#178 - Orexin Agonists Are Here: This Is The New Stuff

The orexin receptor agonists are coming. After years of managing narcolepsy with stimulants, sodium oxybate, and wake-promoting agents, we soon will have medications that target the root cause of the disorder: the loss of orexin signaling. These new drugs—developed by Takeda, Alkermes, and Centessa—aren’t just incremental improvements. They represent a genuine shift in how we understand and treat hypersomnolence disorders. In this episode, we will:

• Define what orexin is and why losing it destabilizes wakefulness, REM boundaries, muscle tone, and cognition
• Learn how orexin agonists work—not as stimulants, but as replacement therapy for a missing neurotransmitter
• Find out why OX2R is the key receptor, and how selective agonists restore stable wakefulness, reduce cataplexy, and normalize attention
• Review the available clinical data from the new wave of programs: oveporexton (Takeda), alixorexton (Alkermes), and ORX750 (Centessa)
• See what makes these drugs different from modafinil, amphetamines, solriamfetol, and oxybate therapies
• Learn why Phase 1, Phase 2, and Phase 3 trials matter—with quick insights on how these drugs reached such strong results
• Consider safety and side effects, including what Hy’s Law means and why regulators watch liver signals so closely
• Look ahead to what these medications may mean for NT1, NT2, IH, and other hypersomnolence disorders in the coming years
• Speculate why this class represents one of the most exciting moments in modern sleep medicine

Produced by: Maeve Winter

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Thanks for listening and sleep well!