modafinil: clinical use

Prescribing considerations

• Confirm narcolepsy after evaluation of excessive sleepiness and exclusion of other causes; initiation should be supervised by an appropriately experienced physician.
• Assess psychiatric history, substance misuse risk, insomnia, cardiovascular disease, hepatic or renal impairment, pregnancy potential and interacting medicines.
• The selected product should not be used in people younger than 18 years.

Contraindications and cautions

• Hypersensitivity to modafinil or an excipient.
• Uncontrolled moderate-to-severe hypertension.
• Cardiac arrhythmias.

Monitoring

• Obtain an ECG before treatment; investigate abnormal findings before considering modafinil.
• Monitor blood pressure and heart rate regularly.
• Review psychiatric symptoms, residual sleepiness, skin reactions, contraception and clinically significant interactions.
• Periodically reassess benefit, adverse effects, misuse and dependence risk.

Clinical pharmacology

Modafinil is a racemic wakefulness-promoting compound with an incompletely defined mechanism. It inhibits dopamine reuptake and, more weakly, noradrenaline uptake. It induces CYP3A4/5 and may inhibit CYP2C19 and CYP2C9 pathways.

Formulation and product differences

• The selected product is an uncoated, score-marked tablet that can be divided into equal halves.
• It contains lactose monohydrate and is essentially sodium-free.

Tablet

Route: Oral

Strengths: 100 mg, 200 mg