The FDA has approved Orzeyful (oveporexton), the first medication for adults with narcolepsy type 1 that targets the disease's underlying orexin deficiency, making it the first treatment to address the full spectrum of symptoms. According to the FDA, clinical trials demonstrated significant improvements in wakefulness, daytime sleepiness, cataplexy, sleep paralysis, hallucinations, and disrupted nighttime sleep, offering a novel mechanism compared with traditional stimulant- or sedative-based therapies. Orzeyful represents a major advance as the first orexin receptor agonist with important considerations including twice-daily dosing, avoidance with strong CYP3A inhibitors, and monitoring for insomnia and urinary adverse effects.