BMA Concise Guide to Medicine & Drugs

Modafinil

Brand name Provigil

Used in the following combined preparations None

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Drug group Nervous system stimulant

Overdose danger rating Medium

Dependence rating Medium

Prescription needed Yes

Available as generic No

GENERAL INFORMATION

Modafinil is a nervous system stimulant used for the relief of excessive sleepiness associated with narcolepsy, obstructive sleep apnoea, and chronic shift work. Modafinil has some features in common with the stimulant amfetamine, including a potential for dependence and abuse but the risk of these is much lower with modafinil than with amfetamine itself. However, treatment with modafinil should be initiated by a doctor with a specialist interest in sleep disorders and only after other efforts have been made to treat the underlying condition. It should not be given to people with severe or poorly controlled high blood pressure or heart disease.

INFORMATION FOR USERS

Your drug prescription is tailored for you. Do not alter dosage without checking with your doctor.

How taken/used Tablets.

Frequency and timing of doses Single dose in the morning; or twice daily, in the morning and at midday.

Adult dosage range 200–400 mg daily.

Onset of effect Within a few hours.

Duration of action 12–24 hours.

Diet advice None.

Storage Keep in original container at room temperature out of the reach of children.

Missed dose Take as soon as you remember if needed for relief of symptoms. If not needed, do not take the missed dose, and return to your normal dose schedule when necessary.

Stopping the drug Do not stop the drug without consulting your doctor; symptoms may recur.

Exceeding the dose An occasional unintentional extra dose is unlikely to cause problems. Large overdoses may cause insomnia, restlessness, confusion, high blood pressure, and fast heart rate. Notify your doctor.

POSSIBLE ADVERSE EFFECTS

Modafinil may cause a wide range of side effects. The most common is headache, which affects about a fifth of those taking the drug. Other common side effects include palpitations, a fast heart rate, dizziness, blurred vision, nausea, abdominal pain, decreased appetite, nervousness, and insomnia. Contact your doctor if any of these are severe or if chest pain, depression, or a rash occur; in the case of a rash, you should also stop taking the drug. Rarely, modafinil may cause thoughts of suicide; if so, stop taking the drug and contact your doctor immediately.

INTERACTIONS

Ciclosprin Modafinil reduces blood levels of ciclosporin.

Oral contraceptives Modafinil reduces the effectiveness of oestrogen-containing contraceptive pills.

Phenytoin Modafinil may increase blood levels of phenytoin.

SPECIAL PRECAUTIONS

Be sure to tell your doctor if:

· You have a liver or kidney problem.

· You have high blood pressure.

· You have a heart problem.

· You have had a psychiatric illness.

· You have a history of alcohol or illicit substance abuse.

· You are taking any other medicine.

Pregnancy Safety not established. Discuss with your doctor.

Breast-feeding Safety not established. Discuss with your doctor.

Infants and children Not prescribed for children under 12 years.

Over 60 Increased likelihood of adverse effects. Reduced dose may therefore be necessary.

Driving and hazardous work Avoid until you know how the drug affects you because it may cause dizziness or blurred vision.

Alcohol No special problems.

PROLONGED USE

No special problems.

Monitoring If you have high blood pressure, regular blood pressure monitoring may be carried out.

Mometasone

Brand names Asmanex, Elocon, Nasonex

Used in the following combined preparations None

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Drug group Corticosteroid

Overdose danger rating Low

Dependence rating Low

Prescription needed Yes

Available as generic No

GENERAL INFORMATION

Mometasone is a corticosteroid drug used as an inhaler to prevent asthma attacks and as a nasal spray to relieve the symptoms of allergic rhinitis. It is also used topically for the treatment of severe inflammatory skin disorders and in conditions such as eczema that have not responded to other corticosteroids (see Topical corticosteroids).

Serious adverse effects are rare if the drug is used for short periods or in small amounts, but prolonged or excessive topical use may cause local side effects such as thin skin and systemic side effects such as osteoporosis, muscle weakness, and peptic ulcers.

Fungal infections causing irritation of the mouth and throat are a possible side effect of inhaling mometasone. These can be avoided to some degree by rinsing the mouth and gargling with water after each inhalation.

INFORMATION FOR USERS

Your drug prescription is tailored for you. Do not alter dosage without checking with your doctor.

How taken/used Cream, ointment, scalp lotion, inhaler, powder for inhalation, nasal spray.

Frequency and timing of doses 1 x 2 times daily (inhaler); once daily (other forms).

Adult dosage range Inhaler 200–800mcg. Nasal spray 100mcg (2 puffs) into each nostril. Topical preparations As directed, applied thinly.

Onset of effect 12 hours. Full beneficial effect after 48 hours.

Duration of action 24 hours. Effects can last for several days after the drug is stopped.

Diet advice None.

Storage Keep in original container at room temperature out of the reach of children.

Missed dose Take as soon as you remember. If your next dose/application is due within 8 hours, take a single dose or apply the usual amount now and skip the next.

Stopping the drug Do not stop the drug without consulting your doctor; symptoms may recur.

Exceeding the dose An occasional unintentional extra dose/application may not be a cause for concern, but if you notice any unusual symptoms, notify your doctor.

POSSIBLE ADVERSE EFFECTS

Serious adverse effects are unlikely when mometasone is used at low doses and/or for short periods. With the inhaler or nasal spray, the most common side effects are nasal irritation, cough, and bruising. Discuss with your doctor if these are severe or if you develop a sore throat or hoarseness or have nosebleeds. More serious side effects, such as permanent skin changes, may occur with the long-term use of the cream or ointment, which should not normally be used on the face. Discuss with your doctor if you notice any such changes. Long-term use of any preparation of mometasone may cause various disorders (see Prolonged use).

INTERACTIONS

Ketoconazole and itraconazole may increase mometasone’s systemic effect.

SPECIAL PRECAUTIONS

Be sure to tell your doctor if:

· You have had tuberculosis or another respiratory infection.

· You have any other nasal or skin infection.

· You have had recent nasal ulcers or nasal surgery.

Pregnancy Safety not established. Discuss with your doctor.

Breast-feeding No evidence of risk. Discuss with your doctor.

Infants and children Only used for very short courses in children.

Over 60 No special problems.

Driving and hazardous work No special problems.

Alcohol No special problems.

PROLONGED USE

Long-term use can lead to peptic ulcers, glaucoma, muscle weakness, osteoporosis, growth retardation in children, and, rarely, adrenal gland suppression. Prolonged use of topical treatment may also lead to skin thinning. Patients on long-term treatment should carry a steroid card or wear a MedicAlert bracelet.

Monitoring Periodic checks on adrenal gland function may be required if large doses are being taken. Children should have their height monitored.