Efectos adversos a nivel cardiovascular y neurológico asociados al consumo de modafinilo / Adverse effects at the cardiovascular and neurological level associated with the consumption of modafinil

Resumen Introducción: el modafinilo es un fármaco neuroestimulante utilizado principalmente para promover estados de vigilia atención y disminuir la fatiga ante ciertos comportamientos que propician la somnolencia diurna excesiva. Objetivo: identificar en la literatura científica los efectos adversos neurológicos y cardiovasculares causados por el consumo del modafinilo. Materiales y Métodos: revisión bibliográfica de los artículos encontrados entre los meses de abril y julio de 2019 en las bases de datos PUBMED, SCOPUS, DIALNET. 51 artículos superaron la evaluación de calidad metodológica y se incluyeron en la revisión. Resultados: se identificaron que los principales efectos adversos a nivel cardiovascular son la cardiomiopatía Tako-Tsubo y la taquicardia ventricular polimórfica, mientras que a nivel neurológico puede generar insomnio y distonías. Conclusiones: El consumo del modafinilo genera repercusiones en las funciones cognitivas y cardiovasculares por lo cual no es aconsejable su uso a largo plazo en personas sanas. MÉD. UIS.2020;33(1):31-8.

Abstract Introduction: modafinil is a neurostimulant drug used mainly to promote wakefulness, attention and decrease fatigue in certain behaviors that cause excessive daytime sleepiness. Objective: identify in the scientific literature the neurological and cardiovascular adverse effects caused by the consumption of modafinil. Materials and Methods: bibliographic review of the articles found between the months of April and July of 2019 in the PUBMED, SCOPUS, DIALNET databases. 51 articles passed the methodological quality assessment and were included in the review. Results: the main adverse effects at the cardiovascular level were identified as Tako-Tsubo cardiomyopathy and polymorphic ventricular tachycardia, while at the neurological level it can generate insomnia and dystonia. Conclusions: the consumption of modafinil generates repercussions on cognitive and cardiovascular functions, so its long-term use in healthy people is not advisable. MÉD.UIS.2020;33(1):31-8.

Modafinil and Learning and Memory- Is there a Connection? Evaluation of the Effect of Modafinil on Learning and Memory in Wistar Rats

Background: Modafinil, a drug approved for use innarcolepsy, has shown conflicting effects on cognition.This study was conducted to observe the effects ofModafinil on learning and memory following acute andchronic administration in Wistar rats. Aim andObjectives: To observe the effects of Modafinil onlearning and memory following acute and chronicadministration. Material and Methods: The studyconducted in 42 male Wistar rats, had seven groups:Group I: Control, Group II: Negative Control(Vehicle), Group III: Standard Control (Donepezil),Group IV: Chronic Modafinil 10 mg/kg, Group V:Chronic Modafinil 20 mg/kg, Group VI: AcuteModafinil 10 mg/kg, Group VII: Acute Modafinil 10mg/kg. All drugs were administered for 15 days.th Scopolamine was used to induce amnesia on the 15day in all groups except Group I. Using the HebbWilliam maze, baseline learning score was recorded onday 1, and post-treatment learning scores wererecorded on days 15 and 16. Results: On days 15 and16, the learning scores significantly decreased in GroupI, while it significantly increased in group II, comparedto baseline, indicating induction of amnesia byscopolamine. In Group III the learning scores on days15 and 16 (8.66 ± 2.63, 9.66 ± 2.75, in seconds) weredecreased significantly compared to baseline (18.83 ±2.65), indicating a reversal of scopolamine-inducedamnesia. All doses of Modafinil (Acute 10 mg and 20mg/kg, Chronic 10 mg and 20 mg/kg) showed astatistically significant increase in learning scores ondays 15 and 16, compared to baseline, indicating noreversal of scopolamine-induced amnesia. Conclusion:Modafinil in doses of 10 mg/kg and 20 mg/kg, giveneither as a single dose or over a period of time, does notreverse amnesia induced by scopolamine in rats.

