Armodafinil Dosing
For obstructive sleep apnea and narcolepsy, start armodafinil 150 mg once daily in the morning, which can be increased to 250 mg daily if needed; for shift work disorder, use 150 mg approximately 1 hour before the work shift begins. 1
Standard Dosing by Indication
Obstructive Sleep Apnea and Narcolepsy
- The FDA-approved dose is 150-250 mg taken orally once daily as a single morning dose 1
- Doses up to 250 mg/day have been well tolerated, though there is no consistent evidence that 250 mg provides additional benefit beyond 150 mg 1
- Clinical trials demonstrate that armodafinil significantly improves mean sleep latency and produces clinical improvement in 72% of patients compared to 37% with placebo 2
Shift Work Sleep Disorder
- Use 150 mg taken orally once daily, approximately 1 hour prior to the start of the work shift 1
- This timing optimizes peak plasma concentrations during the critical work period 3
Special Population Adjustments
Elderly Patients
- Consider lower starting doses and close monitoring in geriatric patients 1
- While armodafinil-specific geriatric data is limited, modafinil guidelines recommend starting at 100 mg once upon awakening in elderly patients, with weekly titration as necessary 4, 5
- The typical maintenance range for elderly patients is 200-400 mg daily for modafinil; apply similar caution with armodafinil 4
Severe Hepatic Impairment
- Reduce the dosage of armodafinil in patients with severe hepatic impairment 1
- This is critical because both maximum plasma concentration and elimination half-life increase significantly in hepatic impairment 6
Cardiovascular Considerations
- Monitor blood pressure, heart rate, and cardiac rhythm when initiating or adjusting doses 4
- In long-term studies, modest increases in vital signs were observed (blood pressure +3.6/2.3 mm Hg, heart rate +6.7 bpm), with most changes occurring by month 3 7
- Increased monitoring of blood pressure is appropriate in patients on armodafinil 7
Timing and Administration
Optimal Dosing Schedule
- Administer as a single morning dose for OSA and narcolepsy to avoid interference with nighttime sleep 1
- The last dose should be no later than 2:00 PM to prevent insomnia 5
- For shift work disorder, timing should be approximately 1 hour before shift start 1
Split Dosing Considerations
- While the FDA label recommends once-daily dosing for armodafinil 1, modafinil data suggests that split dosing (morning and midday) may be superior for sustaining wakefulness throughout the entire day, particularly for late-afternoon/evening sleepiness 8
- A 400 mg split-dose regimen of modafinil improved evening wakefulness significantly compared to once-daily dosing 8
Efficacy and Duration
Clinical Response Timeline
- Improvements in wakefulness begin at the first assessment (typically week 4) and are maintained throughout treatment 2
- Long-term efficacy is sustained for at least 12 months with continued tolerability 7
- Armodafinil does not adversely affect nighttime sleep architecture or polysomnography parameters 2
Common Adverse Effects
Most Frequent Side Effects
- Headache (25%), nasopharyngitis (17%), and insomnia (14%) are the most common adverse events 7
- Nausea, anxiety, and dizziness also occur but are generally mild to moderate in intensity 2
- Discontinuation due to adverse events occurs in approximately 13% of patients during the first 12 months 7
Critical Safety Monitoring
Baseline and Ongoing Assessments
- Check blood pressure and heart rate at baseline before initiating therapy 4
- Monitor for hypertension, palpitations, and arrhythmias during dose adjustments 4
- Assess for excessive stimulatory effects, nocturnal sleep disturbances, and behavioral changes including psychosis 4
- More frequent follow-up visits are recommended when starting or adjusting doses 4
Contraindications and Warnings
- Armodafinil can cause Stevens-Johnson syndrome, a rare but life-threatening condition; monitor for rash 5
- The drug has lower abuse potential than traditional stimulants like amphetamines, with limited physical and psychological dependence risk 5, 6