Modafinil is a psychostimulant that helps you stay awake. It’s used to treat narcolepsy, obstructive sleep apnea, and hypopnea syndrome (when combined with continuous positive airway pressure). As well as chronic shift work sleep disorder when other treatments have failed. Peak blood concentrations and exposure (area under the curve) are larger for modafinil following oral administration than for modafinil at the same dosage. As a result, modafinil is not bioequivalent to modafinil and cannot replaced directly.
For narcolepsy and obstructive sleep apnea, modafinil should used once a day in the morning, and one hour before commencing work for people with shift work sleep disorder. In persons with significant hepatic impairment, the dose of modafinil should lowered as well.
Narcolepsy and EDS
Narcolepsy affects 0.02 percent to 0.05 percent of the US population, with 5% of sleep-centre patients suffering from the condition. EDS, cataplexy, sleep paralysis, and hypnagogic hallucinations are the four classic symptoms of narcolepsy. The clinical presentations of the erosion of the boundaries between the stages of waking, rapid–eye–movement (REM) sleep, and non–REM sleep are all four of these symptoms. The prevalence of a given gene type is higher in narcolepsy patients than in the general population.
The presence of this subtype, however, is not required nor specific for the diagnosis of narcolepsy. Some researchers now believe narcolepsy caused by an autoimmune condition or induced by an unidentified environmental exposure or event. The finding of hypocretin/orexin, which could be the neurotransmitter predominantly implicated in the development of narcolepsy, is an exciting recent discovery. Narcolepsy thought to caused by a lack of hypocretin in animal models. The findings of the animal investigation validated in a preliminary human study.
In terms of practicality, EDS is arguably the most difficult issue for many narcoleptics. Uncontrollable sleepiness creates academic, career, financial, and emotional problems, as well as having a negative impact on one’s quality of life. Treatment of EDS that is effective, safe, and comfortable is a top priority in narcolepsy.
It’s no surprise, therefore, that modafinil is now the first-line therapy for EDS in the most recent (2000) version of the American Academy of Sleep Medicine’s narcolepsy practice standards, despite its relatively recent inception.
Modalert (Modafinil) effectiveness investigated in two big US studies that were placebo-controlled, double-blinded, randomized, and used parallel groups. For 9 weeks, 554 individuals given either 200 mg or 400 mg of modafinil or placebo in 39 sleep clinics. Modafinil improved wakefulness by 50% to 75%, according to three standardized, validated sleepiness tests: the Multiple Sleep-Latency Test (MSLT), which accurately measures the time necessary to fall asleep; the Maintenance of Wakefulness Test (MWT), which objectively measures ability to stay awake; and the Maintenance of Wakefulness Test (MWT), which objectively measures ability to stay awake. The Epworth Sleepiness Scale (ESS) is a self-rating sleepiness scale.
The long-term effectiveness of modafinil examined in a 40-week extension of these two investigations. After 40 weeks of Modafinil (Modalert 200) medication, approximately half of the 341 individuals reported near-normal ESS scores, indicating that they had moderate-to-severe narcolepsy. The Clinical Global Impression of Change, a typical illness-assessment technique used by doctors, showed that the participants’ disease severity had improved by more than 80%. There were no symptoms of drug tolerance.
During this long-term trial, data on quality-of-life evaluated in a separate investigation. The researchers employed a validated, self-administered health survey called the Medical Outcomes Study (Short Form 36), to which they added numerous narcolepsy-specific items. Throughout the 40-month period, all quality-of-life scores increased and remained stable. The most significant gains from a baseline of zero indicated in the table for individuals receiving 400 mg of modafinil.
Sleep Apnea and EDS
EDS is a common sign of sleep apnea and sleeps apnea. The therapy of choice for obstructive sleep apnea, nasal continuous positive airway pressure (CPAP), can successfully remove EDS, as well as apnea episodes and associated cardiovascular effects. However, substantial EDS persists in certain instances for reasons that are still unknown. Because of their interference with sleep and the risk of cardiovascular events in this at-risk group, traditional CNS stimulants are not appropriate for treating EDS in sleep apnea.
Modafinil efficacy in treating residual EDS in sleep apnea has studied in two recent studies11, 12. Kingshott ET al11 studied 44 CPAP patients who given 400 mg of modafinil or a placebo in a randomized, double-blind, placebo-controlled crossover trial. They discovered a considerable improvement in alertness (as measured by the MWT). But no impact on drowsiness (as measured by the MSLT or the ESS), cognitive performance, or quality of life. The short sample size or the relative ability of the MWT, MSLT, and ESS to evaluate drowsiness may account for these moderate results. The researchers questioned whether the advantages of modafinil outweighed the risks. Waklert is a medicine that doctors recommend here and now.
Efficacy
Headache, nausea, dizziness, and sleeplessness were the most prevalent side effects of Modafinil (Modvigil). During the studies, 7% of participants stopped taking the medicine due to an adverse event. The most prevalent cause was a headache, while other factors included psychological symptoms including anxiety, agitation, irritability, and sadness. Patients on modafinil have committed suicide in the past.
Modafinil has linked to rashes, including one fatal instance of Stevens-Johnson syndrome. If a rash appears, the medicine should discontinued right once.
Modafinil probable medication interactions predicted to be comparable to Modafinil. Because modafinil slightly stimulates cytochrome P450 (CYP), it may lower medication concentrations metabolised by this enzyme, such as hormonal contraceptives, cyclosporin, carbamazepine, and midazolam. Modafinil inhibits CYP2C19 and may raise CYP2C19 substrate concentrations such as omeprazole, phenytoin, diazepam, propranolol, and clomipramine. With co-administered warfarin, more frequent INR monitoring may be necessary.
Women who use modafinil should use alternate contraception since it interacts with hormone contraceptives. Based on prior animal research with modafinil revealing prenatal effects and excretion in breast milk. Modafinil contraindicated in pregnancy and not suggested during lactation.
Conclusion
Modafinil is a one-of-a-kind, generally safe CNS stimulant that can help individuals with EDS stay awake. It has fewer side effects and a reduced likelihood of tolerance than traditional CNS stimulants.