Proper administration of psychostimulants

Psychostimulants are a broad class of sympathomimetic drugs that include drugs of abuse, such as illegal substances, as well as therapeutic drugs, such as methylphenidate and modafinil. The common effect of psychostimulants is to improve motivation, mood, movement, energy, wakefulness, arousal, anorexia and attention. Methylphenidate and modafinil are psychostimulants used in the treatment of attention deficit hyperactivity disorder and narcolepsy. They have also been found to be effective for treating certain cognitive disorders that result in secondary depression or profound apathy, obesity, cancer-related fatigue as well as in specific treatment-resistant depressions as an augmentation therapy with antidepressants. Psychostimulants are also used in an non-medical manner, such as cognitive and/or performance enhancers in healthy population. However, the most limiting adverse effect of psychostimulants is their vulnerability to psychological and physical dependence. Therefore, the abuse and misuse of stimulants, including methylphenidate and modafinil, for the purpose of neuroenhancement is an issue of concern throughout the world including Korea. Although several recent studies have reported on the cognitive and performance enhancement effects of methylphenidate and modafinil in healthy population, psychostimulants should be administered with discretion in the light of their potential adverse effects and the lacks of long-standing efficacy.

Modafinil Dependence: A Case with Attention-Deficit/Hyperactivity Disorder

Modafinil is generally known as a drug with low addiction potential. There are few case reports in the literature demonstrating that Modafinil, stated being capable of diminishing symptoms of attention deficit/hyperactivity disorder (ADHD), causes addiction. In the present article a Modafinil addicted ADHD case, consuming usurious doses (5,000 mg/per day) of Modafinil is presented. The case presented to our psychiatry outpatient clinic due to: requirement of in taking high dose Modafinil in order to achieve the initial effects, difficulty in obtaining the drug, irritability, anxiousness, sleep irregularities, fatigue and unpleasant vivid dreams when he did not use the drug. It was realized that the patient, himself increased doses of Modafinil incrementally, in order to keep its effects on attention symptoms at the same level. It has to be kept in mind that ADHD patients can develop Modafinil addiction. It is necessary to carry out systemic studies on this subject.

Consumo de modafinilo en profesionales de la salud mental: reporte de un caso y revisión bibliográfica / Modafinil use in mental health professionals: case report and bibliographic review

INTRODUCCIÓN El presente estudio busca comenzar un abordaje inicial del fenómeno del consumo de Modafinilo en profesionales de la Salud Mental en Chile y los factores precipitantes que promueven el consumo de esta sustancia psicoestimulante. OBJETIVOS: Realizar una revisión bibliográfica respecto del consumo de Psicoestimulantes en Profesionales de la Salud Mental; identificar el psicoestimulante de más fácil acceso; buscar y contactar a profesionales de la salud mental del SSMC que consuman activamente Modafinilo e Identificar los posibles factores precipitantes asociados al consumo de Modafinilo. MATERIAL Y MÉTODOS: Reporte de caso y análisis de discurso de una entrevista en profundidad, identificando las categorías centrales que estructuran la experiencia del profesional respecto de su consumo. RESULTADOS Y DISCUSIÓN: De acuerdo al análisis de la entrevista, podemos destacar cuatro factores que desencadenan el consumo habitual de la sustancia psicoestimulante: la narcolepsia, sobrecarga laboral, sobrecarga emocional y el fácil acceso al Modafinilo. CONCLUSIONES: La bibliografía existente es muy escasa; este estudio se constituye como una primera aproximación al abordaje de este tema a nivel nacional; la sobrecarga emocional cobra gran importancia ya que complementa la dependencia fisiológica; los estados emocionales que generan y mantienen el consumo en el profesional se ven asociados a eventos ambientales, y la dependencia psicológica es una realidad inseparable de la dependencia fisiológica.

BACKGROUND: The present study aims to start an initial approach to the phenomenon of Modafinil use in mental health professionals in Chile, and the precipitating factors that promote the consumption of this psychostimulant substance. OBJETIVES: To carry out a bibliographic review regarding the use of Psychostimulants in Mental Health Professionals; to identify the most easily accessible psychostimulant; to find and contact mental health professionals who actively consume Modafinil and to identify the possible precipitating factors associated with consumption of Modafinil. METHODS: Case report and discourse analysis of an in-depth interview, identifying the central categories that structure the professional's experience regarding their consumption. RESULTS AND DISCUSSION: According to the analysis of the interview, we can highlight four factors that trigger the habitual consumption of the psychostimulant substance: Narcolepsy, work overload, emotional overload and easy access to Modafinil. CONCLUSIONS: The existing literature is very scarce; this study constitutes a first approach of this topic at national level; emotional overload is of great importance since it complements the physiological dependence; the emotional states that generate and maintain consumption in the professional are seen associated with environmental factors, and psychological dependence is an inseparable reality of physiological dependence.

