Armodafinil
NUVIGIL
Pronunciation: ar-moe-DAF-i-nil (NOO-vi-jil)
“Armored Daffodil”
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.
Available strengths
- tab 50, 150, 200, 250 mg
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
Cost
| Strength | #/mo | generic $/mo | CostPlus | |
|---|---|---|---|---|
| 50 mg | tab | 30 qd | $9.17 | not offered |
| 150 mg | tab | 30 qd | $23.63 | not offered |
| 200 mg | tab | 30 qd | $24.08 | not offered |
| 250 mg | tab | 30 qd | $27.25 | not offered |
Generic entry2012
NO BOXED WARNINGS
Principal riskIt induces CYP3A4 enough to fail oral contraceptives
Classes and tags
Clinical profile
Legacy pregnancy categoryC
Defining liabilitySerious rash, psychiatric activation and CYP-mediated interactions; misuse potential is present.
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