Maximum Dose of Armodafinil
The maximum dose of armodafinil is 250 mg taken orally once daily as a single dose in the morning. 1
Dosage Guidelines by Indication
FDA-Approved Indications
- Obstructive Sleep Apnea (OSA): 150-250 mg once daily in the morning 1
- Narcolepsy: 150-250 mg once daily in the morning 1
- Shift Work Disorder (SWD): 150 mg taken approximately 1 hour prior to start of work shift 1
Special Populations
- Severe hepatic impairment: Dosage reduction required 1
- Geriatric patients: Lower doses and close monitoring recommended 1
Pharmacokinetic Considerations
Armodafinil exhibits linear pharmacokinetics over the 50-400 mg dose range 2. Key pharmacokinetic properties include:
- Peak plasma concentrations reached approximately 2 hours after administration in fasted state
- Food delays peak concentration by 2-4 hours but doesn't affect overall bioavailability
- Mean elimination half-life of approximately 15 hours
- Steady state typically reached within 7 days of daily dosing 2
Clinical Evidence for Higher Doses
While some case reports suggest potential benefits of higher doses in specific conditions (e.g., treatment-resistant bipolar depression with doses up to 1,000 mg/day) 3, these exceed FDA-approved dosing and lack sufficient safety data to recommend routinely.
Safety Considerations
Common adverse events include:
At doses above the recommended maximum of 250 mg/day, the risk of adverse effects increases without consistent evidence of additional therapeutic benefit 1.
Important Clinical Notes
- Armodafinil is the R-enantiomer of modafinil with a different pharmacokinetic profile
- Despite having similar terminal half-lives, armodafinil maintains higher plasma concentrations later in the day compared to modafinil on a milligram-to-milligram basis 5
- For most indications, 150 mg daily is often sufficient, with the 250 mg dose reserved for cases with inadequate response to the lower dose
Monitoring
When prescribing armodafinil, monitor for:
- Development or worsening of anxiety
- Sleep disturbances
- Cardiovascular symptoms
- Psychological changes 4
Remember that exceeding the maximum recommended dose of 250 mg daily is not supported by the FDA labeling and may increase the risk of adverse effects without providing additional therapeutic benefit.