Home Drug Guide Armodafinil

Drug Guide

Generic Name

Armodafinil

Brand Names Nuvigil

Classification

Therapeutic: Stimulant for wakefulness

Pharmacological: Eugeroic

FDA Approved Indications

  • Narcolepsy
  • Obstructive sleep apnea/hypopnea syndrome
  • Shift work sleep disorder

Mechanism of Action

Armodafinil promotes wakefulness primarily by affecting hypothalamic pathways that regulate the sleep-wake cycle, possibly through increasing synaptic concentrations of dopamine by inhibiting dopamine reuptake.

Dosage and Administration

Adult: Typically 150 mg once daily in the morning. Dose adjustments may be made based on response and tolerability.

Pediatric: Not FDA approved for pediatric use; safety and efficacy not established.

Geriatric: Use with caution; start at the lower end of the dosing range due to potential increased sensitivity.

Renal Impairment: Adjust dose cautiously; no specific guidelines, but renal function affects drug clearance.

Hepatic Impairment: Use with caution; no specific guidelines, but hepatic impairment may increase plasma concentrations.

Pharmacokinetics

Absorption: Rapidly absorbed, peak plasma concentrations in approximately 2 hours.

Distribution: Widely distributed; protein binding approximately 60%.

Metabolism: Metabolized mainly by hydrolysis and N-acetylation; CYP3A4 involved partially.

Excretion: Excreted primarily in urine (around 60%), with the remainder in feces.

Half Life: Approximately 12-15 hours.

Contraindications

  • Hypersensitivity to armodafinil or modafinil.
  • History of hypersensitivity reactions.

Precautions

  • Use with caution in patients with a history of psychiatric disorders, cardiovascular disease, or drug abuse.
  • Potential for severe skin reactions (e.g., Stevens-Johnson syndrome).
  • Monitor for neuropsychiatric symptoms, such as anxiety, hallucinations, or agitation.

Adverse Reactions - Common

  • Headache (Common)
  • Nausea (Common)
  • Dizziness (Common)
  • Insomnia (Common)

Adverse Reactions - Serious

  • Serious skin reactions (e.g., Stevens-Johnson syndrome) (Rare)
  • Cardiovascular events (e.g., hypertension, tachycardia) (Rare)
  • Psychiatric symptoms (e.g., anxiety, hallucinations) (Rare)

Drug-Drug Interactions

  • Contraceptives (may reduce effectiveness)
  • Other CNS stimulants or depressants

Drug-Food Interactions

  • Possible altered absorption with high-fat meals

Drug-Herb Interactions

  • Potential interactions with St. John's Wort and other CYP3A4 inducers/inhibitors

Nursing Implications

Assessment: Monitor sleep patterns, cardiovascular status, mental health status.

Diagnoses:

  • Risk for sleep deprivation

Implementation: Administer in the morning; monitor for adverse effects; educate patient about potential interactions.

Evaluation: Assess for improvement in wakefulness and alertness; monitor for adverse effects.

Patient/Family Teaching

  • Take medication exactly as prescribed.
  • Report any skin rashes or allergic reactions immediately.
  • Avoid alcohol and other CNS depressants.
  • Be aware of potential side effects like headache and insomnia.

Special Considerations

Black Box Warnings:

  • Potential for severe skin reactions and hypersensitivity.
  • Risk of serious dermatologic reactions.

Genetic Factors: Limited data, but genetic variability may affect metabolism and response.

Lab Test Interference: May interfere with urine drug screens for stimulants.

Overdose Management

Signs/Symptoms: Agitation, headache, confusion, hallucinations, tachycardia, hypertension.

Treatment: Supportive care; control of symptoms; activated charcoal if ingestion recent; dialysis not effective due to high protein binding.

Storage and Handling

Storage: Store at room temperature (20-25°C), away from moisture and light.

Stability: Stable under recommended storage conditions.

🛡️ 5 Critical Medication Safety Tips for Nurses

1

Triple-Check High-Risk Medications

Always have another nurse verify insulin, heparin, warfarin, and chemotherapy drugs. These "high-alert" medications cause the most serious errors. Check concentration, dose calculation, and pump settings twice.

2

Know Look-Alike, Sound-Alike Drugs

Common mix-ups: hydromorphone/morphine, Celebrex/Celexa, Zyprexa/Zyrtec. Always use BOTH generic and brand names, read labels twice, and use barcode scanning when available. One wrong letter can be fatal.

3

Assess Before AND After Giving Meds

Check vitals before cardiac meds, pain levels before analgesics, and blood glucose before insulin. Always reassess within 30 minutes to evaluate effectiveness and watch for adverse reactions.

4

Watch for Drug Interactions

Common dangerous combinations: warfarin + aspirin (bleeding), ACE inhibitors + potassium (hyperkalemia), digoxin + diuretics (toxicity). Always check drug interactions before administering new medications.

5

Educate Your Patients

Teach patients medication names, purposes, major side effects, and what to report. Informed patients catch errors and improve compliance. Always encourage questions - an educated patient is a safer patient.

⚡ Remember: When in doubt, don't give it out! It's always safer to double-check than regret later.

⚠️ Medical Disclaimer

This drug guide is for educational purposes only and is NOT intended for clinical use. Always consult current prescribing information, healthcare providers, and institutional protocols before administering any medication. Do not use this information for patient care decisions.