Modafinil therapies

Amantadine 100 mg orally every morning and early afternoon Modafinil 200 mg orally daily Second-line therapies ... 

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

Modafinil is approved by the FDA to improve wakefulness in those who have residual daytime sleepiness while treated with PAP. It should be used only after patients are using optimal PAP therapy to alleviate sleep-disordered breathing. 

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... 

Drugs That Interfere with Hormonal Contraceptives Concomitant use of HIV-protease inhibitors, griseofulvin, modafinil, penicillins, rifampin, rifabutin, phenytoin, carbamazepine, or certain herbal supplements such as St. John s wort with hormonal contraceptive agents may reduce the effectiveness of the contraception and up to one month after discontinuation of these concomitant therapies. Therefore, women requiring treatment with one or more of these drugs must use two other effective or highly effective methods of contraception or abstain from heterosexual sexual contact while taking thalidomide... 

Persons with cognitive decline may respond to rivastigmine (1.5-6 mg twice daily), memantine (5-10 mg daily), or donepezil (5-10 mg daily) (see Chapter 60) affective disorders to antidepressants or anxiolytic agents (see Chapter 30) excessive daytime sleepiness to modafinil (100-400 mg in the morning) (see Chapter 9), and bladder and bowel disorders to appropriate symptomatic therapy (see Chapter 8). 

Pack AL, Black JE, Schwartz JR, Matheson JK. Modafinil as adjunct therapy for daytime sleepiness in obstructive sleep apnea. Am J Respir Crit Care Med. 2001 164(9) 1675-1681. 

Schwartz JRL, Hirshkowitz M, Erman MK, Schmidt-Nowara W (2003) Modafinil as Adjunct Therapy for Daytime Sleepiness in Obstructive Sleep Apnea A 12-Week, Open-Label Study. Chest 124 2192-2199... 

MODAFINIL DRUG DEPENDENCE THERAPIES - Bupropion t risk of seizures. This risk is marked in elderly people, in patients with a history of seizures, with addidion to opiates/cocaine/ stimulants, and in diabetics treated with oral hypoglycaemics or insulin Bupropion is associated with a dose-related risk of seizures. These drugs, which lower seizure threshold, are individually epileptogenic. Additive effects when combined Extreme caution. The dose of bupropion should not exceed 450mg/day(or150mg/ day in patients with severe hepatic cirrhosis)... 

Modafinil is itself an augmenting therapy to antidepressants tor residual sleepiness and fatigue in major depressive disorder... 

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