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Modafinil
Brand Name: Provigil
Overview
Provigil is the brand name for modafinil, a CNS (central nervous system) stimulant.
In general, CNS stimulants increase alertness and wakefulness. In large doses, CNS
stimulants can also cause insomnia, nervousness and tension, and hyperactivity.
Why
is this drug prescribed?
Relatively recently, Provigil has been used to treat ADHD in children, but there are
conflicting studies. Some studies indicate that Provigil is helpful, while others
find that it has no effect on symptoms of ADHD. Studies consistently indicate that
Provigil is well tolerated and side effects from this drug are minimal.
Otherwise, Provigil is used to treat narcolepsy. Narcolepsy is a disorder of sleep
associated with excessive daytime sleepiness, involuntary sleeping and/or sudden
limpness during the day. Sometimes narcoleptics have difficulty sleeping at night.
Provigil treats the symptoms of narcolepsy, but is not a cure. The usual adult dosage
is 200mg once a day, usually in the morning.
Warnings
and Precautions
Studies of Provigil have been confined to adults; no information about the specific
effects of Provigil in children is available. As with most medications, its effects on
children, especially side effects, are likely to be stronger in children.
Provigil can interfere with hormonal birth-control medicines such as birth-control
pills or implants. Alternate methods of birth control, such as condoms, should be used
during Provigil therapy and for one month after Provigil therapy.
Provigil should be taken in the lowest effective dose, as it can be addictive when
taken for a long time or in large doses.
For Pregnant or Nursing Mothers: Provigil has not been studied in pregnant women,
but animal studies indicate that it may cause birth defects and an increased chance of
miscarriage. It is not known whether Provigil passes into breast milk, but many
medications do pass into breast milk, and breastfeeding mothers are advised to use
caution and discuss alternative medications with a doctor.
Contraindications
Provigil should Not be used for people with the following medical conditions:
- a history of heart problems when other CNS stimulants are used
- a history of severe mental illness – Provigil may increase cause it to return
Precautions
Provigil may be used with caution in people with the following conditions:
- Liver disease – Provigil dosage may need to be lowered as liver disease can decrease the rate at which medication is removed from the blood.
- Kidney disease – may increase blood levels of a breakdown product of Provigil.
- Heart disease – it is not well understood the impact that Provigil may have on heart disease.
- High blood pressure – CNS stimulation may increase blood pressure
Adverse
Reactions
Provigil may cause the following reactions:
- Insomnia – this side effect can be minimized if Provigil is taken on a regular schedule. Missing a dose or taking it late may cause a disruption in sleep patterns.
- Anxiety
- Headache
- Nausea
- Nervousness
The remaining side effects are uncommon:
- Decrease in appetite
- Diarrhea
- dryness of mouth
- dryness of skin
- flushing or redness of skin
- muscle stiffness
- stuffy or runny nose
- tingling, burning, or prickling sensations in the skin
- trembling or shaking
- vomiting
- Agitation or excitement
- fast or pounding heartbeat
- increased blood pressure
- Blurred vision or other vision changes
- chills or fever
- clumsiness or unsteadiness
- confusion
- dizziness or fainting
- increased thirst and increased urination
- mental depression
- problems with memory
- rapidly changing moods
- shortness of breath
- sore throat
- trouble in urinating
- uncontrolled movements of the face, mouth, or tongue
Interactions
with Drugs and Other Substances
Drugs or substances that may interact with Provigil include:
- Stimulants: Methylphenidate (Ritalin), Bupropion (Wellbutrin), Pemoline (Cylert), Amantadine (Symmetrel), amphetamines, appetite suppressants (diet pills), Caffeine, Chlophedianol (Ulone), cocaine, asthma medicine, cold medications, sinus medication, allergy medications (including nose drops or sprays), Nabilone (Cesamet)– these medications are stimulants and may increase the CNS stimulation from Provigil, especially its side effects.
- Diazepam (Valium), Warfarin (Coumadin), Cyclosporine (Sandimmune), Mephenytoin (Mesantoin), Phenytoin (Dilantin), Propranolol (Inderal), Theophylline (Slo-Bid Gyrocaps, Theo-Dur)—Provigil may increase blood levels of these medications or interfere with the way they work. It may be possible to take both medications if the dosage of one or both medication is adjusted.
- Medications known to have a high risk of serious drug interactions: Monoamine oxidase (MAO) inhibitors - furazolidone (Furoxone), isocarboxazid (Marplan), phenelzine (Nardil), procarbazine (Matulane), selegiline (Eldepryl), tranylcypromine (Parnate)—these medications are not specifically known to interact with Provigil, but extreme caution is advised if any are used in combination with Provigil or any other medication.
- Steroid contraceptives: birth control pills and implants such as Norplant—steroid (hormone) birth control methods may not be effective during Provigil therapy, and for one month after Provigil therapy is ceased. Other methods of birth control should be used during this time.
- Tricyclic antidepressants: amitriptyline (Elavil), amoxapine (Asendin), clomipramine (Anafranil), desipramine (Pertofrane), doxepin (Sinequan), imipramine (Tofranil), nortriptyline (Aventyl), protriptyline (Vivactil), trimipramine (Surmontil)— Provigil may increase blood levels of these medications or interfere with the way they work.
Sources
http://www.healthtouch.com/bin/EContent_HT/drugShowLfts.asp?fname=usp0716.htm&title=Provigil&cid=HTDRUG
http://www.nlm.nih.gov/medlineplus/druginfo/modafinilsystemic203466.html
http://www.addclinic.net/review_section_03.asp
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