautions (5.2)]. Because of the risks of CNS depression and abuse and misuse, LUMRYZ is available only through a restricted program under a Risk Evaluation and Mitigation Strategy (REMS) called the LUMRYZ REMS [see Warnings and Precautions (5.3)].

1 INDICATIONS AND USAGE

LUMRYZ is indicated for the treatment of cataplexy or excessive daytime sleepiness (EDS) in patients 7 years of age and older with narcolepsy.

2 DOSAGE AND ADMINISTRATION

2.1 Adult Dosing Information

The recommended starting dosage of LUMRYZ in adults is 4.5 grams (g) once per night administered orally. Increase the dosage by 1.5 g per night at weekly intervals to the recommended dosage range of 6 g to 9 g once per night orally. The dosage may be gradually titrated based on efficacy and tolerability. Doses higher than 9 g per night have not been studied and should not ordinarily be administered.

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2.2 Pediatric Dosing Information

The recommended starting pediatric dosage, titration regimen, and maximum total nightly dosage are based on patient weight.

Pediatric Patients 7 years and Older Weighing at least 45 kg

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The recommended starting dosage of LUMRYZ in pediatric patients 7 years and older weighing at least 45 kg is 4.5 g once per night administered orally. Increase the dosage by 1.5 g per night at weekly intervals to the maximum recommended dosage of 9 g once per night orally. The dosage may be gradually titrated based on efficacy and tolerability.

Pediatric Patients 7 years and Older Weighing Less than 45 kg

Because the recommended starting dosage in pediatric patients 7 years and older weighing less than 45 kg cannot be achieved with the available strengths of LUMRYZ, use another sodium oxybate product to initiate treatment. Refer to the Prescribing Information of other sodium oxybate products for the recommended dosage for those products.

The maximum recommended dosage for patients 7 years and older weighing 20 kg to <30 kg is 6 g once per night orally, and the maximum recommended dosage for patients 7 years and older weighing 30 kg to <45 kg is 7.5 g once per night orally [see Dosage and Administration (2.4)]. There is insufficient information to provide specific dosing recommendations for patients 7 years and older who weigh less than 20 kg.

2.3 Important Administration Instructions

LUMRYZ is taken orally as a single dose at bedtime. Prepare the dose of LUMRYZ prior to bedtime. Prior to ingestion, the dose of LUMRYZ should be suspended in approximately 1/3 cup (approximately 80 mL) of water (with or without calorie-free drink mix or flavored water enhancer) in the mixing cup provided [see Instructions for Use]. Do not use hot water [see Clinical Pharmacology (12.3)]. After mixing, consume LUMRYZ within 30 minutes.

Take LUMRYZ at least 2 hours after eating [see Clinical Pharmacology (12.3)].

Patients should take LUMRYZ while in bed and lie down immediately after dosing as LUMRYZ may cause them to fall asleep abruptly without first feeling drowsy. Patients will often fall asleep within 5 minutes of taking LUMRYZ, and will usually fall asleep within 15 minutes, though the time it takes any individual patient to fall asleep may vary from night to night. Patients should remain in bed following ingestion of LUMRYZ.

2.4 Switching Patients from Immediate-Release Sodium Oxybate

Patients who are currently being treated with immediate-release sodium oxybate may be switched to LUMRYZ at the nearest equivalent dosage in grams per night (e.g., 7.5 g sodium oxybate divided into two 3.75 g doses per night to 7.5 g LUMRYZ once per night).

3 DOSAGE FORMS AND STRENGTHS

For extended-release oral suspension: LUMRYZ is a white to off-white powder provided in packets of 4.5 g, 6 g, 7.5 g, or 9 g of sodium oxybate.

4 CONTRAINDICATIONS

LUMRYZ is contraindicated for use in:

• combination with sedative hypnotics [see Warnings and Precautions (5.1)]

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• combination with alcohol [see Warnings and Precautions (5.1)]

• patients with succinic semialdehyde dehydrogenase deficiency [see Clinical Pharmacology (12.3)]

