Modafinil (Provigil) & Armodafinil (Nuvigil)

Novel stimulant (dopamine reupatke inhibitor; serotonin/norepinephrine reupate inhibition)

Dosing

50-250mg in am, can take PRN. Improves fatigue, mood, shift-work syndrome, reduces impulsivity and binge eating, treats ADHD about half as well as stimulants. Tell patient some insurers don’t cover it and we can’t authorize it since it’s not officially a psych med, but can get out-of-pocket for $35 at Harris Teetor or Costco or GoodRx.com

Management

Common SE: anxiety, headache, insomnia (but can also help sleep by setting the sleep cycle); all improve with dose reduction. Caution of possible heart arrhythmias, hypertension, serious rash.

Compared to modafinil, armodafinil has steadier serum levels throughout the day.

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EMR Text