Class: Wakefulness-promoting Agent FDA Indications: Narcolepsy, Narcolepsy, Obstructive Sleep Apnea/Hypopnea Syndrome (OSAHS), Shift Work Sleep Disorder (SWSD) Off-Label Use: ADHD, Jet Lag, Treatment Resistant Depression, Cocaine Addiction, Sleepiness Associated With Opioid Analgesia, Lewy Body Dementia
FDA Schedule IV Forms: 100, 200mg tablet Dose Range: 200-800 mg/day Starting: 200 mg qam is usual dose; max dose 800 mg daily Stopping: Tapering unnecessary, though some patients may have sleepiness on discontinuation
Contraindications: Not recommended for use in patients with a h/o LVH, ischemic ECG Δ's, chest pain, arrhythmias or recent MI Serious Side Effects: Stevens-Johnson Syndrome Side Effects: xerostomia, diarrhea, nausea, insomnia, anxiety, palpitations, rhinitis/rhinorrhea, hypertension, headache (34%)
1° MOA: Exact mechanism of action is unknown, but it is believed that the increase in synaptic dopamine following blockade of DAT leads to increased tonic firing and downstream effects on neurotransmitters including those involved in wakefulness, such as histamine and orexin/ hypocretin Target: DAT, D2 partial agonist
- has as novel mechanism of action and therapeutic uses with less abuse potential, but is often classified as a stimulant
binds at the DAT and is only about eightfold less potent than cocaine as a DAT inhibitor
α1 antagonists (e.g., prazosin) may block its therapeutic actions
may be useful in treating fatigue in patients with depression, multiple sclerosis, myotonic dystrophy and HIV/AIDS
subjective sensation is generally normal wakefulness, not stimulation, but can occasionally include jitteriness
may induce its own metabolism at high doses via 3A4 induction
Category Undefined.—Animal data suggest moderate risk, but limited human pregnancy experience prevents a full assessment of risk. Avoiding modafinil during pregnancy is the best course, but inadvertent exposure does not appear to represent a major risk of embryo-fetal harm
No reports describing the use of modafinil during human lactation have been located
Clearance of modafinil may be reduced in the elderly
There is inadequate information to determine safety and efficacy of dosing in patients with severe renal impairment
Dose should be reduced in patients with severe hepatic impairment
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Last updated March 25 2019 15:25:58. Disclaimer: This website does not provide medical advice, nor is it a substitute for clinical judgment.
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