5 WARNINGS AND PRECAUTIONS

5.1 Central Nervous System Depression

LUMRYZ is a central nervous system (CNS) depressant. Clinically significant respiratory depression and obtundation has occurred in patients treated with immediate-release sodium oxybate at recommended doses in clinical trials and may occur in patients treated with LUMRYZ at recommended doses. LUMRYZ is contraindicated in combination with alcohol and sedative hypnotics. The concurrent use of LUMRYZ with other CNS depressants, including but not limited to opioid analgesics, benzodiazepines, sedating antidepressants or antipsychotics, sedating antiepileptic drugs, general anesthetics, muscle relaxants, and/or illicit CNS depressants, may increase the risk of respiratory depression, hypotension, profound sedation, syncope, and death. If use of these CNS depressants in combination with LUMRYZ is required, dose reduction or discontinuation of one or more CNS depressants (including LUMRYZ) should be considered. In addition, if short-term use of an opioid (e.g., post- or perioperative) is required, interruption of treatment with LUMRYZ should be considered. In addition to coadministration of LUMRYZ and alcohol being contraindicated because of respiratory depression, consumption of alcohol while taking LUMRYZ may also result in a more rapid release of the dose of sodium oxybate [see Clinical Pharmacology (12.3)].

Healthcare providers should caution patients about operating hazardous machinery, including automobiles or airplanes, until they are reasonably certain that LUMRYZ does not affect them adversely (e.g., impair judgment, thinking, or motor skills). Patients should not engage in hazardous occupations or activities requiring complete mental alertness or motor coordination, such as operating machinery or a motor vehicle or flying an airplane, for at least 6 hours after taking LUMRYZ. Patients should be queried about CNS depression-related events upon initiation of LUMRYZ therapy and periodically thereafter.

LUMRYZ is available only through a restricted program under a REMS [see Warnings and Precautions (5.3)].

5.2 Abuse and Misuse

LUMRYZ is a Schedule III controlled substance. The active ingredient of LUMRYZ, sodium oxybate, is the sodium salt of gamma-hydroxybutyrate (GHB), a Schedule I controlled substance. Abuse of illicit GHB, either alone or in combination with other CNS depressants, is associated with CNS adverse reactions, including seizure, respiratory depression, decreases in the level of consciousness, coma, and death. The rapid onset of sedation, coupled with the amnestic features of GHB, particularly when combined with alcohol, has proven to be dangerous for the voluntary and involuntary user (e.g., assault victim). Because illicit use and abuse of GHB have been reported, physicians should carefully evaluate patients for a history of drug abuse and follow such patients closely, observing them for signs of misuse or abuse of GHB

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(e.g., increase in size or frequency of dosing, drug-seeking behavior, feigned cataplexy) [see Warnings and Precautions (5.3) and Drug Abuse and Dependence (9.2)].

LUMRYZ is available only through a restricted program under a REMS [see Warnings and Precautions (5.3)].

5.3 LUMRYZ REMS

LUMRYZ is available only through a restricted distribution program called the LUMRYZ REMS because of the risks of central nervous system depression and abuse and misuse [see Warnings and Precautions (5.1, 5.2)].

Notable requirements of the LUMRYZ REMS include the following:

• Healthcare providers who prescribe LUMRYZ are specially certified.

• LUMRYZ will be dispensed only by pharmacies that are specially certified.

• LUMRYZ will be dispensed and shipped only to patients who are enrolled in the LUMRYZ REMS with documentation of safe use conditions.

Further information is available at www.LUMRYZREMS.com or by calling 1-877-453-1029.

5.4 Respiratory Depression and Sleep-Disordered Breathing

LUMRYZ may impair respiratory drive, especially in patients with compromised respiratory function. In overdoses of oxybate and with illicit use of GHB, life-threatening respiratory depression has been reported [see Overdosage (10)].

Increased apnea and reduced oxygenation may occur with LUMRYZ administration. A significant increase in the number of central apneas and clinically significant oxygen desaturation may occur in patients with obstructive sleep apnea treated with LUMRYZ.

During polysomnographic evaluation (PSG), central sleep apnea and oxygen desaturation were observed in pediatric patients with narcolepsy treated with immediate-release sodium oxybate.

In adult clinical trials of LUMRYZ in patients with narcolepsy, no subjects with apnea/hypopnea indexes greater than 15 were allowed to enroll.

In an adult study assessing the respiratory-depressant effects of immediate-release sodium oxybate at doses up to 9 g per night in 21 patients with narcolepsy, no dose-related changes in oxygen saturation were demonstrated in the group as a whole. One of four patients with preexisting moderate-to-severe sleep apnea had significant worsening of the apnea/hypopnea index during treatment.

