DAYTIME SLEEPINESS: PROVIGIL/NUVIGIL
Dennis B. Kottler, MD
Westlake Village, CA
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Two novel medications, PROVIGIL (modafinil) and NUVIGIL (armodafinil), have been shown effective in the treatment of daytime sleepiness.
These medications have FDA approval for use in treating Narcolepsy,* Shift Work Sleep Disorder, and Obstructive Sleep Apnea (OSA). Their use in treating daytime sleepiness due to other conditions is "off label." They have also been used "off label" in the treatment of depression and ADHD.
Nuvigil is the newest of these medications and is the single-isomeric form of Provigil. It is thought that single isomer medication (e.g. Lexapro) may have fewer side effects and therefore be better tolerated than the generally older mixed isomer (racemic) medications. These medications may also have value in treating some forms of dementia and ADHD.
Some of the features of PROVIGIL/NUVIGIL include:
1 - Not related to the traditional stimulants such as methylphenidate (Ritalin) and the amphetamines.
2 - Does not seem to cause irritability and motor restlessness often associated with amphetamines.
3 - Seems to have more specific effects on the brain sleep mechanism vs. amphetamines.
4 - Is not a CONTROLLED SUBSTANCE - a triplicate prescription is not required.
5 - Probably has less potential for abuse and misuse than traditional stimulants.
As with all medications there are potential side effects and other medical considerations to be evaluated prior to and during medication treatment. It is essential to consult with a psychiatrist, or other physician, knowledgeable about daytime sleepiness and related medical and psychiatric conditions.
PROVIGIL is frequently prescribed in the dosage range of 100mg to 400mg. Nuvigil is prescribed as 50mg, 150mg and 250mg.
Dosing will vary depending on the physician's assessment of the patient's needs.
PROVIGIL and NUVIGIL are marketed in the US by Cephalon.
*Narcolepsy is a specific disorder characterized by paroxysmal sleep episodes and cataplexy, or sudden loss of muscle tone.
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