Artvigil: Enhance Wakefulness and Cognitive Performance

Artvigil

Product dosage: 150 mg
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Synonyms Nuvigil

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Artvigil is a prescription medication containing armodafinil, the R-enantiomer of modafinil, designed to promote wakefulness in individuals with excessive sleepiness associated with narcolepsy, obstructive sleep apnea, and shift work sleep disorder. It functions as a eugeroic, or wakefulness-promoting agent, by altering the natural chemicals (neurotransmitters) in the brain area that controls sleep and wakefulness. Unlike traditional stimulants, Artvigil offers a smoother, more sustained alertness with a reduced potential for jitteriness or a pronounced crash, making it a valuable tool in managing sleep-wake cycle disruptions under professional supervision. Its precise mechanism, while not fully elucidated, is believed to involve dopamine reuptake inhibition, leading to increased extracellular dopamine in the brain, which contributes to heightened alertness and cognitive function.

Features

• Active Ingredient: Armodafinil (150 mg per tablet)
• Drug Class: Eugeroic (Wakefulness-Promoting Agent)
• Formulation: Oral tablet
• Half-Life: Approximately 15 hours
• Time to Peak Plasma Concentration: ~2 hours in a fasted state
• Bioavailability: High
• Metabolism: Primarily hepatic, via amide hydrolysis, CYP3A4/5-mediated dehydrogenation, and other pathways
• Excretion: Primarily renal (≈80%)
• Schedule: Schedule IV Controlled Substance (US)

Benefits

• Promotes sustained wakefulness and alertness throughout the day, helping to combat excessive sleepiness.
• Improves cognitive function, including enhanced focus, concentration, and memory recall in individuals with sleep disorders.
• Supports normalized daytime functioning for shift workers, allowing for improved performance and safety during non-standard hours.
• Reduces the intrusion of sleep episodes in patients with narcolepsy, leading to a more controlled and predictable daily routine.
• Offers a favorable side effect profile compared to traditional stimulants like amphetamines, with a lower incidence of euphoria or significant cardiovascular strain.

Common use

Artvigil (armodafinil) is FDA-approved for improving wakefulness in adult patients with excessive sleepiness associated with:

• Narcolepsy: A chronic neurological disorder characterized by the brain’s inability to regulate sleep-wake cycles normally, leading to sudden attacks of sleep.
• Obstructive Sleep Apnea (OSA): Used as adjunctive therapy to standard treatment (e.g., continuous positive airway pressure, or CPAP) for residual excessive daytime sleepiness. It is not a treatment for the underlying airway obstruction.
• Shift Work Sleep Disorder (SWSD): A condition affecting individuals who work nontraditional hours (e.g., night shifts, rotating shifts), characterized by insomnia when sleep is desired and excessive sleepiness during the scheduled work period.

Its use off-label for cognitive enhancement, ADHD, or fatigue associated with other medical conditions is not approved by the FDA and should only be considered after a thorough risk-benefit analysis by a qualified healthcare professional.

Dosage and direction

The recommended dosage of Artvigil is 150 mg or 250 mg taken orally once daily.

• For Narcolepsy or OSA: 150 mg or 250 mg is taken as a single dose in the morning.
• For Shift Work Sleep Disorder: 150 mg is taken approximately 1 hour before the start of the work shift.
• Administration should occur at the same time each day to maintain consistent plasma levels.
• Tablets can be taken with or without food; however, a high-fat meal may delay the absorption of the drug, slightly prolonging the time to reach peak effect.
• The dosage should be individualized based on clinical response and tolerability. It is crucial to follow the prescribing physician’s instructions exactly. Do not crush, chew, or break the tablet.

Precautions

• Pregnancy and Lactation: Artvigil is classified as Pregnancy Category C. There are no adequate and well-controlled studies in pregnant women. Use during pregnancy only if the potential benefit justifies the potential risk to the fetus. It is not known whether armodafinil is excreted in human milk; caution is advised if administering to a nursing woman.
• Cardiovascular System: Use with caution in patients with a history of left ventricular hypertrophy, mitral valve prolapse, or recent myocardial infarction. Patients may experience increased blood pressure and heart rate; monitoring is recommended.
• Psychiatric History: May cause psychiatric symptoms such as anxiety, agitation, insomnia, irritability, depression, or, in rare cases, psychosis, mania, or hallucinations. Use with extreme caution in patients with a history of psychosis, depression, or mania.
• Dependence Potential: While the risk is lower than with amphetamines, Artvigil is a Schedule IV controlled substance with a known potential for dependence and abuse. A history of drug or alcohol addiction increases this risk.
• Driving and Operating Machinery: Patients should be cautioned about operating automobiles or other hazardous machinery until they know how the drug affects them, as it may affect judgment and motor skills.

Contraindications

Artvigil is contraindicated in patients with:

• Known hypersensitivity to armodafinil, modafinil, or any of the inactive ingredients in the formulation.
• A history of serious skin reactions, such as Stevens-Johnson Syndrome (SJS), Toxic Epidermal Necrolysis (TEN), or Drug Rash with Eosinophilia and Systemic Symptoms (DRESS), associated with modafinil or armodafinil use.

