Modafinil (CAS No. 68693-11-8) is a medicine which stimulates central nervous system and is used commonly in conditions which lead to excessive daytime sleepiness. These conditions may include shift work sleep disorder usually encountered in shift workers working outside the normal schedule, narcolepsy related fatigue experienced during daytime and obstructive sleep apnea in combination with continuous positive airway pressure (CPAP).
The primary mechanism of action of modafinil is not very clear but it is known to be inhibiting the dopamine reuptake, hence increasing its concentration in blood which is a stimulant itself and well known as ‘happy hormone’. It has also been observed that it increases the concentrations of nor-epinephrine and serotonin in the prefrontal cortex and hypothalamus which can be due to indirect effect of increased dopamine. All these hormones and neurotransmitters are considered as stimulant, thereby making modafinil as wakefulness promoting agent.
Modafinil is readily absorbed orally, and it is available as 100mg and 200mg oral tablets. For adults, it is recommended to take 200mg orally once a day in the morning for the treatment of narcolepsy or obstructive sleep apnea and one hour before the start of the work shift for treatment of shift work disorder. Modafinil is not approved to be used in pediatric population because its efficacy and safety in this age group has not been established yet.
Modafinil is generally well-tolerated medicine with extremely rare serious adverse events. Commonly experienced adverse events are very mild including headache, nausea and decreased appetite which have been observed in less than 10% of the users. Few other adverse effects may include anxiety, insomnia, dizziness, diarrhea, and rhinitis. Although it is a safe drug but if any patient experiences any rare serious rash including Stevens-Johnson syndrome, it should be discontinued at the same time.
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