Armodafinil

Dopamine Reuptake Inhibitor·Neurology - ADHD & Cognition

Narcolepsy, excessive sleepiness in Obstructive Sleep Apnea (OSA), Shift Work Sleep Disorder

Authority requiredPBSNOT S8Nuvigil250 mg tablet+2

Max Dose

250 mg/day

Half-life

15 h

OCP Failure

HIGH RISK

SJS/TEN

RARE BUT FATAL

Rapid Summary

Overview

The purified, long-acting R-enantiomer of Modafinil. A highly potent wakefulness-promoting agent. Keeps the patient alert without the severe cardiovascular rush or addiction potential of amphetamines.

Maximum Dose

Max 250 mg/day.

Clinical Focus

Induces CYP enzymes, rendering the oral contraceptive pill (OCP) completely useless. Can trigger life-threatening skin detachments (SJS/TEN).

Bottom Line

Armodafinil is a wakefulness-promoting agent for narcolepsy and shift work disorder, but can reduce hormonal contraceptive efficacy and may be abused for cognitive enhancement.

Formulation & Access

Brand Names

Nuvigil

Oral Routes

Tablets (50, 150, 250 mg).

Prescribing & PBS

Authority Required (PBS) for narcolepsy/OSA. Private script for shift workers. Unlike Dexamphetamine, it is NOT an S8 controlled drug (it is S4).

Indications & Use

Primary

PBSTGA

Narcolepsy, excessive sleepiness in Obstructive Sleep Apnea (OSA), Shift Work Sleep Disorder.

Off-Label

OFF

Severe fatigue in multiple sclerosis, depression-associated fatigue.

Clinical Place

The gold standard for keeping shift-workers awake and functional without turning them into amphetamine addicts.

Quick reference

Class & Role

Dopamine Reuptake Inhibitor — The purified, long-acting R-enantiomer of Modafinil.

Route / Formulation

Tablets (50, 150, 250 mg). (Nuvigil)

Usual Dose & Max

PO 150-250 mg OD in the morning. Max 250 mg/day.

Key Indication Doses

Narcolepsy / Sleep Apnea Fatigue: PO 150-250 mg OD in the morning. Shift Work Sleep Disorder: PO 150 mg OD taken exactly 1 hour before the start of the night shift. Severe Hepatic Impairment: Halve the dose.

Best Uses

Armodafinil is a wakefulness-promoting agent for narcolepsy and shift work disorder, but can reduce hormonal contraceptive efficacy and may be abused for cognitive enhancement.

Avoid / Cautions

History of left ventricular hypertrophy, mitral valve prolapse, or ischemic ECG changes with prior CNS stimulants. Pregnancy Category D. Must be ceased 2 months before planned conception.

Key Risks

Dermatological: Stevens-Johnson Syndrome (SJS), Toxic Epidermal Necrolysis (TEN), DRESS syndrome. Highest risk is in the first 1-5 weeks of therapy. Neurological: Headache (extremely common, >15%), severe insomnia, anxiety, agitation. Cardiovascular: Mild tachycardia, palpitations, hypertension.

Key Interactions

Strong inducer of CYP3A4. It rapidly destroys the estrogen/progesterone in the Combined Oral Contraceptive Pill. Women MUST use alternative non-hormonal contraception (Copper IUD) while on the drug and for 1 month after stopping. Inhibits CYP2C19 (Spikes levels of Diazepam, Phenytoin, Omeprazole).

Monitoring

Warn the patient: 'If you develop ANY skin rash, mouth ulcers, or fever, stop the drug immediately and go to the Emergency Department.'. Monitor BP and HR.

Clinical Pearl

Standard Modafinil (Modavigil) is a 50:50 mix of the R and S enantiomers. The S-enantiomer wears off in 4 hours, causing an afternoon 'crash'. Armodafinil (Nuvigil) contains ONLY the R-enantiomer, providing a smooth, flat, 15-hour wakefulness curve with no afternoon crash.

Access

Authority requiredNuvigil250 mg tablet

Brand: Nuvigil
PBS status: Authority required
Formulation: Tablets (50, 150, 250 mg)

Armodafinil

Dopamine Reuptake Inhibitor·Neurology - ADHD & Cognition

Narcolepsy, excessive sleepiness in Obstructive Sleep Apnea (OSA), Shift Work Sleep Disorder

Authority requiredPBSNOT S8Nuvigil250 mg tablet+2

Max Dose

250 mg/day

Half-life

15 h

OCP Failure

HIGH RISK

SJS/TEN

RARE BUT FATAL

Rapid Summary

Overview

Maximum Dose

Max 250 mg/day.

Clinical Focus

Induces CYP enzymes, rendering the oral contraceptive pill (OCP) completely useless. Can trigger life-threatening skin detachments (SJS/TEN).

Bottom Line

Armodafinil is a wakefulness-promoting agent for narcolepsy and shift work disorder, but can reduce hormonal contraceptive efficacy and may be abused for cognitive enhancement.

Formulation & Access

Brand Names

Nuvigil

Oral Routes

Tablets (50, 150, 250 mg).

Prescribing & PBS

Authority Required (PBS) for narcolepsy/OSA. Private script for shift workers. Unlike Dexamphetamine, it is NOT an S8 controlled drug (it is S4).

Indications & Use

Primary

PBSTGA

Narcolepsy, excessive sleepiness in Obstructive Sleep Apnea (OSA), Shift Work Sleep Disorder.

Off-Label

OFF

Severe fatigue in multiple sclerosis, depression-associated fatigue.

Clinical Place

The gold standard for keeping shift-workers awake and functional without turning them into amphetamine addicts.

Quick reference

Class & Role

Dopamine Reuptake Inhibitor — The purified, long-acting R-enantiomer of Modafinil.

Route / Formulation

Tablets (50, 150, 250 mg). (Nuvigil)

Usual Dose & Max

PO 150-250 mg OD in the morning. Max 250 mg/day.

Key Indication Doses

Best Uses

Armodafinil is a wakefulness-promoting agent for narcolepsy and shift work disorder, but can reduce hormonal contraceptive efficacy and may be abused for cognitive enhancement.

Avoid / Cautions

History of left ventricular hypertrophy, mitral valve prolapse, or ischemic ECG changes with prior CNS stimulants. Pregnancy Category D. Must be ceased 2 months before planned conception.

Key Risks

Key Interactions

Monitoring

Warn the patient: 'If you develop ANY skin rash, mouth ulcers, or fever, stop the drug immediately and go to the Emergency Department.'. Monitor BP and HR.

Clinical Pearl

Access

Authority requiredNuvigil250 mg tablet

Brand: Nuvigil
PBS status: Authority required
Formulation: Tablets (50, 150, 250 mg)