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93 - Modafinil

Published online by Cambridge University Press:  06 October 2020

Stephen D. Silberstein
Affiliation:
Thomas Jefferson University, Philadelphia
Michael J. Marmura
Affiliation:
Thomas Jefferson University, Philadelphia
Hsiangkuo Yuan
Affiliation:
Thomas Jefferson University, Philadelphia
Stephen M. Stahl
Affiliation:
University of California, San Diego
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Summary

THERAPEUTICS

Brands

• Provigil, Alertec, Modiodal

Generic?

• Yes

Class

• Psychostimulant

Commonly Prescribed for

(FDA approved in bold)

Reducing excessive sleepiness in patients with narcolepsy or shift work disorder

Reducing excessive sleepiness in patients with obstructive sleep apnea (OSA)/ hypopnea syndrome

• Treatment of fatigue in multiple sclerosis (MS)

• Fatigue in depression

• Attention deficit hyperactivity disorder

• Fatigue in cancer, HIV, fibromyalgia, or post-stroke patients

• Bipolar depression

How the Drug Works

• Unlike traditional stimulants which act directly via dopaminergic pathways, it may also act in the hypothalamus by stimulating wake-promoting areas, or inhibiting sleeppromoting areas

• It may also have effects on dopamine transporter pathways similar to other stimulants, hypothetically inhibiting the dopamine transporter

• Increases neuronal activity selectively in the hypothalamus and activates tuberomammillary nucleus neurons that release histamine

• It also activates hypothalamic neurons that release orexin/hypocretin

How Long Until It Works

• Typically 1–2 hours, although maximal benefit may take days to weeks

If It Works

• Continue to use indefinitely as long as symptoms persist. Complete resolution of symptoms is unusual. Does not cause insomnia when dosed correctly

If It Doesn’t Work

• Change to most effective dose or alternative agent. Re-evaluate treatment of underlying cause (i.e., OSA) of fatigue. Consider other causes of fatigue (i.e., anemia, heart disease) as appropriate. Screen for use of CNS depressants that can interfere with sleep, i.e., opioids or alcohol

Best Augmenting Combos for Partial Response or Treatment-Resistance

• In treating OSA, modafinil is an adjunct to standard treatments such as continuous positive airway pressure (CPAP), weight loss, and treatment of obstruction when possible

• In MS change drug regimen, i.e., antispasticity or disease-modifying agents when possible if they are significantly contributing to fatigue. Amantadine is an alternative treatment for MS-related fatigue.

• Treat coexisting medical illnesses such as HIV, depression, or chronic pain disorders with appropriate agents

Tests

• None required

Type
Chapter
Information
Essential Neuropharmacology
The Prescriber's Guide
, pp. 341 - 344
Publisher: Cambridge University Press
Print publication year: 2015

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  • Modafinil
  • Stephen D. Silberstein, Thomas Jefferson University, Philadelphia, Michael J. Marmura, Thomas Jefferson University, Philadelphia, Hsiangkuo Yuan, Thomas Jefferson University, Philadelphia
  • Edited in consultation with Stephen M. Stahl, University of California, San Diego
  • Book: Essential Neuropharmacology
  • Online publication: 06 October 2020
  • Chapter DOI: https://doi.org/10.1017/9781316161753.094
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  • Modafinil
  • Stephen D. Silberstein, Thomas Jefferson University, Philadelphia, Michael J. Marmura, Thomas Jefferson University, Philadelphia, Hsiangkuo Yuan, Thomas Jefferson University, Philadelphia
  • Edited in consultation with Stephen M. Stahl, University of California, San Diego
  • Book: Essential Neuropharmacology
  • Online publication: 06 October 2020
  • Chapter DOI: https://doi.org/10.1017/9781316161753.094
Available formats
×

Save book to Google Drive

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Google Drive.

  • Modafinil
  • Stephen D. Silberstein, Thomas Jefferson University, Philadelphia, Michael J. Marmura, Thomas Jefferson University, Philadelphia, Hsiangkuo Yuan, Thomas Jefferson University, Philadelphia
  • Edited in consultation with Stephen M. Stahl, University of California, San Diego
  • Book: Essential Neuropharmacology
  • Online publication: 06 October 2020
  • Chapter DOI: https://doi.org/10.1017/9781316161753.094
Available formats
×