Hipersomnias / Hypersomnia

Las hipersomnias son un grupo de trastornos caracterizados por una somnolencia excesiva durante al menos 1 mes, evidenciada tanto por episodios prolongados de sueño como por episodios de sueño diurno que se producen prácticamente cada día. Se dividen en primarios o centrales, (Hipersomnia idiopática, Narcolepsia y Síndrome de Klein-Levin) y secundarios (Privación del sueño crónica en niños). La somnolencia excesiva debe ser de su ciente gravedad como para provocar alteraciones clínicas significativas o deterioro social, escolar, laboral o de otras áreas importantes de la actividad del individuo; no aparece en el transcurso de otro trastorno del sueño o de otro trastorno mental ni se debe a los efectos fisiológicos directos de una sustancia o de una enfermedad médica. La somnolencia excesiva diurna (SDE) es una manifestación común, se presenta con una frecuencia variable; del 11% en niños hasta el 52,8% en adolescentes. La predominancia es igual en la narcolepsia con o sin cataplejía y en el Síndrome de Kleine-Levin. Su diagnóstico adecuado se basa en la historia clínica y estudios de polisomnografía. Y el tratamiento, ayudará al paciente a mejorar en sus actividades y a elevar su autoestima. La fisiopatología no es clara y su tratamiento va enfocado a disminuir el sueño diurno con fármacos como el Modafinil, Claritromicina o simpaticomiméticos y terapias de apoyo.

Abstract Hypersomnias are a group of disorders characterized by excessive drowsiness for at least 1 month, evidenced by both prolonged episodes of sleep and episodes of daytime sleep that occur almost every day. They are divided into primary or central, (idiopathic hypersomnia, Narcolepsy and Klein-Levin Syndrome) and secondary (Deprivation of chronic sleep in children). Excessive drowsiness should be of sufficient severity to cause significant cant clinical alterations or social, school, work or other important areas of the individual's activity; which does not appear in the course of another sleep disorder or other mental disorder, nor is it due to the direct physiological effects of substances or medical illness. Excessive daytime sleepiness (EDS) is a common manifestation; it occurs with a variable frequency; From 11% in children to 52.8% in adolescents. The predominance is the same in Narcolepsy with or without cataplexy and in Kleine-Levin Syndrome. The adequate diagnosis is based on clinical history and studies of polysomnography. The treatment will help the patient to improve their activities and raise their self-esteem. The pathophysiology is not clear and the treatment is focused on decreasing daytime sleep with drugs such as Modafinil, Clarithromycin or sympathomimetics and supportive therapies.

Metilfenidato y modafinilo: justicia igualitaria y políticas de acceso al mejoramiento cognitivo farmacológico / Methylphenidate and modafinil: egalitarian justice and policies of access to pharmacological cognitive enhancement / Metilfenidato e Modafinil: justiça igualitária e políticas de acesso a melhoria cognitiva farmacológica

Resumen: El artículo investiga criterios de acceso a tecnologías de mejoramiento cognitivo farmacológico, especialmente modafinilo y metilfenidato, en caso de adultos sanos. Desde la perspectiva de la justicia igualitaria, tomando como referencia la teoría de justicia de Rawls, se argumenta a favor de una política de acceso libre mediante mecanismos de mercado, pero facilitado en caso de los peor situados de la sociedad.

Abstract: The article addresses criteria for access to pharmacological cognitive enhancement technologies, especially modafinil and methylphenidate, to healthy adults. From the perspective of equalitarian justice and taking as point of reference Rawls' theory of justice it argues in favor of a policy of open market access, but facilitated for the worst-off.

