Can Armodafinil (Nuvigil) be crushed?

From the Guidelines

Armodafinil tablets should not be crushed whenever possible due to potential risks of exposure to the drug and inaccuracies of drug dosing. When considering the administration of armodafinil through an enteral feeding tube, it is crucial to consult the relevant Summary of Product Characteristics to understand the legal position regarding individual prescriptions and dosage forms 1. Crushing medicines, in general, is discouraged because of the potential risks involved, and alternative options should be explored. If a patient has difficulty swallowing armodafinil tablets, a pharmacist can advise on the administration of medicines through enteral feeding tubes and may suggest alternative medicines or patient management options 1.

Some key considerations when administering medicines through enteral feeding tubes include:

• The potential for tube occlusions, which can occur with both solid and liquid dosage forms
• The risk of gut disturbances with liquid medicines containing sorbitol or having high osmolality
• The importance of involving pharmacists in advising on the administration of medicines through enteral feeding tubes, as recommended in national guidelines 1

In the case of armodafinil, if crushing is absolutely necessary, it should be done completely, and the medication should be mixed with a small amount of food or liquid for immediate consumption. However, this should only be done under the guidance of a healthcare provider, and the patient should be closely monitored for any potential side effects or changes in the medication's efficacy. It is essential to prioritize the patient's safety and the medication's stability when considering crushing armodafinil tablets.

From the Research

Armodafinil Administration

• The provided studies do not directly address whether armodafinil can be crushed 2, 3, 4, 5, 6.
• However, the studies discuss the pharmacokinetic profile of armodafinil, its efficacy in treating excessive sleepiness, and its safety in various patient populations.
• Armodafinil is typically administered orally, and its absorption is affected by food, but not its overall bioavailability 2.
• The medication is generally well tolerated, with common adverse events including headache, dizziness, and nausea 2, 3, 5.

Pharmacokinetic Profile

• Armodafinil exhibits linear pharmacokinetics over a dose range of 50-400 mg, with peak plasma concentrations reached around 2 hours after administration in the fasted state 2.
• The mean elimination half-life of armodafinil is approximately 15 hours, and steady state is reached within 7 days 2.
• Armodafinil has a different pharmacokinetic profile compared to modafinil, with higher plasma concentrations later in the day 4.

Efficacy and Safety

• Armodafinil has been shown to be effective in improving wakefulness in patients with excessive sleepiness associated with obstructive sleep apnea, narcolepsy, and shift work sleep disorder 3, 5.
• The medication has also been studied for its potential to reduce cancer-related fatigue in patients with high-grade glioma, but the results were inconclusive 6.
• Armodafinil is generally well tolerated, but common adverse events include headache, nausea, and dizziness 2, 3, 5.