Class: CNS Stimulant. C-IV
Dosage Forms. Tablet: 100 mg, 200 mg
Common FDA Label Indication, Dosing, and Titration.
1. Narcolepsy: 200 mg po daily in the morning; max 400 mg/d
2. Obstructive sleep apnea, improve excessive sleepiness; adjunct: 200 mg po daily in the morning; max 400 mg/d
3. Shift work-sleep disorder: 200 mg po daily 1 h before start of work shift; max 400 mg/d
1. Attention deficit hyperactivity disorder: 200 mg po daily
MOA. The mechanism of action of modafinil is uncertain. Modafinil is a wakefulness-promoting agent acting as a central nervous system stimulant. It is chemically and pharmacologically unrelated to other CNS stimulants, such as methylphenidate, amphetamine, or pemoline.
Drug Characteristics: Modafinil
Medication Safety Issues: Modafinil
Drug Interactions: Modafinil
Adverse Reactions: Modafinil
Efficacy Monitoring Parameters. Degree of sleepiness, improvement of mental and behavioral symptoms.
Toxicity Monitoring Parameters. Palpitations, near syncope, or syncope; may be indicative of a cardiac condition; BP and heart rate.
Key Patient Counseling Points. This drug may decrease effectiveness of hormonal or IUD contraception. Recommend additional form of birth control during therapy and 1 mo after last dose. Avoid activities requiring mental alertness or coordination until drug effects are realized. If using drug for daytime wakefulness, take in the morning; if using to maintain wakefulness during shift work, take drug 1 h prior to working. Do not drink alcohol while taking this drug. Practice good sleep hygiene. Does not replace need for CPAP machines in patients with obstructive sleep apnea.
Clinical Pearls. Safety and effectiveness in children <16 y old have not been established. Heart rate and BP should be evaluated at baseline, during routine follow-up within 1-3 mo, and at follow-up visits every 6-12 mo. Increases in BP and heart rate have been reported with the use of certain ADHD drugs. Dispense with medication safety guide.