Marilyn A. D. Yee completed her Doctor of Pharmacy degree from the University of Michigan in Ann Arbor in 1995. Dr. Yee received further training for two years in two pharmacy residencies offered by the University Of Arizona College Of Pharmacy, and the University Medical Center in Tucson, Arizona.
Jay W. Marks, MD, is a board-certified internist and gastroenterologist. He graduated from Yale University School of Medicine and trained in internal medicine and gastroenterology at UCLA/Cedars-Sinai Medical Center in Los Angeles.
DRUG CLASS AND MECHANISM:
Modafinil is an oral drug that is used for improving wakefulness in patients
with excessive sleepiness. The effect of modafinil is similar to caffeine. Both drugs promote wakefulness by stimulating the brain. Thus, both drugs are considered stimulants. Other stimulants, for example, dextroamphetamine (Dexedrine) and sibutramine (Meridia), also have the different effect of suppressing appetite. All four of these drugs affect the neurotransmitters in the brain, the chemicals that the nerves of the brain use to communicate with each other; however, they affect the neurotransmitters differently. Modafinil was approved by the FDA in December, 1998.
PRESCRIPTION: Yes
GENERIC AVAILABLE: No
PREPARATIONS: Tablets: 100 mg and 200 mg.
STORAGE: Modafinil should be stored at room temperature, 15-30°C(59-86°F).
PRESCRIBED FOR: Modafinil is
used to promote wakefulness in patients with excessive sleepiness associated
with narcolepsy, obstructive sleep apnea/hypopnea syndrome (as an adjunct for
treatment of the underlying obstruction), and shiftwork sleep disorder.
Narcolepsy is a chronic disease of the brain and spinal cord characterized most
commonly by a recurrent, uncontrollable desire to sleep. Shiftwork sleep
disorder is a condition in which the normal rhythm of sleep is disturbed, often as a result of working at night.
DOSING: Modafinil usually is taken at a dose of 200 or 400 mg daily, although the 400 mg dose has not been shown to be more effective than the 200 mg dose. Modafinil can be taken with or without food.
DRUG INTERACTIONS: Modafinil can decrease or increase the activity of enzymes in the liver that metabolize (eliminate) other drugs. This can result in decreased levels of some drugs that reduce their effectiveness and increased levels of other drugs that leads to their toxicity. Modafinil treatment should be carefully monitored if taken with any of these drugs.
Drugs which may have reduced effectiveness if taken with modafinil include cyclosporine (Sandimmune), theophylline, and hormonal contraceptives such as progestin-only or estrogen and progesterone containing drugs (e.g., Micronor, Ortho-Novum 1/50). Alternative hormonal contraceptives or an additional non-drug form of contraception should be considered during treatment with modafinil, and treatment should continue for one month after modafinil therapy ends (since the effects of modafinil on contraceptive hormones may continue for several weeks). The effects of modafinil on hormonal contraceptives occurs if the hormones are taken by mouth, patch, or implant.
Drugs that may show increased effects or toxicity if taken with modafinil include warfarin (Coumadin), diazepam (Valium), propranolol (Inderal), imipramine (Tofranil), desipramine (Norpramin), phenytoin (Dilantin) and mephenytoin (Mesantoin).
Some other drugs that may increase the effectiveness and/or toxicity of modafinil. These drugs include carbamazepine (Tegretol), phenobarbital, and rifampin (Rifadin). Other drugs, such as ketoconazole (Nizoral) and itraconazole (Sporanox) may reduce the effectiveness of modafinil.
It is not clear if there are interactions between modafinil and alcohol.
PREGNANCY: Modafinil is toxic to rat embryos. There are no adequate studies that assess effects of modafinil in pregnant women.
NURSING MOTHERS: It is not known if modafinil is excreted in breast milk.
SIDE EFFECTS: The most common side effects of modafinil in clinical trials are headache, upper respiratory tract infection, nausea, nervousness, anxiety and insomnia. These each occur in more than 5% of patients.
A number of vital tasks carried out during sleep help maintain good health and enable people to function at their best. Sleep needs vary from individual to individual and change throughout your life. Not getting enough sleep can hurt memory performance, health, and your mood.
Seasonal affective disorder is a type of depression that tends to occur as the days grow shorter in the fall and winter. Symptoms of seasonal affective disorder include tiredness, fatigue, depression, irritability, body aches, poor sleep and overeating.
Narcolepsy, a chronic disease of the central nervous system causes have not been fully determined. Some theories include abnormalities in hypocretin neurons in the brain or an autoimmune disorder. Symptoms of narcolepsy include excessive daytime sleepiness, cataplexy, hypnagogic hallucinations, sleep paralysis, disturbed nocturnal sleep, and automatic behavior. Diagnosis of narcolepsy is based on a clinical evaluation, specific questionnaires, sleep logs or diaries, and the results of sleep laboratory tests. Treatments of narcolepsy symptoms include medication and lifestyle changes.
Hypersomnia is a condition where a person has excessive daytime sleepiness and trouble staying awake during the day. Treatment for hypersomnia includes medication, CPAP machines, and lifestyle changes.
Kleine-Levin syndrome is a rare sleep condition, primarily affecting adolescent males. Symptoms of Kleine-Levin syndrome include recurring but reversible periods "episodes" of excessive sleep. There is no definitive treatment for Kleine-Levin syndrome. Medication can be prescribed to treat sleepiness and episodes.
Hypersomnia, or excessive sleepiness, is a condition in which a person has trouble staying awake during the day. People who have hypersomnia can fall asleep at any time; for instance, at work or while they are driving. They may also have other sleep-related problems, including a lack of energy and trouble thinking clearly.
According to the National Sleep Foundation, up to 40% of people have some symptoms of hypersomnia from time to time.
What Causes Hypersomnia?
There are several potential causes of hypersomnia, including:
The sleep disorders narcolepsy (daytime sleepiness) and sleep apnea
(interruptions of breathing during sleep)
Not getting enough sleep at night (sleep deprivation)
Being overweight
Drug or
alcohol abuse
A head injury or a neurological disease, such as multiple sclerosis
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