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Movement disorders
Published in Henry J. Woodford, Essential Geriatrics, 2022
Excessive daytime sleepiness can be a feature of PD and is made worse by dopaminergic treatments, especially DAs. Those affected who currently drive should be advised to stop and inform the DVLA.7 Withdrawal of DA medication may be appropriate. Steps to improve nocturnal sleep can reduce daytime sleepiness. Simple measures include cutting out caffeine and alcohol, getting exercise during the day and avoiding daytime napping. Modafinil is a centrally-acting stimulant drug that has been proposed to help with daytime sleepiness, but there is no clear evidence of efficacy.87 It has a long list of potential adverse effects including arrhythmias, hypertension, confusion, depression and gastrointestinal disturbances. It is very unlikely to be suitable for frail older people.
Immunosuppressants, rheumatic and gastrointestinal topics
Published in Evelyne Jacqz-Aigrain, Imti Choonara, Paediatric Clinical Pharmacology, 2021
Evelyne Jacqz-Aigrain, Imti Choonara
When the disorder is severe enough to disturb the child’s daily functioning, particularly when the disorder is associated with catalepsia, modafinil or methyphenidate may be prescribed. Modafinil may be administered at a dose of 100 mg/day and, progressively increased every other week, to reach a daily dose of 200 mg.
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Published in Caroline Ashley, Aileen Dunleavy, John Cunningham, The Renal Drug Handbook, 2018
Caroline Ashley, Aileen Dunleavy, John Cunningham
Modafinil is not recommended in severe renal impairment by the manufacturer due to lack of data. In single dose studies with 200 mg modafinil, at a GFR<20 mL/min there was no difference in the pharmacokinetics although there was a 9-fold increase in exposure to the inactive metabolite.
Dose-dependent subacute cardiovascular effects of modafinil in rats
Published in Drug and Chemical Toxicology, 2022
Dilan Canyurt, Lokman Hekim Tanriverdi, Onural Ozhan, Mehmet Cansel, Hakan Parlakpinar, Nigar Vardi, Yilmaz Cigremis, Azibe Yildiz, Yucel Karaca, Seyma Yasar, Ahmet Acet
Modafinil is used to treat various sleep disorders, characterized by excessive sleepiness that may happen with sleep apnea, narcolepsy, or shift work problems (Ballon and Feifel 2006). Modafinil was first approved by the FDA for narcolepsy in 1998 (Mitler et al. 1998). Modafinil has been shown to enhance executive functions (including attention) with comparable effectiveness to amphetamine drugs and also decreased incidence of side effects and addiction in these sleep-deprived individuals (Minzenberg and Carter 2008). The net mechanism of action of modafinil is not yet known today. However, when the neurochemical effects are examined, it has been shown in the animal studies that modafinil interacts with dopaminergic, noradrenergic, glutamatergic, GABAergic, serotoninergic, orexinergic, and histaminergic means (Makela et al.2003). Modafinil has been found to have a weak but highly selective binding affinity especially for dopamine reuptake regions (Mignot et al.1994). Modafinil is thought to act as part of the hypocretin/orexin agonist, which has a stimulating effect on adrenergic neurons in locus cereus (Elovic 2000, Pierre 2007).
Analgesic and anti-inflammatory effects of modafinil in a mouse model of neuropathic pain: A role for nitrergic and serotonergic pathways
Published in Neurological Research, 2022
Hossein Ghorbanzadeh, Parastoo Mohebkhodaei, Mehran Nematizadeh, Nastaran Rahimi, Mahsa Rafeiean, Mehdi Ghasemi, Ahmad R. Dehpour
Modafinil is a nonamphetaminic psycho-stimulant and wake-promoting agent approved for narcolepsy, shift work sleep disorder, and obstructive sleep apnea with residual excessive sleepiness despite optimal use of continuous positive airway pressure (CPAP) [8]. Increasing off-label modafinil prescription up to 89% has been reported which is mostly for depression (18%) and fatigue in multiple sclerosis (12%) [9] . While having stimulant effects, modafinil, with low toxicity and absence of tolerance effects, has low abuse capacity [10]. It stimulates the central nervous system (CNS) somehow in a different way than other CNS stimulants such as amphetamine or cocaine. It modulates the release or reuptake of many neurotransmitters including serotonin, dopamine, noradrenaline, orexin, and γ-aminobutyric acid (GABA) [8,11]. Recent studies have revealed that modafinil may have neuroprotective and anti-inflammatory properties [12]. Its therapeutic effect on Parkinson’s disease, chronic fatigue syndrome, attention-deficit hyperactivity disorder (ADHD), myotonic dystrophy, and schizophrenia have been reported [12,13]. Anti-inflammatory effects of modafinil through inhibiting Akt/NF-κB pathway are also demonstrated in a mouse model of atherosclerosis [14]. Modafinil also exerts neuroprotective effects in animal models of Parkinson’s disease [15,16] and is able to protects striatal cell against methamphetamine-induced neurotoxicity in mice [17]. Recent investigations have also demonstrated that modafinil has beneficial effects on vincristine-induced neuropathic pain in rats [18].
Pharmacokinetic and pharmacodynamic of the cognitive enhancer modafinil: Relevant clinical and forensic aspects
Published in Substance Abuse, 2020
Ana Sousa, Ricardo Jorge Dinis-Oliveira
Due of its wake-promoting and psychotropic effects, modafinil is prescribed to improve wakefulness in adults who have excessive day sleepiness due to one of the following diagnosed sleep disorders:96–98 i) narcolepsy, as first-line treatment; ii) obstructive sleep apnea (OSA), as an adjunct to continuous positive airway pressure (CPAP); and iii) shift work disorder sleep (SWSD), as first-line treatment. The usual starting dose is 200 mg per day (100 mg twice daily). Nonetheless, it can be gradually increased to 400 mg per day (200 mg twice daily) in case of insufficient response.99 Modafinil is also approved for Air Force missions in the U.S. as an alternative to amphetamines for military usage and has also been shown to reduce jet lag symptomatology.24 In 2007, the longer-acting form of modafinil, armodafinil, was also approved for the treatment of excessive sleepiness associated with narcolepsy, OSA and SWSD,100,101 taken in a single dose (varying from 100 to 250 mg) in the morning.99,102 In narcoleptic patients previously treated unsatisfactorily with psychostimulants like d-amphetamine, methylphenidate, or pemoline, modafinil seems to be an effective and well-tolerated treatment for improving daytime wakefulness, regardless of which psychostimulant was taken formerly.103