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Michal Gajewski, Gerald Weinhouse
As patients recover from their critical illness, the focus of intensive care unit (ICU) care becomes rehabilitation. Fatigue, excessive daytime somnolence (EDS), and depression can delay their recovery and potentially worsen outcomes. Psychostimulants, particularly modafinil (Provigil), have been shown to alleviate some of these symptoms in various patient populations, and as clinical trials are underway exploring this novel use of the drug, we present a case series of 3 patients in our institution's Thoracic Surgery Intensive Care Unit...
February 2016: Journal of Intensive Care Medicine
Jonathan Wisor
Modafinil, in its two clinical formulations (Provigil(®) and Nuvigil(®)), is a widely prescribed wake-promoting therapeutic agent. It binds competitively to the cell-membrane dopamine (DA) transporter and is dependent on catecholaminergic (dopaminergic and adrenergic) signaling for its wake-promoting effects. The clinical spectrum of effects for modafinil is distinct from the effects seen with other catecholaminergic agents. Relative to other commonly used agents that act through catecholaminergic mechanisms, modafinil has a relatively low abuse potential, produces wakefulness with an attenuated compensatory sleep recovery thereafter, and does not ameliorate cataplexy in narcolepsy...
October 7, 2013: Frontiers in Neurology
Miranda Davies, Lynda Wilton, Saad Shakir
BACKGROUND: Modafinil (Provigil) was marketed in the UK in 1998 to promote wakefulness in the treatment of narcolepsy. In April 2004, the licence was extended to include chronic pathological conditions; 2 years later, the prescription of modafinil was restricted to patients with shift work sleep disorder, narcolepsy and obstructive sleep apnoea/hypopnoea syndrome. Following a recent review of the safety data, the licence has been further restricted to only treat patients with narcolepsy...
April 2013: Drug Safety: An International Journal of Medical Toxicology and Drug Experience
Heinz Steiner, Vincent Van Waes
The psychostimulants methylphenidate (Ritalin, Concerta), amphetamine (Adderall), and modafinil (Provigil) are widely used in the treatment of medical conditions such as attention-deficit hyperactivity disorder and narcolepsy and, increasingly, as "cognitive enhancers" by healthy people. The long-term neuronal effects of these drugs, however, are poorly understood. A substantial amount of research over the past two decades has investigated the effects of psychostimulants such as cocaine and amphetamines on gene regulation in the brain because these molecular changes are considered critical for psychostimulant addiction...
January 2013: Progress in Neurobiology
Luca Ferraro, Tiziana Antonelli, Sarah Beggiato, Maria Cristina Tomasini, Kjell Fuxe, Sergio Tanganelli
Modafinil, (RS)-2-(diphenylmethylsulfinyl)acetamide derivative (Modiodal, Provigil), is a vigilance-promoting agent which reduces sleep episodes by improving wakefulness. It is approved by the USA FDA for narcolepsy, shiftwork sleep disorder and obstructive sleep apnoea with residual excessive sleepiness despite optimal use of continuous positive airway pressure. Unlike classical psychostimulants such as amphetamine and amphetamine-like compounds, the awaking effect of modafinil is not associated with a disturbance of nighttime sleep, tolerance, and sensitization...
April 2013: Mini Reviews in Medicinal Chemistry
Aaron S Kesselheim, Jessica A Myers, Daniel H Solomon, Wolfgang C Winkelmayer, Raisa Levin, Jerry Avorn
INTRODUCTION: The Orphan Drug Act encourages drug development for rare conditions. However, some orphan drugs become top sellers for unclear reasons. We sought to evaluate the extent and cost of approved and unapproved uses of orphan drugs with the highest unit sales. METHODS: We assessed prescription patterns for four top-selling orphan drugs: lidocaine patch (Lidoderm) approved for post-herpetic neuralgia, modafinil (Provigil) approved for narcolepsy, cinacalcet (Sensipar) approved for hypercalcemia of parathyroid carcinoma, and imatinib (Gleevec) approved for chronic myelogenous leukemia and gastrointestinal stromal tumor...
2012: PloS One
Andy C Dean, Rajkumar J Sevak, John R Monterosso, Gerhard Hellemann, Catherine A Sugar, Edythe D London
OBJECTIVE: Individuals who are methamphetamine dependent exhibit higher rates of cognitive dysfunction than healthy people who do not use methamphetamine, and this dysfunction may have a negative effect on the success of behavioral treatments for the disorder. Therefore, a medication that improves cognition, such as modafinil (Provigil), may serve as a useful adjunct to behavioral treatments for methamphetamine dependence. Although cognitive-enhancing effects of modafinil have been reported in several populations, little is known about the effects of modafinil in methamphetamine-dependent individuals...