Resumo: O artigo investiga os critérios para o acesso às tecnologias de aprimoramento cognitivo farmacológica, especialmente o modafinil e o metilfenidato, no caso de adultos saudáveis. Na perspectiva da justiça igualitária, tendo como referência a teoria da justiça de Rawls, argumenta-se a favor de uma política de acesso livre através de mecanismos de mercado, porém com acesso facilitado no caso dos piores situados na sociedade.

Modafinil Dependence and Hypersexuality: A Case Report and Review of the Evidence

Apart from sleep wake disorders, nowadays, modafinil is being prescribed for several psychiatric disorders including depression. Despite being reported as to be having very low abuse potential, cases of modafinil dependence had come to the limelight. In this case report, we describe a 35 year old man with bipolar affective disorder while in remission who developed modafinil dependence and later on, had hypersexuality when he increased the dose of modafinil from 400 to 1,000 mg/day. Existing literature suggests that modafinil when taken above prescribed doses can cause many side effects ranging from nausea, vomiting to psychotic exacerbation and mania. However, hypersexuality as a side effect of modafinil overuse is not commonly seen. The exact pathophysiological mechanism of modafinil induced hypersexuality is not clear. Clinicians should be aware of possibility of modafinil leading to dependence and this rare significant side effect of modafinil.

Use of Modafi nil for Shortening the Recovery Period of Patients Subjected to Conscious Sedation.

Conscious sedation is a safe and effective technique for patients subjected to invasive diagnostic procedures or minor surgeries. One of the most common seen side effects of this procedure involves Drowsiness, which may be so severe that the patient is not able and advised to resume his normal day to day activities up to 24 h post procedure. This amount of time in recovery is discomforting to the patient and thus should be reduced to a bare minimum following analgesic action of the sedatives. The mechanisms of action of all major classes of sedatives follow a common route via stimulation of gamma amino butyric acid (GABA) receptors along with depression in the release of dopamine, which controls locomotor activity. Modafi nil leads to increase in extracellular and synaptic concentrations of dopamine, elevates hypothalamic histamine levels and also causes activation of glutamatergic circuits, while inhibiting GABAergic neurotransmission. The objective of this short communication was to search for a universal agent to facilitate the recovery post conscious sedation and to determine the role of Modafi nil for the same. At the end, we hypothesized that modafi nil can act as a reliable universal drug to shorten the recovery period of patients subjected to procedural anesthesia.

Effects of Modafinil on Behavioral Learning and Hippocampal Synaptic Transmission in Rats / 대한배뇨장애요실금학회지

PURPOSE: Modafinil is a wake-promoting agent that has been proposed to improve cognitive performance at the preclinical and clinical levels. Since there is insufficient evidence for modafinil to be regarded as a cognitive enhancer, the aim of this study was to investigate the effects of chronic modafinil administration on behavioral learning in healthy adult rats. METHODS: Y-maze training was used to assess learning performance, and the whole-cell patch clamp technique was used to assess synaptic transmission in pyramidal neurons of the hippocampal CA1 region of rats. RESULTS: Intraperitoneal administration of modafinil at 200 mg/kg or 300 mg/kg significantly improved learning performance. Furthermore, perfusion with 1mM modafinil enhanced the frequency and amplitude of spontaneous postsynaptic currents and spontaneous excitatory postsynaptic currents in CA1 pyramidal neurons in hippocampal slices. However, the frequency and amplitude of spontaneous inhibitory postsynaptic currents in CA1 pyramidal neurons were inhibited by treatment with 1mM modafinil. CONCLUSIONS: These results indicate that modafinil improves learning and memory in rats possibly by enhancing glutamatergic excitatory synaptic transmission and inhibiting GABAergic (gamma-aminobutyric acid-ergic) inhibitory synaptic transmission.

Management of Obstructive Sleep Apnea.

