Modafinil narcolepsy

Becker PM, Jamieson AO, Jewel CE, Bogan RK, James DS. Randomized trial of modafinil as a treatment for the excessive daytime somnolence of narcolepsy US Modafinil Narcolepsy Multicenter Study Group. Neurol 2000 54(5) 1166-75. 

The mode of action of modafinil, a new arousal-promoting compound used in the treatment of sleepiness associated with narcolepsy, is not fully understood. 

Administer the ESS at each visit to monitor progress with modafinil or stimulant therapy. Unfortunately, EDS in narcolepsy patients rarely is fully reversed. 

Compiled from US. Modafinil in Narcolepsy Multicenter Study Group and Standard of Practice Committee of the American Sleep Disorders Association. Pradice parameters for the use of stimulants in the treatment of narcolepsy. Seep 1994 17 348-351. 

Substance-Induced Anxiety Disorder. Numerous medicines and drugs of abuse can produce panic attacks. Panic attacks can be triggered by central nervous system stimulants such as cocaine, methamphetamine, caffeine, over-the-counter herbal stimulants such as ephedra, or any of the medications commonly used to treat narcolepsy and ADHD, including psychostimulants and modafinil. Thyroid supplementation with thyroxine (Synthroid) or triiodothyronine (Cytomel) can rarely produce panic attacks. Abrupt withdrawal from central nervous system depressants such as alcohol, barbiturates, and benzodiazepines can cause panic attacks as well. This can be especially problematic with short-acting benzodiazepines such as alprazolam (Xanax), which is an effective treatment for panic disorder but which has been associated with between dose withdrawal symptoms. 

Modafinil (Provigil). The newest stimulant, modafinil, is not, pharmacologically, a true stimulant. Nevertheless, it is an effective treatment for narcolepsy at doses from 200 to 400mg/day. Several studies indicate that modahnil has little potential for abuse and is easier to tolerate than other stimulants. Modafinil has been studied in the treatment of ADHD. Though not approved for marketing by the FDA at the time of this writing, it may gain the indication in the near future. 

Comparisons of modafinil with agents that have proven effective in narcolepsy, including methylphenidate, pemoline, and dextroamphetamine, are needed to clarify its relative safety and efficacy, and place in therapy... 

Modafinil is a stimulant medication used to improve wakefulness in patients with narcolepsy, obstructive sleep apnea/hypopnea syndrome (as adjunct to standard treatments for the underlying disorder), and shift work sleep disorder. Controlled and open trials provided data on the efficacy and safety of modafinil in patients with narcolepsy (Besset et al. 1996 Billiard et al. 1994 Broughton et al. 1997 Mitler et al. 2000 U.S. Modafinil in Narcolepsy Multicenter Study Group 1998, 2000). Modafinil has a long duration of action and low potential for dependence and may be a reasonable first choice in the treatment of mild to moderate narcolepsy (Silber 2001). There is also considerable interest in the potential use of modafinil in the treatment of ADHD, and studies are in progress. 

Besset A, Chetrit M, Carlander B, et al Use of modafinil in the treatment of narcolepsy a long-term follow-up study. Neurophysiol Clin 26 60-66, 1996... 

Broughton RJ, Fleming JA, George CF, et al Randomized, double-blind, placebo-controlled crossover trial of modafinil in the treatment of excessive daytime sleepiness in narcolepsy. Neurology 49 444-451, 1997... 

Mitler MM, Harsh J, Hirshkowitz M, et al Long-term efficacy and safety of modafinil (Provigil) for the treatment of excessive daytime sleepiness associated with narcolepsy. Sleep Med 1 231-243, 2000... 

A structurally very simple carboxylic acid, modafinil (62-4), increases alertness and inhibits narcolepsy as a result of its activity as a cerebral ai-adrenergic agonist. The short synthesis begins with the reaction of benzhydrol proper (62-1) with chloroacetic... 

Sangal RB, Mitler MM, Sangal JM and US modafinil in narcolepsy multicenter study group. MSLT, MWT and ESS indices of sleepiness in 522 drug-free patients with narcolepsy. Sleep Res 1997 26 492. 

U.S. Modafinil in Narcolepsy Multicenter Study Group. Randomized trial of modafmil for the treatment of pathological somnolence in narcolepsy. Ann Neurol 1998 43 88-97. 

The recommended dose of modafinil is 200 mg/day for the treatment of excessive daytime sleepiness associated with narcolepsy however, doses of 400 mg/day are FDA-approved. While there is evidence that the higher dose is well tolerated, it has not been established that it confers additional therapeutic benefit (196). In sleep-deprived subjects, doses of 600 mg/day have been administered, but the preponderance of evidence suggests that 300M00 mg/day is probably sufficient and less likely to produce unwanted side effects. 

Bastuji H, Jouvet M. Successful treatment of idiopathic hypersomnia and narcolepsy with modafinil. Prog Neuro-psychopharmacol Biol Psychiatry 1988 12 695-700. 

McClellan KJ, Spencer CM. Modafinil a review of its pharmacology and clinical efficacy in the management of narcolepsy. CNS Drugs 1998 9(4) 311-324. 

Billiard M. Introduction Modafinil, a new treatment of narcolepsy and idiopathic hypersomnia. Drugs Today 1996 32(suppl I) 1 -5. 

Boivin DB, Montplaisir J, Petit D, Lambert C, Lubin S. Effects of modafinil on symptomatology of human narcolepsy. Clin Neuropharmacol 1993 16(l) 46-53. 

Within the last few years, the role of wake-promoting medication has received renewed and increasing attention with development of modafinil. Although the mechanism through which modafinil works remains to be determined, the low abuse potential (51) and absence of cardiovascular effects (52,53), combined with its clear wake-promoting properties, increase the potential uses for this drug. Studies have shown consistent increases in alertness for narcolepsy (54), in sleep apnea patients (treated with CPAP) with residual sleepiness (55), for shift work sleep disorder (56), and for sleep deprivation (57). 

On the other hand, pharmacological wake promotion is a new concept brought about by modafinil. Use of modafinil for medical conditions other than narcolepsy has begun to receive the attention of both basic and applied researchers and physicians caring for these patients. Moreover, modafinil consumption is envisioned by some as logical for some critical occupational situa-... 

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