Recommended Dosage and Usage of Nuvigil (Armodafinil) for Sleep Disorders
The recommended dosage of Nuvigil (armodafinil) is 150 mg taken orally once daily in the morning for patients with obstructive sleep apnea (OSA) or narcolepsy, and 150 mg taken approximately 1 hour before the start of work shift for patients with shift work disorder (SWD). 1
Dosage Guidelines by Condition
Obstructive Sleep Apnea (OSA) and Narcolepsy
- Starting dose: 150 mg once daily in the morning
- Dose range: 150-250 mg daily
- While doses up to 250 mg/day have been well tolerated, there is no consistent evidence that these higher doses provide additional benefit beyond the 150 mg/day dose 1
Shift Work Disorder (SWD)
- Fixed dose: 150 mg taken once daily approximately 1 hour before the start of the work shift 1
Idiopathic Hypersomnia
- The American Academy of Sleep Medicine recommends modafinil (armodafinil's parent compound) for idiopathic hypersomnia 2
- For armodafinil, a similar approach to the OSA/narcolepsy dosing is appropriate
Special Population Considerations
Patients with Severe Hepatic Impairment
- Dose reduction is required 1
- Start with lower doses and monitor closely
Geriatric Patients
- Lower doses should be considered
- Close monitoring is recommended 1
Efficacy and Tolerability
Armodafinil has demonstrated effectiveness in improving wakefulness in patients with excessive sleepiness associated with:
- OSA (despite CPAP treatment)
- Narcolepsy
- Shift work disorder 3
Long-term studies have shown that armodafinil remains effective and is generally well tolerated for treatment periods of 12 months or longer 4, 5. In clinical trials, 80% of patients with treated OSA and 84% of patients with narcolepsy showed at least minimal improvement in their overall clinical condition 5.
Common Side Effects
The most commonly reported adverse events include:
- Headache (14-25%)
- Nasopharyngitis (17%)
- Insomnia (14%) 4
Important Clinical Considerations
- Armodafinil is the R-enantiomer of modafinil with a longer half-life (10-15 hours) 6
- Unlike amphetamines, armodafinil has a low abuse potential and does not cause rebound phenomena after treatment withdrawal 7
- Blood pressure monitoring may be appropriate as modest increases in vital signs have been observed (average 3.6/2.3 mmHg increase in blood pressure) 4
- Armodafinil does not adversely affect CPAP therapy in patients with OSA 5
Pitfalls and Caveats
- Armodafinil may reduce the efficacy of low-dose oral contraceptives
- The medication is contraindicated in patients with moderate to severe hypertension
- While effective for excessive daytime sleepiness, armodafinil does not suppress cataplexy in narcolepsy patients 7
- Patients should be advised that armodafinil is not a replacement for adequate sleep and proper sleep hygiene