Obstructive Sleep Apnea (OSA) is an important public health problem and is associated with considerable morbidity and mortality. Therefore, treatment of this condition is of paramount importance. The treatment of OSA includes general and behavioural measures, mechanical measures including continuous positive airway pressure (CPAP), Bilevel positive airway pressure (BiPAP) and Oral Appliances (OA), pharmacological treatment and surgical procedures. Continuous positive airway pressure (CPAP) treatment reverses the repetitive upper airway obstruction of sleep apnea and associated daytime sleepiness and is the most effective treatment for OSA. However maintaining patient adherence to CPAP therapy is a challenge. Weight loss should be recommended to overweight patients with OSA, as it has been shown that weight reduction has additional health benefits. Treatment of underlying medical conditions such as hypothyroidism or acromegaly has profound effect on apnea/hypopnea index. A subset of patients with OSA may benefit from supplemental oxygen and positional therapy. Presently, there are no effective pharmacotherapeutic agents for treatment of patients with OSA and the role of surgical treatment in OSA is controversial. However, pharmacological treatment of persisting residual sleepiness, despite adequate positive airway pressure therapy delivery and adherence, is indicated and may improve daytime sleepiness.

Development and Validation of RP-HPLC method for determination of Modafinil in bulk and dosage form.

A reverse phase high performance liquid chromatographic method was developed for the determination of Modafinil in bulk and dosage form. The separation was effective on a Hypersil ODS C18 column (250 mm x 4.6 mm; 5μ) using a mobile phase mixture of Buffer:Acetonitrile in a ratio of 55:45 (v/v) at a flow rate of 1.0ml/min. The detection was made at 220nm. The retention time of modafinil was found to be 4.80±0.06 min. Calibration curve was linear over the concentration range of 20-120μg/ml of modafinil. The proposed method was validated as per the ICH guidelines. The method was accurate, precise, specific and rapid and thus found to be suitable for the quantitative analysis of modafi-nil in the bulk and dosage form.

Practical Use and Risk of Modafinil, a Novel Waking Drug

OBJECTIVES: Modafinil is a waking drug prescribed to narcolepsy patients, but its usage among healthy individuals is increasing to enhance their alertness or to mitigate fatigue. This study was conducted to investigate practical use and toxic effects on neuro-immune interaction of modafinil. METHODS: This study reviewed the significance of psychoactive drugs, and discussed the benefits and risks of the application of modafinil, which seems to be ideal as an anti-psychotic or anti-fatigue agent. RESULTS: Modafinil is known to have less or no adverse effects than those found in traditional psychostimulants such as amphetamine, methylphenidate or cocaine. It can be applied as an anti-psychotic or anti-fatigue agent. However, the waking mechanism of modafinil is yet to be fully revealed. Recent studies reported that modafinil may be subject to abuse and addiction. In addition prolonged sleeplessness induces stress responses and impairs immune function. CONCLUSIONS: Modafinil can be used by anyone, who wishes to work late, stay awake, enhance their cognitive reactions, or brighten their moods. Users may already be under a great level of stress, i.e. cancer patients or soldiers in a battle field. A psychoneuroimmunological approach is thus needed to investigate the multi-functional effects of modafinil.

Development and Validation of RP-HPLC method for determination of Modafinil in bulk and dosage form.

A reverse phase high performance liquid chromatographic method was developed for the determination of Modafinil in bulk and dosage form. The separation was effective on a Hypersil ODS C18 column (250 mm x 4.6 mm; 5μ) using a mobile phase mixture of Buffer:Acetonitrile in a ratio of 55:45 (v/v) at a flow rate of 1.0ml/min. The detection was made at 220nm. The retention time of modafinil was found to be 4.80±0.06 min. Calibration curve was linear over the concentration range of 20-120μg/ml of modafinil. The proposed method was validated as per the ICH guidelines. The method was accurate, precise, specific and rapid and thus found to be suitable for the quantitative analysis of modafi-nil in the bulk and dosage form.

Safety and Efficacy of Add on Modafinil to Selective Serotonin Reuptake Inhibitors in Major Depressive Disorder.