In an adult study assessing the effects of immediate-release sodium oxybate 9 g per night in 50 patients with obstructive sleep apnea, immediate-release sodium oxybate did not increase the severity of sleep-disordered breathing and did not adversely affect the average duration and severity of oxygen desaturation overall. However, there was a significant increase in the number of central apneas in patients taking immediate-release sodium oxybate, and clinically significant oxygen desaturation (≤55%) was measured in three patients (6%) after administration, with one patient withdrawing from the study and two continuing after single brief instances of desaturation.

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In adult clinical trials in 128 patients with narcolepsy administered immediate-release sodium oxybate, two subjects had profound CNS depression, which resolved after supportive respiratory intervention. Two other patients discontinued immediate-release sodium oxybate because of severe difficulty breathing and an increase in obstructive sleep apnea. In two controlled trials assessing polysomnographic (PSG) measures in adult patients with narcolepsy administered immediate-release sodium oxybate, 40 of 477 patients were included with a baseline apnea/hypopnea index of 16 to 67 events per hour, indicative of mild to severe sleep-disordered breathing. None of the 40 patients had a clinically significant worsening of respiratory function, as measured by apnea/hypopnea index and pulse oximetry at doses of 4.5 g to 9 g per night.

Prescribers should be aware that sleep-related breathing disorders tend to be more prevalent in obese patients, in men, in postmenopausal women not on hormone replacement therapy, and among patients with narcolepsy. Increased central apneas and clinically relevant desaturation events have been observed with immediate-release sodium oxybate administration in adult and pediatric patients.

5.5 Depression and Suicidality

Depression, and suicidal ideation and behavior, can occur in patients treated with LUMRYZ.

In an adult clinical trial in patients with narcolepsy administered LUMRYZ [see Adverse Reactions (6.1)], there were no suicide attempts, but one patient developed suicidal ideation at the 9 g dose. In adult clinical trials in patients with narcolepsy (n=781) administered immediaterelease sodium oxybate, there were two suicides and two attempted suicides in patients treated with immediate-release sodium oxybate, including three patients with a previous history of depressive psychiatric disorder. Of the two suicides, one patient used immediate-release sodium oxybate in conjunction with other drugs. Immediate-release sodium oxybate was not involved in the second suicide. Adverse reactions of depression were reported by 7% of 781 patients treated with immediate-release sodium oxybate, with four patients (<1%) discontinuing because of depression. In most cases, no change in immediate-release sodium oxybate treatment was required.

In a controlled trial in adults with narcolepsy administered LUMRYZ where patients were titrated from 4.5 g to 9 g per night, the incidences of depression were 0% at 4.5 g, 1% at 6 g, 1.1% at 7.5 g, and 1.3% at 9 g. In a controlled adult trial, with patients randomized to fixed doses of 3 g, 6 g, or 9 g per night immediate-release sodium oxybate or placebo, there was a single event of depression at the 3 g per night dose. In another adult controlled trial, with patients titrated from an initial 4.5 g per night starting dose of immediate-release sodium oxybate, the incidences of depression were 1.7%, 1.5%, 3.2%, and 3.6% for the placebo, 4.5 g, 6 g, and 9 g per night doses, respectively.

In a clinical trial in pediatric patients with narcolepsy (n=104) administered immediate-release sodium oxybate, one patient experienced suicidal ideation and two patients reported depression while taking immediate-release sodium oxybate.

The emergence of depression in patients treated with LUMRYZ requires careful and immediate evaluation. Patients with a previous history of a depressive illness and/or suicide attempt should be monitored carefully for the emergence of depressive symptoms while taking LUMRYZ.

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5.6 Other Behavioral or Psychiatric Adverse Reactions

Other behavioral and psychiatric adverse reactions can occur in patients taking LUMRYZ.

During adult clinical trials in patients with narcolepsy administered LUMRYZ, 2% of 107 patients treated with LUMRYZ experienced a confusional state. During adult clinical trials in patients with narcolepsy administered immediate-release sodium oxybate, 3% of 781 patients treated with immediate-release sodium oxybate experienced confusion, with incidence generally increasing with dose.

