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      "text": "Yeah, absolutely. Because it interacts with everything.",
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      "text": "Q: \"I think, you had said that at one point, you had as many as 10, and now you have a lot less. Why is that?\"\nA: \"People discontinue it for side effects or lack of efficacy or what is perceived as efficacy, I should say.\"",
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      "text": "Q: \"So, headaches with stimulants, and what happens with SSRIs? I think it increases the concentration of the drug.\"\nA: \"It depends on which medication we're talking about. Sometimes it increases it; sometimes, it decreases it because they work through different cytochrome P450 enzymes. But again, the most common side effect of all that will be a headache because it just drives monoamines. What they were doing when I left was that I advised the company that they should really have a website where you can—like drugs.com—where you can put in the drug that the patient may be on so that you can give advice about how it interacts rather than trying to figure it out yourself.\"\nQ: \"So, you're saying that the drug-drug interactions were so significant that you thought the company should have a separate website for people? \"\nA: \"Yeah, absolutely. Because it interacts with everything.\" – Neurologist in the UK who also practiced in the US; used Wakix in both settings",
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      "text": "Q: \"Let's walk through each of those different drug-drug interactions. If they're on a stimulant and they take pitolisant, they get headaches that are bad enough where they discontinue?\"\nA: \"Yes. That is my common experience of this. The headaches are the biggest limiting factor to this.\"",
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      "text": "Q: \"So, you have issues if you take it with an SSRI? You have issues if you take it with a stimulant. You have issues if you take it with birth control.\"\nA: \"[Chuckles] Basically, yeah.\" – Neurologist in the UK who also practiced in the US; used Wakix in both settings",
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      "text": "Lack of efficacy, drug-drug interactions, and major side effects that cause discontinuation",
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      "text": "Q: \"And what percentage of patients are typically on stimulants? Most of them because they need to stay awake?\"\nA: \"It wasn't first-line when I was there, so they had to have tried stimulants before they could get pitolisant.\"",
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      "text": "Drug-drug interactions very prevalent – \"it interacts with everything\"",
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      "text": "Q: \"Talk to me about both of those: discontinuation rates, lack of efficacy, and side effects. What have you observed? When do they happen? How significant are they, etc.?\"\nA: \"In the U.S., I had early access to the drug before it was approved. So, we used it I quite a few patients then. The problem with the medication—it's very interesting because it's a new mechanism of action; there's nothing like that. So, that's quite exciting to think about from that approach. But it has drug-drug interactions, and that makes it much more complicated to use because a lot of these individuals have mental health issues as well, like anxiety/depression, so they're on SSRIs, SNRIs, and they interact with the medication. So, that's one problem. The other issue is that a lot of them are not naïve to the medication; they've tried other things, which, in my experience, if you add it in when people are on stimulants, a wake-promoting agent, they have headaches, and the headaches are quite significant that it makes them discontinue. So, that's one thing. The other issue it interacts with the birth control. Oral contraceptives. So, if they contain estrogen, that's an issue as well; it interacts with that drug.\"",
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      "text": "People discontinue it for side effects or lack of efficacy or what is perceived as efficacy, I should say. — Neurologist in the UK who also practiced in the US; used Wakix in both settings",
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      "text": "Source: Scorpion Capital consultation calls with experts",
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      "text": "Prescriber #9: UK-based neurologist who has advised Harmony and until recently practiced in the US and used Wakix in both settings",
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