Aim: Despite the efficacy of selective serotonin reuptake inhibitors (SSRIs) in the treatment of major depression, a significant number of patients show partial or no remission of symptoms. Although antidepressant medications are effective, they have a delayed onset of therapeutic effect. Modafinil is a novel psychostimulant that may be helpful in treating patients with residual symptoms of depression. The efficacy of modafinil as add-on therapy to SSRIs in depressed patients in Indian population is lacking; hence this study was designed to study the efficacy and safety of Modafinil as add-on therapy to SSRI in depressed patient in Indian Population.Methods: In an open, randomized study, 50 patients diagnosed with major depressive disorder (MDD) were divided into two groups. In Group A (n = 25) patients received conventional SSRIs with low dose Modafinil for 8 weeks. In Group B (n = 25) patients received conventional SSRIs for 8 weeks. Patients were evaluated at baseline and then at the end of 2, 4, 6, and 8 weeks. Results: There was significant improvement in Hamilton depression rating scale (HDRS), Epworth Sleepiness Scale (ESS), Fatigue severity Scale (FSS) and Clinical Global Improvement – severity (CGI-S) Scale (p < 0.05) in both groups. Modafinil in low dose as add on therapy showed more decrease in scores, had earlier onset of action, as compared to conventional treatment (p < 0.05). No serious adverse event was reported in either of the groups. Conclusion: Low dose Modafinil as add-on therapy had shown better efficacy, earlier onset of action as compared to conventional treatment in MDD in Indian patients.

Effect of Modafinil and Methylphenidate on Sleep-Wake Architecture and EEG Power Spectra in Rats / 대한정신약물학회지

OBJECTIVE : Modafinil, methylphenidate, and caffeine are wakefulness-promoting substances. Previously, it was reported that caffeine-induced wakefulness differs from natural wakefulness in terms of the EEG spectral profiles. In order to evaluate whether wakefulness induced by other psychostimulants differs from both caffeine-induced and natural wakefulness, we examined the effects of the psychostimulants on sleep-wake architecture and EEG spectral profiles. METHODS : Eighteen Sprague-Dawley male rats underwent an EEG/EMG recording session from 10 : 30 to 17 : 30. They received caffeine (7.5, 15, 30 mg/kg i.p.), methylphenidate (1, 2, 5, 10 mg/kg i.p.) or modafinil (5, 10, 25, 50, 100 mg/kg i.p.) at 13 : 30. The number, total duration, and average duration of sleepwake states were obtained. EEG band powers were calculated by spectral analysis. Frequency bands were divided into the following ranges : D1, 1-2.5 Hz ; D2, 2.5-4.5 Hz ; T1, 4.5-7 Hz ; T2, 7-10 Hz ; SI, 10-14 Hz ; B1, 14-22 Hz ; B2, 22-34 Hz ; GA, 34-50 Hz. RESULTS : All three psychostimulants significantly and dose-dependently increased active wake duration and decreased slow-wave sleep. Equipotent doses of caffeine, methylphenidate, and modafinil for increasing active wake and decreasing slow-wave sleep were 7.5 mg/kg, 10 mg/kg, and 100 mg/kg, respectively. In equipotent doses, an increase of active wake duration by caffeine and methylphenidate was attributed to increases of both frequency and average duration of active wake state, whereas increase of active wake duration by modafinil was attributed to increase of average duration of active wake state only. In equipotent doses, caffeine and methylphenidate decreased the power of lower frequency bands (1-22 Hz), whereas modafinil did not. During slow-wave sleep, modafinil and methylphenidate increased the power of lower frequency bands, but caffeine did not. All the psychostimulants increased the power of the GA band, which was more prominent in the frontal cortex than the parietal cortex. CONCLUSION : These results suggest that moda-nil-induced wakefulness differs from caffeine- or methylphenidate-induced wakefulness in terms of EEG spectral profiles and sleep-wake architecture.

Effects of cocaine, methamphetamine and modafinil challenge on sleep rebound after paradoxical sleep deprivation in rats

Sleep loss is both common and critically relevant to our society and might lead to the abuse of psychostimulants such as amphetamines, cocaine and modafinil. Since psychoactive substance abuse often occurs within a scenario of sleep deficit, the purpose of this investigation was to compare the sleep patterns of rats challenged with cocaine (7 mg/kg, ip), methamphetamine (7 mg/kg, ip), or modafinil (100 mg/kg, ip) subsequent to paradoxical sleep deprivation (PSD) for 96 h. Our results show that, immediately after 96 h of PSD, rats (10 per group) that were injected with a psychostimulant presented lower percentages of paradoxical sleep compared to those injected with saline (P < 0.01). Regarding slow wave sleep (SWS), rats injected with psychostimulants after PSD presented a late rebound (on the second night subsequent to the injection) in the percentage of this phase of sleep when compared to PSD rats injected with saline (P < 0.05). In addition, the current study has produced evidence of the characteristic effect of each drug on sleep architecture. Home cage control rats injected with modafinil and methamphetamine showed a reduction in SWS compared with the saline group. Methamphetamine affected sleep patterns most, since it significantly reduced paradoxical sleep, SWS and sleep efficiency before and after PSD compared to control (P < 0.05). Cocaine was the psychostimulant causing the least changes in sleep pattern in relation to those observed after saline injection. Therefore, our results suggest that abuse of these psychostimulants in a PSD paradigm aggravates their impact on sleep patterns.

