From the Guidelines
Modafinil is primarily used to treat excessive daytime sleepiness associated with narcolepsy, shift work sleep disorder, and obstructive sleep apnea, with a typical starting dose of 200 mg taken once daily in the morning 1. The medication works by affecting certain brain chemicals that control the sleep-wake cycle, though its exact mechanism isn't fully understood. It's believed to increase dopamine levels in the brain by blocking dopamine transporters, which helps promote wakefulness without the intense stimulant effects of amphetamines. Some key points to consider when using modafinil include:
- The typical dose range is from 100 mg to 400 mg daily, depending on the patient's response and specific condition being treated 1.
- Common side effects include headache, nausea, nervousness, and insomnia 1.
- Patients should avoid alcohol while taking modafinil, and those with heart conditions, high blood pressure, liver problems, or a history of mental health disorders should use it with caution.
- Modafinil is not a replacement for adequate sleep and should be used as part of a comprehensive treatment plan that addresses underlying sleep disorders.
- The use of modafinil in individuals less than 17 years of age should be monitored with caution due to reports of serious side effects, including life-threatening development of Stevens-Johnson syndrome 1.
- Recent studies have shown that modafinil can be effective in improving daytime alertness and behavioral concerns in patients with Prader-Willi syndrome, with a starting dose of 100 mg/day 1. Overall, modafinil is a useful medication for treating excessive daytime sleepiness, but its use should be carefully monitored and adjusted based on individual patient needs and responses 1.
From the FDA Drug Label
Modafinil is indicated to improve wakefulness in adult patients with excessive sleepiness associated with narcolepsy, obstructive sleep apnea, and shift work disorder. Modafinil tablets are a prescription medicine used to improve wakefulness in adults who are very sleepy due to one of the following diagnosed sleep disorders: * narcolepsy * obstructive sleep apnea (OSA). * shift work disorder (SWD)
Modafinil is used to improve wakefulness in adults with excessive sleepiness associated with narcolepsy, obstructive sleep apnea (OSA), and shift work disorder (SWD). It is used as an adjunct to standard treatment(s) for the underlying obstruction in OSA. Modafinil does not take the place of using a CPAP machine or other treatments prescribed by a doctor for OSA. It may help the sleepiness caused by these conditions but may not stop all sleepiness, and it does not take the place of getting enough sleep 2, 2.
From the Research
Modafinil for Sleep Disorders
Modafinil is used to treat excessive sleepiness associated with various sleep disorders, including:
- Narcolepsy
- Obstructive sleep apnoea/hypopnoea syndrome (OSA/HS)
- Shift work sleep disorder (SWSD)
- Idiopathic hypersomnia (IH)
Mechanism of Action
Modafinil is a wake-promoting agent that is pharmacologically distinct from CNS stimulants, such as amfetamine, dexamfetamine, and methylphenidate 3. It promotes wakefulness in patients with OSA/HS and SWSD, and is an effective adjunctive therapy in patients with residual excessive sleepiness associated with OSA/HS who are receiving nasal continuous positive airway pressure (nCPAP) therapy.
Efficacy in Sleep Disorders
Studies have shown that modafinil is effective in reducing excessive sleepiness and improving wakefulness in patients with:
- OSA/HS: Modafinil improved nighttime wakefulness and reduced excessive sleepiness in patients with OSA/HS 3, 4.
- SWSD: Modafinil improved nighttime wakefulness and reduced excessive sleepiness in patients with SWSD 3, 4.
- IH: Modafinil decreased sleepiness and improved mean sleep latency in patients with IH 5.
- Narcolepsy: Modafinil improved excessive sleepiness and illness severity in patients with narcolepsy 6.
Safety and Tolerability
Modafinil is generally well tolerated in patients with OSA/HS or SWSD, and has a low abuse potential 3, 7. Common adverse events include headache, nausea, nervousness, and hypertension 6, 7.
Clinical Use
Modafinil is approved for use in the US and certain European countries for the treatment of excessive sleepiness associated with narcolepsy, OSA/HS, and SWSD 3, 7. It is also used off-label for the treatment of IH and other sleep disorders. The dosage of modafinil should be reduced in the elderly and in patients with hepatic disease, and caution is needed in patients with severe renal insufficiency 6.