November 2011: Journal of Studies on Alcohol and Drugs
Pascal Jean-Pierre, Gary R Morrow, Joseph A Roscoe, Charles Heckler, Supriya Mohile, Michelle Janelsins, Luke Peppone, Amy Hemstad, Benjamin T Esparaz, Judith O Hopkins
BACKGROUND: Cancer-related fatigue is a debilitating symptom affecting psychosocial functioning and quality of life in 70% to 100% of cancer patients during and after treatment. The authors examined the effect of 200 mg of modafinil daily on the severity of cancer-related fatigue. METHODS: The authors conducted a multicenter, randomized, double-blind, placebo-controlled, phase 3, clinical trial to examine the effect of modafinil on patient-reported fatigue in cancer patients undergoing chemotherapy...
July 15, 2010: Cancer
Carmela M Reichel, Ronald E See
RATIONALE: Modafinil (Provigil) is a wake-promoting drug characterized by cognitive enhancing abilities. Recent clinical data have supported the use of modafinil for treatment of chronic psychostimulant addiction and relapse prevention. MATERIALS AND METHODS: We used an intravenous methamphetamine (meth) self-administration procedure to assess the dose-dependent effects of modafinil on reinstatement following abstinence and after extinction on conditioned-cue and meth-primed reinstatement of meth seeking...
June 2010: Psychopharmacology
Gal Neuman, Naim Shehadeh, Giora Pillar
Modafinil (Provigil) is a wake-promoting drug approved for patients with narcolepsy or other causes of excessive daytime sleepiness. Each pill is 100 to 200 mg; maximal daily dose of modafinil in adults is 400 mg (the medication is not approved by the FDA for children younger than 16 years of age). We report the case of an adolescent who attempted to commit suicide by ingesting 50 pills of modafinil. The medication was prescribed for her mother to treat symptoms associated with multiple sclerosis. Approximately 2 hours following ingestion the patient complained of headache, nausea and abdominal pain...
August 15, 2009: Journal of Clinical Sleep Medicine: JCSM: Official Publication of the American Academy of Sleep Medicine
Matthew Wolf-Meyer
Since the mid-1990s, Americans have been made more aware of chronic sleep deprivation and sleep disorders exacerbated by dominant temporal regimes of work, school, and family life, primarily through increased medical and media attention. Concomitantly, Americans have turned to medical treatments and pharmaceutical cocktails to achieve normalcy rather than attending to the social and cultural causes of sleep sickness. This turn toward pharmaceuticalization is aided in part by the proliferation of medical disorders and the pharmaceuticals marketed to treat them (e...
January 2009: Medical Anthropology
Martin C McElhiney, Judith G Rabkin, Richard Rabkin, Edward V Nunes
OBJECTIVES: To evaluate the efficacy of modafinil combined with cognitive behavioral therapy (CBT) for treatment of methamphetamine (MA) dependence among HIV+ gay men. METHODS: In a single blind trial, modafinil was administered for 12 weeks, followed by a 4-week placebo phase. CBT was conducted for 18 sessions over the 16-week study. Primary outcome measures were self-reported use of days per week plus urine toxicology assays. Additional measures included the Beck Depression Inventory, Cravings Scale, and O/C Crystal Use Scale...
2009: American Journal of Drug and Alcohol Abuse
Jau-Shin Lou
Fatigue is a common and potentially debilitating symptom of amyotrophic lateral sclerosis (ALS). Questionnaire studies show that ALS subjects have increased subjective fatigue. Physiologic studies demonstrate that ALS subjects have increased physical fatigue, both central and peripheral in origin. No treatment has been proved effective through evidence-based medicine; however, modafinil (Provigil) may be a helpful pharmacologic treatment. Palliative care measures, such as noninvasive ventilation and high-frequency chest wall oscillation, may also reduce fatigue...
August 2008: Physical Medicine and Rehabilitation Clinics of North America
Robert A Schnoll, E Paul Wileyto, Angela Pinto, Frank Leone, Peter Gariti, Steven Siegel, Kenneth A Perkins, Charles Dackis, Daniel F Heitjan, Wade Berrettini, Caryn Lerman
BACKGROUND: Nicotine deprivation symptoms, including fatigue and attentional deficits, predict relapse following smoking cessation. Modafinil (Provigil), a wakefulness medication shown to have efficacy for the treatment of cocaine addiction, was tested as a novel therapy for nicotine dependence in a double-blind placebo-controlled trial. METHODS: One hundred and fifty-seven treatment-seeking smokers received brief smoking cessation counseling and were randomized to: (1) 8 weeks of modafinil (200mg/day), or (2) 8 weeks of placebo...
