What is the management approach for a patient experiencing excessive daytime somnolence while taking Sertraline (Zoloft) 50mg and Aripiprazole (Abilify) 2mg?

From the Guidelines

I strongly recommend adding modafinil to the patient's current medication regimen, starting with a dose of 100-200 mg daily, to help alleviate excessive daytime sleepiness and fatigue. The patient's complaints of sleepiness and tiredness during the day while on Zoloft 50mg and Abilify 2mg can be addressed by introducing a wakefulness-promoting agent like modafinil, as evidenced by its efficacy in treating fatigue in various patient populations, including those with cancer-related fatigue 1. Some key points to consider when prescribing modafinil include:

• Its novel mechanism of action, which enhances activity in the hypothalamic wakefulness center, and its relatively good safety profile with less abuse potential compared to other psychostimulants 1.
• The most common adverse events associated with modafinil, such as headache, nausea, and nervousness, which are generally well-tolerated 1.
• The potential for modafinil to improve not just fatigue but also mood, quality of life, and functional status, as seen in studies on cancer-related fatigue 1. It is essential to monitor the patient's response to modafinil and adjust the dose as needed, considering that higher doses may be more effective for sleepiness, while lower doses might be better suited for concentration problems and fatigue 1. Additionally, the patient should be advised to maintain good sleep hygiene practices, avoid alcohol and sedating substances, and keep a regular sleep schedule to help manage their symptoms. The healthcare provider should also investigate other potential causes of fatigue, such as thyroid disorders, anemia, or sleep apnea, to ensure comprehensive management of the patient's condition.

From the Research

Possible Causes of Daytime Sleepiness

• Excessive daytime sleepiness can be caused by various factors, including pathologic abnormalities of the central nervous system, deficiencies in quality or quantity of sleep, disturbances to the body's natural circadian rhythm, and drugs 2
• The patient's current medications, Zoloft 50mg and Abilify 2mg, may be contributing to their daytime sleepiness, as some medications can increase sleepiness as a side effect 2

Treatment Options for Excessive Daytime Sleepiness

• Modafinil is a wake-promoting agent that can be used to treat excessive daytime sleepiness associated with narcolepsy, obstructive sleep apnoea/hypopnoea syndrome, and shift work sleep disorder 3, 4
• Modafinil has been shown to be effective in improving daytime wakefulness in patients with excessive daytime sleepiness, but it may not be suitable for all patients, particularly those with certain medical conditions or taking certain medications 5, 6

Considerations for Treatment

• Determining the cause of the patient's daytime sleepiness is essential in developing an effective treatment plan 2
• Modafinil should be administered carefully, particularly in older patients or those with complications such as glucose intolerance 5
• The patient's treatment plan should be regularly monitored and adjusted as needed to ensure optimal treatment outcomes 2, 6