Armodafinil

About Armodafinil

Like modafinil, armodafinil promotes wakefulness and is taken once a day. Its label covers adults with excessive sleepiness from narcolepsy, obstructive sleep apnea or shift work disorder; in sleep apnea it treats the sleepiness, not the obstruction, so CPAP or other treatment of the airway continues. For narcolepsy or sleep apnea the dose is 150 to 250 mg once a day in the morning; for shift work disorder it is 150 mg about an hour before the shift begins. The dose is reduced in severe liver impairment, older adults may be given a lower dose with closer monitoring, and it is approved only for adults.

There is no boxed warning. Its warnings are much like modafinil’s: serious skin reactions, including Stevens-Johnson syndrome, which mean stopping it at the first sign of rash, skin or mouth sores, or blistering unless the rash is clearly unrelated; a drug reaction with fever, rash and other organs affected (DRESS); swelling of the face, lips, tongue or throat and anaphylaxis; and psychiatric symptoms such as mania, delusions, hallucinations, aggression and suicidal thoughts. It is not recommended for people with a history of left ventricular hypertrophy, or who had mitral valve prolapse syndrome with earlier stimulant use, and heart rate and blood pressure may be monitored more closely. Headache, nausea, dizziness and trouble sleeping are the common side effects. Anyone allergic to armodafinil or modafinil must not take it.

Wakefulness may not return fully to normal, so the prescriber reassesses sleepiness and may advise against driving. As a Schedule IV drug, a prescription can carry up to five refills within six months of the date written, and refill information can be transferred between pharmacies only once unless they share a real-time online database. Hormonal contraceptives are less effective during treatment and for one month after the last dose, so another or an added method is needed. Intrauterine growth restriction and miscarriage have been reported with armodafinil and modafinil, and a pregnancy registry collects outcomes.

Taking Armodafinil

How to take it

Once a day at about the same time: in the morning for narcolepsy or sleep apnea, or about an hour before the work shift for shift work disorder. Do not change the time without asking the prescriber, and keep using CPAP if it is prescribed.

If you miss a dose

MedlinePlus says to skip the missed dose and continue your regular schedule. Do not take a double dose to make up for it.

Storage

At room temperature in the original tightly closed container, away from excess heat and moisture (not in the bathroom), out of reach of children. Use a take-back program rather than flushing unused tablets.

Interactions to know about

Hormonal contraceptives are less reliable during treatment and for one month after stopping, and cyclosporine levels may fall. It can raise levels of omeprazole, phenytoin and diazepam, and warfarin may need more frequent clotting tests (INR). Avoid alcohol, ask the prescriber about grapefruit, and do not drive until you know how it affects you.

This summarizes the official prescribing information. Your prescriber’s and pharmacist’s instructions, and the leaflet that comes with your medicine, take priority.

Why the cash price for Armodafinil differs from pharmacy to pharmacy

Generic armodafinil competes with the Nuvigil brand, so a quote for the generic reflects mainly the pharmacy’s markup and dispensing fee, while a prescription that names Nuvigil and blocks substitution is quoted at a brand price. With four strengths, a pharmacy may keep only some on hand and order the rest.

Controlled-substance rules also play a part: refill information for a Schedule IV prescription can be transferred only once unless the pharmacies share a real-time database, so it is worth choosing the pharmacy before the first fill.

Ways to pay less for Armodafinil without insurance

• Ask for generic armodafinil, and make sure the prescription allows substitution rather than naming Nuvigil only.
• Check that your dose is written as one tablet of the right strength, not a combination of smaller tablets.
• Compare more than one pharmacy, and confirm your strength is in stock before the prescription is sent.
• If armodafinil is quoted high, ask the prescriber whether generic modafinil would suit you.
• Upload the prescription to Script Unlock so licensed pharmacies can quote their cash price. You pay the pharmacy directly.

Questions to ask your pharmacist about Armodafinil

1. 1.Should I take it in the morning or before my shift, and what if my shift changes?
2. 2.Does it affect my hormonal birth control, and for how long after I stop?
3. 3.Which rash, swelling or mood changes mean I should stop it and get help?
4. 4.Does it interact with my omeprazole, diazepam, cyclosporine or seizure medicine?

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