Non-Stimulant Medications in the Treatment of Attention-Deficit Hyperactivity Disorder

The aim of this paper is to evaluate the use of non-stimulants, including atomoxetine, bupropion and modafinil, as alternative approaches to the treatment of children with attention-deficit hyperactivity disorder. A comprehensive review of the empirically based literature regarding the efficacy and the safety of the non-stimulants was performed. There is a large and increasing body of data supporting the efficacy and the safety of non-stimulants. Although the treatment effect sizes for non-stimulants may be smaller than those for stimulants, non-stimulants alone have been shown to be effective in the treatment of attention-deficit hyperactivity disorder as well as several comorbidities. These results suggest that nonstimulants are effective in the treatment of attention-deficit hyperactivity disorder. Further studies are needed to improve our understanding of alternative pharmacological medications in the treatment of attention-deficit hyperactivity disorder.

The effects of modafinil on clinical features and sleep structure of narcolepsy patients and healthy controls / 수면정신생리

INTRODUCTION: Excessive daytime sleepiness and cataplexy are key features of narcolepsy. Modafinil is psychostimulant used in the treatment of narcolepsy. In this study, we evaluated effects of modafinil on nocturnal sleep structure and sleep latency in multiple sleep latency test and clinical features. METHODS: Twelve narcoleptic patients (7 male, age: 22.9 +/- 2.6 yrs) were participated in the study. All of them had done nocturnal polysomnography (nPSG), multiple sleep latency test (MSLT), clinical symptoms scales and have repeated same procedure after taking 200 mg of modafinil. We have done linear mixed model analysis to describe effects of group, medication and nap time on these measures. RESULTS: Modafinil did not affect clinical scales except PSQI which had been reduced after medication. In this study, Modafinil reduced total sleep time, sleep efficiency and increased wake after sleep onset and percent of arousal during sleep in nocturnal polysomnography and prolonged mean sleep latency in multiple sleep latency tests in both group. DISCUSSION: Modafinil has stimulant effect of central nervous system but its effect on night sleep is less than other psychostimulants such as methylphenidate. We ascertained that modafinil affected total sleep time, sleep efficiency and percent of wake during sleep but did not effect on sleep structure. Modafinil was effective in the management of day time sleepiness. Modafinil can enhance alertness of control group without day time sleepiness.

Modafinil Effect in Psychostimulant-Inapplicable Children with Attention Deficit Hyperactivity Disorder - Preliminary Study / 신경정신의학

OBJECTIVES: This study was aimed to examine the efficacy and safety of modafinil in psychostimulant-inapplicable children with attention deficit hyperactivity disorder (ADHD) due to insufficient treatment response or intolerable adverse effects. METHODS: Fifteen children (8.8+/-1.8 years, 14 boys, total IQ 107.22+/-13.4) were recruited for this study. ADHD was confirmed by K-SADS-PL. The efficacy was assessed by ADHD rating scale (ADHDRS), Conner's parental rating scale-revised (CPRS-R), ADHDRS school version, clinical global impression (CGI) and computerized neurocognitive function test. Mean dose of modafnil was 250. 0+/-103.3 mg. RESULTS: Total score (p=0.012) and hyperactive/impulsive score (p=0.021) of ADHDRS for investigator, as well as CPRS-R score (p<0.01) and CGI-severity score (p<0.01) were significantly reduced after 39.2+/-8.7 days of modafinil administration. Response time of word color test was also significantly decreased after medication. Decreased appetite (2 subjects), insomnia (2 subjects), irritability (1 subject) and alopecia (1 subject) were observed during this study period. CONCLUSION: Modafinil was effective and well-tolerated for the psychostimulant-inapplicable children with ADHD.