Armodafinil
NUVIGIL
What it isDopamine-reuptake-inhibiting wake-promoter; narcolepsy, sleep-apnea sleepiness, and shift-work disorder.
Why this oneAs modafinil's R-enantiomer, it sustains wakefulness later in the day from morning administration.
What limits itCYP3A4 induction can compromise hormonal contraception. Serious rash, insomnia, and misuse risk also matter.
FDA-approved for
- narcolepsy/shift-work/OSA sleepiness (2007)
Off-label
- fatigue in multiple sclerosis
- ADHD
- antidepressant augmentation
FDA label
Read the full label on DailyMed ↗
| FDA dosing | Population | Start | Target | Max |
|---|---|---|---|---|
| Obstructive sleep apnea (excessive sleepiness) | adults | 150-250 mg QD (morning) | 150-250 mg QD | 250 mg QD |
| Narcolepsy | adults | 150-250 mg QD (morning) | 150-250 mg QD | 250 mg QD |
| Shift work disorder | adults | 150 mg QD (~1 h before shift) | 150 mg QD | 150 mg QD |
Renal Undefined
Hepatic Severe hepatic impairment: reduce dose.
Instructions
- OSA/narcolepsy: take once daily in the morning.
- Shift work disorder: take ~1 hour before the work shift.
- Geriatric patients: consider a lower dose.
- Discontinue at first sign of rash unless clearly not drug-related.
Cautions
- Serious rash including Stevens-Johnson syndrome / toxic epidermal necrolysis
- DRESS / multi-organ hypersensitivity
- Angioedema and anaphylaxis
- Persistent sleepiness — caution with driving/hazardous activity
- Psychiatric symptoms — caution with history of psychosis, depression, or mania
- Cardiovascular disease — consider increased monitoring
- Not studied/approved in pediatric patients
Adverse reactions
- Headache
- Nausea
- Dizziness
- Insomnia
Pregnancy Insufficient data; IUGR and spontaneous abortion reported; may cause fetal harm (animal data).
Lactation Undefined
NO BOXED WARNINGS
Principal riskIt induces CYP3A4 enough to fail oral contraceptives
Cost, est. cash$10–$300/month
Generic entry2012
Classes and tags
Clinical profile
Legacy pregnancy categoryC
Defining liabilitySerious rash, psychiatric activation and CYP-mediated interactions; misuse potential is present.
Mechanism of action: Armodafinil ballicule
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Memory aids: mascots and interaction avatars