Possible side effect

Like all medications, Artvigil can cause side effects, although not everybody gets them. Common side effects (≥5%) include:

• Headache
• Nausea
• Dizziness
• Insomnia
• Anxiety
• Diarrhea
• Dry mouth

Less common but more serious side effects require immediate medical attention:

• Serious skin rashes (e.g., SJS, TEN, DRESS)
• Signs of an allergic reaction (hives; difficulty breathing; swelling of the face, lips, tongue, or throat)
• Symptoms of heart problems (chest pain, trouble breathing, irregular heartbeat)
• Psychiatric symptoms (depression, anxiety, aggression, mania, hallucinations, suicidal thoughts)
• Symptoms of a multiorgan hypersensitivity reaction (fever, rash, swollen lymph nodes, abnormal liver function tests)

Drug interaction

Artvigil can interact with many other medications, potentially altering their effectiveness or increasing the risk of side effects.

• CYP3A4 Inducers/Inhibitors: Drugs that induce CYP3A4 (e.g., carbamazepine, phenobarbital, rifampin) may decrease armodafinil plasma concentrations. Inhibitors (e.g., ketoconazole, itraconazole) may increase them.
• CYP2C19 Substrates: Artvigil may increase the exposure of drugs metabolized by CYP2C19 (e.g., diazepam, phenytoin, propranolol, omeprazole). Dose adjustment of these drugs may be necessary.
• Hormonal Contraceptives: Armodafinil can significantly reduce the effectiveness of ethinyl estradiol-containing contraceptives (birth control pills, patches, rings). Alternative or simultaneous barrier methods of contraception are recommended during and for one month after stopping Artvigil therapy.
• Cyclosporine: Artvigil may reduce blood levels of cyclosporine; monitoring of cyclosporine levels is advised.
• Warfarin: Artvigil may alter the metabolism of warfarin (Coumadin), requiring more frequent monitoring of prothrombin time/INR.
• Other CNS Agents: Concurrent use with other central nervous system agents (e.g., benzodiazepines, opioids, antipsychotics) may have additive effects. Use with monoamine oxidase inhibitors (MAOIs) is not recommended.

Missed dose

If a dose is missed, it should be taken as soon as possible on the same day. However, if it is too close to the time of the next scheduled dose (or in the evening), the missed dose should be skipped. Do not double the next dose to make up for a missed one, as this increases the risk of side effects and insomnia.

Overdose

In cases of suspected overdose, contact a poison control center or emergency room immediately. Symptoms of overdose may include:

• Agitation or excitation
• Insomnia
• Anxiety
• Confusion
• Tachycardia (abnormally fast heart rate)
• Hypertension (elevated blood pressure)
• Tremors
• Hallucinations
• Diarrhea, nausea Treatment is symptomatic and supportive. There is no specific antidote for armodafinil overdose. Cardiovascular monitoring is essential.

Storage

• Store Artvigil tablets at room temperature, between 20°C to 25°C (68°F to 77°F).
• Keep the medication in its original blister pack or container, tightly closed, and out of reach of children and pets.
• Protect from excess light and moisture.
• Do not flush medications down the toilet or pour them into a drain unless instructed to do so. Properly discard this product when it is expired or no longer needed through a medicine take-back program.

Disclaimer

This information is for educational purposes only and is not a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition or medication. Never disregard professional medical advice or delay in seeking it because of something you have read here. The information provided is not exhaustive and may not cover all possible uses, directions, precautions, interactions, or adverse effects.

Reviews

• John D., Diagnosed with Narcolepsy: “Artvigil has been a game-changer for managing my narcolepsy. The sleep attacks are far less frequent, and I feel a consistent level of alertness that allows me to work a full day. The ‘smoother’ feeling compared to other medications I’ve tried is notable, with less of an edge.”
• Maria L., Shift Worker (Nurse): “Working the night shift was destroying my quality of life. Since starting Artvigil an hour before my shift, I can stay focused and alert throughout the night without feeling jittery. It’s made me a safer and more effective nurse. The only downside was an initial headache, but it subsided after a week.”
• A Healthcare Professional’s Perspective (Dr. Evans, Neurologist): “In my practice, Artvigil is a valuable tool within a comprehensive treatment plan for sleep disorders. Its long half-life provides sustained coverage, which many patients prefer. I always emphasize it is an adjunct therapy, especially for OSA patients who must continue their primary treatment like CPAP. Monitoring for psychiatric and cardiovascular side effects is paramount.”
• David K., Using for OSA (with CPAP): “Even with perfect CPAP compliance, I had crippling daytime sleepiness. My doctor added Artvigil, and the difference is night and day. I finally feel awake and can participate in life with my family again. It’s important to understand this isn’t a substitute for the CPAP, but it makes the CPAP’s benefits actually feel real.”