No patients treated with LUMRYZ discontinued treatment because of confusion. Less than 1% of patients discontinued the immediate-release sodium oxybate because of confusion. Confusion was reported at all recommended doses of immediate-release sodium oxybate from 6 g to 9 g per night. In a controlled trial in adults where patients were randomized to immediate-release sodium oxybate in fixed total daily doses of 3 g, 6 g, or 9 g per night or placebo, a dose-response relationship for confusion was demonstrated, with 17% of patients at 9 g per night experiencing confusion. In that controlled trial, the confusion resolved in all cases soon after termination of treatment. In one trial where immediate-release sodium oxybate was titrated from an initial 4.5 g per night dose, there was a single event of confusion in one patient at the 9 g per night dose. In the majority of cases in all adult clinical trials in patients with narcolepsy administered immediate-release sodium oxybate, confusion resolved either soon after termination of dosing or with continued treatment.

Anxiety occurred in 7.5% of 107 patients treated with LUMRYZ in the adult trial in patients with narcolepsy. Anxiety occurred in 5.8% of the 874 patients receiving immediate-release sodium oxybate in adult clinical trials in another population.

Other psychiatric reactions reported in adult clinical trials in patients with narcolepsy administered LUMRYZ included irritability, emotional disorder, panic attack, agitation, delirium, and obsessive thoughts. Other neuropsychiatric reactions reported in adult clinical trials in patients with narcolepsy administered immediate-release sodium oxybate and in the postmarketing setting for immediate-release sodium oxybate include hallucinations, paranoia, psychosis, aggression, and agitation.

In a clinical trial in pediatric patients with narcolepsy administered immediate-release sodium oxybate, neuropsychiatric reactions, including acute psychosis, confusion, and anxiety were reported while taking immediate-release sodium oxybate.

The emergence or increase in the occurrence of behavioral or psychiatric events in patients taking LUMRYZ should be carefully monitored.

5.7 Parasomnias

Parasomnias can occur in patients taking LUMRYZ.

Sleepwalking, defined as confused behavior occurring at night and at times associated with wandering, was reported in 3% of 107 adult patients with narcolepsy treated with LUMRYZ. No patients treated with LUMRYZ discontinued due to sleepwalking. Sleepwalking was reported in 6% of 781 patients with narcolepsy treated with immediate-release sodium oxybate in adult controlled and long-term open-label studies, with <1% of patients discontinuing due to sleepwalking. In controlled trials, rates of sleepwalking were similar for patients taking placebo

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and patients taking immediate-release sodium oxybate. It is unclear if some or all of the reported sleepwalking episodes correspond to true somnambulism, which is a parasomnia occurring during non-REM sleep, or to any other specific medical disorder. Five instances of sleepwalking with potential injury or significant injury were reported during a clinical trial of immediaterelease sodium oxybate in patients with narcolepsy.

Parasomnias, including sleepwalking, have been reported in a pediatric clinical trial and in postmarketing experience with immediate-release sodium oxybate. Therefore, episodes of sleepwalking should be fully evaluated, and appropriate interventions considered.

5.8 Use in Patients Sensitive to High Sodium Intake

LUMRYZ has a high sodium content. In patients sensitive to sodium intake (e.g., those with heart failure, hypertension, or renal impairment), consider the amount of daily sodium intake in each dose of LUMRYZ. Table 1 provides the approximate sodium content per LUMRYZ dose.

Table 1: Approximate Sodium Content per Total Nightly Dose of LUMRYZ (g = grams)

LUMRYZ DoseSodium Content/Total Nightly Exposure
4.5 g per night820 mg
6 g per night1100 mg
7.5 g per night1400 mg
9 g per night1640 mg

6 ADVERSE REACTIONS

The following clinically significant adverse reactions appear in other sections of the labeling:

• CNS Depression [see Warnings and Precautions (5.1)]

• Abuse and Misuse [see Warnings and Precautions (5.2)]

• Respiratory Depression and Sleep-Disordered Breathing [see Warnings and Precautions (5.4)]

• Depression and Suicidality [see Warnings and Precautions (5.5)]

• Other Behavioral or Psychiatric Adverse Reactions [see Warnings and Precautions (5.6)]

• Parasomnias [see Warnings and Precautions (5.7)]

• Use in Patients Sensitive to High Sodium Intake [see Warnings and Precautions (5.8)]

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6.1 Clinical Trials Experience

Because clinical trials are conducted under widely varying conditions, adverse reaction rates observed in the clinical trials of a drug cannot be directly compared to rates in the clinical trials of another drug and may not reflect the rates observed in clinical practice.