November 1, 2008: Drug and Alcohol Dependence
Simon J Williams, Clive Seale, Sharon Boden, Pam Lowe, Deborah Lynn Steinberg
This paper examines the social construction of the new wakefulness-promoting drug Modafinil (brand name Provigil) in the British press. Key themes in this newspaper coverage include the potential 'uses' and 'abuses' of this drug in relation to: (i) medical conditions; (ii) lifestyle choices; (iii) military operations; and (iv) sporting competition. The British press, we show, play a dual role in reporting on these trends and developments: on the one hand constructing this as something of a 'wonder drug' in relation to the treatment of a number of medical complaints or conditions, on the other hand articulating and amplifying a range of cultural concerns and anxieties about the non-medical 'uses' and 'abuses' of this drug, both now and in the future...
September 2008: Sociology of Health & Illness
Michael J Minzenberg, Cameron S Carter
Modafinil (2-[(Diphenylmethyl) sulfinyl] acetamide, Provigil) is an FDA-approved medication with wake-promoting properties. Pre-clinical studies of modafinil suggest a complex profile of neurochemical and behavioral effects, distinct from those of amphetamine. In addition, modafinil shows initial promise for a variety of off-label indications in psychiatry, including treatment-resistant depression, attention-deficit/hyperactivity disorder, and schizophrenia. Cognitive dysfunction may be a particularly important emerging treatment target for modafinil, across these and other neuropsychiatric disorders...
June 2008: Neuropsychopharmacology: Official Publication of the American College of Neuropsychopharmacology
Roxanne M Valentino, Nancy Foldvary-Schaefer
Modafinil (Provigil) is approved for treating excessive daytime sleepiness associated with narcolepsy, for shift-work sleep disorder, and as an adjunctive treatment in patients with obstructive sleep apnea syndrome who have residual daytime sleepiness despite optimal treatment with continuous positive airway pressure. Although modafinil improves measures of sleepiness, it does not generally normalize them, and it may be less effective than other stimulants for some narcoleptic patients. We need head-to-head comparisons of modafinil with traditional stimulants in humans to better define its role...
August 2007: Cleveland Clinic Journal of Medicine
Francisco J Urbano, Elena Leznik, Rodolfo R Llinás
Modafinil (Provigil, Modiodal), an antinarcoleptic and mood-enhancing drug, is shown here to sharpen thalamocortical activity and to increase electrical coupling between cortical interneurons and between nerve cells in the inferior olivary nucleus. After irreversible pharmacological block of connexin permeability (i.e., by using either 18beta-glycyrrhetinic derivatives or mefloquine), modafinil restored electrotonic coupling within 30 min. It was further established that this restoration is implemented through a Ca(2+)/calmodulin protein kinase II-dependent step...
July 24, 2007: Proceedings of the National Academy of Sciences of the United States of America
Russell E Morgan, Jaime M Crowley, Roland H Smith, Ronee B LaRoche, Marsha M Dopheide
This study examined the effect of the novel psychostimulant modafinil (Provigil) on a variety of cognitive and behavioral measures including associative learning, sustained attention, inhibitory control, and reaction time. Middle-aged female rats (18-20 months old) were administered oral doses of modafinil (0, 8, 32, and 64 mg/kg) and tested in a 3-choice visual discrimination and sustained attention task. Modafinil produced a dose-dependent pattern of improved response accuracy and impulse control (fewer premature responses) and shorter response latencies, without affecting omission errors, motivation or motor control...
March 2007: Pharmacology, Biochemistry, and Behavior
Jacob S Ballon, David Feifel
BACKGROUND: Modafinil is a novel wake-promoting agent that has U.S. Food and Drug Administration approval for narcolepsy and shift work sleep disorder and as adjunctive treatment of obstructive sleep apnea/hypopnea syndrome. Modafinil has a novel mechanism and is theorized to work in a localized manner, utilizing hypocretin, histamine, epinephrine, gamma-aminobutyric acid, and glutamate. It is a well-tolerated medication with low propensity for abuse and is frequently used for off-label indications...
April 2006: Journal of Clinical Psychiatry
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