Names and pronunciation
(ar-moe-daf′in-il) Nuvigil
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Drug reference
(ar-moe-daf′in-il) Nuvigil
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Func. class.: CNS stimulant Controlled Substance Schedule IV
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ACTION: May inhibit dopamine reup- take, unknown
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USES: Narcolepsy, obstructive sleep apnea/hypoapnea syndrome, circadian rhythm disruption (shift-work sleep A problems)
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CONTRAINDICATIONS: Hyper- sensitivity to this product or modafinil
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SIDE EFFECTS CV: Increased B/P, pulse, palpitations CNS: Anxiety, dizziness, depression, fatigue, headache, insomnia, migraine, paresthesia, tremor, suicidal thoughts/behaviors, mania, hallucinations, delusions GI: Anorexia, nausea, vomiting, constipa- tion, diarrhea, dry mouth GU: Polyuria RESP: Dyspnea INTEG: Dermatitis, allergic reactions, Stevens-Johnson syndrome MISC: Flulike symptoms
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INTERACTIONS Increased: Levels of drugs metabolized by CYP2C19 (diazepam, phenytoin, pro- pranolol), monitor carefully, dosage re- duction may be needed Increased: Level of armodafinil— CYP3A4 inhibitors (erythromycin) Decrease: Levels of drugs metabolized by CYP3A4 (midazolam, cyclosporine) Decrease: Level of armodafinil—CYP3A4 inducers (carbamazepine, rifampin) Decrease: Effect of hormonal contracep- tives, use alternative contraception Drug/Food Decrease: Onset of medication: food Drug/Lab Increase: Alkaline phosphatase, GGT NURSING CONSIDERATIONS
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DOSAGE AND ROUTES Narcolepsy, obstructive sleep apnea/hypoapnea syndrome • Adult and adolescent ≥17 yr: PO 150-250 mg in AM Circadian rhythm disruption (shift- work sleep problems) • Adult and adolescent ≥17 yr: PO 150 mg at start of shift
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Available forms: Tablets 50, 150, 200, 250 mg Administer • Give with or without food consistently at same time of the day
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Assess: • Cardiac status: Monitor for changes in B/P, pulse, ECG, chest pain • Monitor for Stevens-Johnson syndrome/ toxic epidermal necrolysis (red, swollen, blistered, or peeling skin [with or without fever]; red or irritated eyes; or sores in mouth, throat, nose, or eyes), to stop prod- uct immediately and notify prescriber • Monitor for suicidal thoughts/behav- iors, mania, hallucinations, delusions • Monitor for continued sleepiness or inability to stay awake • Identify all products taken, OTC, Rx, supplements, herbal products, to avoid drug interactions • DRESS: Monitor for rash, fever, facial swelling, lymphadenopathy; although rare, occurs with other system involvement
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Evaluate: • Therapeutic response: Ability to stay awake
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Patient and caregiver information: • To report trouble sleeping, nausea, dry mouth, depression, swollen glands, behavioral changes, chest pain, dark urine, change in vision, yellow skin, trouble breathing, bruising, bleeding • To report Stevens-Johnson syndrome/ toxic epidermal necrolysis (red, swollen, blistered, or peeling skin [with or without fever]); red or irritated eyes; or sores in mouth, throat, nose, or eyes; to stop prod- uct immediately and notify prescriber • To report immediately suicidal thoughts/behaviors, mania, hallucina- tions, delusions • To use alternative contraception if tak- ing hormonal contraceptives during and for 1 mo after last dose • To notify prescriber if pregnancy is planned or suspected, or if breastfeeding • To use product at the same time of the day, with or without food consistently • To avoid driving or other hazardous activities until response is known, dizzi- ness may occur • To report all products taken to other health care providers
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PHARMACOKINETICS Onset unknown, peak 2 fasting hr, dura- tion unknown, half-life 15 hr, 60% pro- tein binding
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• Adult and adolescent ≥17 yr: PO 150-250 mg in AM Circadian rhythm disruption (shift- work sleep problems)
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• Adult and adolescent ≥17 yr: PO 150 mg at start of shift
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