Adult Patients

LUMRYZ was studied in one placebo-controlled trial (Study 1) [see Clinical Studies (14.1)] in 212 patients with narcolepsy (107 patients treated with LUMRYZ and 105 with placebo).

Adverse Reactions Leading to Treatment Discontinuation

In Study 1, 15.9% of patients treated with LUMRYZ discontinued because of adverse reactions, compared to 1.9% of patients receiving placebo. The most common adverse reaction leading to discontinuation was dizziness (4.7%). For LUMRYZ, 5.6% of patients discontinued due to adverse reactions on 4.5 g, 4.1% on 6 g, 4.5% on 7.5 g, and 3.9% on 9 g dose.

Most Common Adverse Reactions

The most common adverse reactions (incidence ≥5% and greater than placebo) reported for any dose of LUMRYZ were nausea, dizziness, enuresis, headache, and vomiting.

Adverse Reactions Occurring at an Incidence of 2% or Greater

Table 2 lists adverse reactions occurring in 2% or more of LUMRYZ-treated patients on any individual dose and at a rate greater than placebo-treated patients in Study 1.

Table 2: Adverse Reactions Occurring in 2% or More of LUMRYZ-Treated Adult Patients and Greater than for Placebo-Treated Patients in Study 1 Adverse Reaction Placebo LUMRYZ 4.5 g LUMRYZ 6 g LUMRYZ 7.5 g LUMRYZ 9 g

Adverse ReactionPlacebo (N=105) %LUMRYZ 4.5 g (N=107) %LUMRYZ 6 g (N=97) %LUMRYZ 7.5 g (N=88) %LUMRYZ 9 g (N=77) %
Gastrointestinal Disorders
Vomiting23365
Nausea36871
Investigations
Weight Decreased01004
Metabolism and Nutritional Disorders
Decreased Appetite04433
Nervous System Disorders
Dizziness06465
Somnolence10124
Headache67560
Psychiatric Disorders
Enuresis02499
Anxiety13131
Somnambulism01200

Dose-Response Information

In the clinical trial in adult patients with narcolepsy, a dose-response relationship was observed for enuresis and somnolence.

Additional Adverse Reactions

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Adverse reactions observed in clinical studies with immediate-release sodium oxybate (≥2%), but not observed in Study 1 at a frequency of higher than 2%, and which may be relevant for LUMRYZ: diarrhea, abdominal pain upper, dry mouth, pain, feeling drunk, peripheral edema, cataplexy, muscle spasms, pain in extremity, tremor, disturbance in attention, paresthesia, sleep paralysis, disorientation, irritability, and hyperhidrosis.

Pediatric Patients (7 Years of Age and Older)

The safety of LUMRYZ for the treatment of cataplexy or excessive daytime sleepiness in pediatric patients 7 years of age and older with narcolepsy is supported by an adequate and wellcontrolled trial of immediate-release sodium oxybate [see Clinical Studies (14.2)]. Below is a display of adverse reactions of immediate-release sodium oxybate in this adequate and wellcontrolled trial.

In this trial, 104 patients aged 7 to 17 years (37 patients aged 7 to 11 years; 67 patients aged 12 to 17 years) with narcolepsy received immediate-release sodium oxybate for up to one year. This trial included an open-label safety continuation period in which eligible patients received immediate-release sodium oxybate for up to an additional 2 years. The median and maximum exposure across the entire trial were 371 and 987 days, respectively.

Adverse Reactions Leading to Treatment Discontinuation

In the pediatric clinical trial with immediate-release sodium oxybate, 7 of 104 patients reported adverse reactions that led to withdrawal from the study (hallucination, tactile; suicidal ideation; weight decreased; sleep apnea syndrome; affect lability; anger, anxiety, depression; and headache).

Adverse Reactions in the Pediatric Clinical Trial

The most common adverse reactions (≥5%) were nausea (20%), enuresis (19%), vomiting (18%), headache (17%), weight decreased (13%), decreased appetite (9%), dizziness (8%), and sleepwalking (6%).

Additional information regarding safety in pediatric patients appears in the following sections:

• Respiratory Depression and Sleep-Disordered Breathing [see Warnings and Precautions (5.4)]

• Depression and Suicidality [see Warnings and Precautions (5.5)]

• Other Behavioral or Psychiatric Adverse Reactions [see Warnings and Precautions (5.6)]

• Parasomnias [see Warnings and Precautions (5.7)]

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