Drug interactions- summary-

+ Armodafinil -

CYP3A/5 inducers ( carbamazepine, phenobarbital, rifampin )-
decrease in plasma levels due to increased metabloism

CYP3A4/5 inhibitors ( erythromycin,ketoconazole )-
increase in armodafinil plasma levels due to decreased metabolism

MAOIs eg phenelzine -
use caution when administering MAOIs and armodafinil

Armodafinil +

Alcohol -
Avoid concomittant administration

Benzodiazepine eg diazepam, midazolam, triazolam-
armodafinial can decrease  sytemic exposure to midazolam and triazolam
through CYP3A4/5 induction.
Armodafinil can increase systemic exposure to diazepam.
Dose adjustments may be required

Clomipramine-
armodafinil may increase systemic exposure to clomipramine through
CYP2C19 . Dose reduction may be required

Cyclosporine -
blood levels of cyclosporine may be reduced. Monitor circulating
cyclosporine levels and adjust dose.

Ethinyl estradiol -
armodafinil decrease systemic exposure of ethinyl estradiol .
Dose adjustments may be required

Omeprazole-
armodafinil may increase systemic exposure through inhibition of
CYP2C19 . Dose reduction may be required

Phenytoin-
armodafinil may increase systemic exposure through inhibition of
CYP2C19 . Dose reduction may be required

Propranolol-
armodafinil may increase systemic exposure through inhibition of
CYP2C19 . Dose reduction may be required

Steroidal controceptives -
efficacy of steroidal contraceptives may be reduced during and
for 1 month after armodafinil coadministration. Use of alternative
or concomittant methods of contrception recommended during and
for 1 month after coadminstration with armodafinil

Warfarin-
monitor prothrombin times and international ratios more frequently
when armodafinil is codministred with warfarin

Narcolepsy
Obstructive sleep apnea-hypopnea syndrome

Adverse reactions-

CNS -           anxiety 3%  depression 2%  dizziness  4%   headache   15%   insomnia 4%

Cardiovascular -  palpitation  2%

Dermatologic -      rash   2%

GI -           diarrhea    3%    dry mouth  3%   nausea  6%

Hypersensitivity to the drug or ingreidients

Special Precaution-

Rash -  Armodafinil should be discontinued at the first sign of rash, unless the rash is
clearly not drug related

Persistent sleepiness -  advice patients with abnormal levels of sleepiness who take
amodafinil that their level of wakefulness may not return to normal

Pscychiatric effects- excercise caution when amodafinil is given to patients with a
history of psychosis, expression or mania. If psychiatric symptoms develop in association
with armodafinil  administration consider discontinuing armodafinil

Diagnosis of sleep disoders- use armodafinil only in patients who have a complete evaluation
 of their excessive sleepiness, and in whom a diagnosis of narcolepsy or sleep disorder
has been established

Hazardous tasks- caution patients about operating machinery or driving , until they are
reasonably certain that armodafinil therapy will not affect their ability to ability to engage
in such activites.

Pregnancy- use armodafinil during pregnancy only if the potential justifies the potential
risk to the fetus

Lactation- excercise caution when armodafinil are administered to a breast feeding woman

Children- safety and efficacy of use of armodafinil in patients younger than 17 years of age
has not been established

Elderly- excercise caution. Clearance of armodafinil may be reduced in elderly patients

Monitoring- increased monitoring of blood pressure may be appropiate in patients
on armodafinil

Indication-
Narcolepsy
Obstructive sleep apnea-hypopnea syndrome

Dosage-
150 -250mg given as a single dose in the morining

Elderly- lower doses to be considered

Duration of therapy- efficacy of armodafinil in long term use ( more than 12 weeks
has not been systematically evaluated.

1. Caution patients about operating machinery or driving , until they are  reasonably
    certain that armodafinil therapy will not affect their ability to ability to engage
     in such activites.

2. Advice patients to contact their doctor if they experience rash, depression, anxiety,
    or signs of psychosis or mania

3. Advice patients that it is prudent to avoid alcolhol while taking armodafinil

4. Advice patients thatb they should inform their doctor if they become pregnant or
   intend to become pregnant during therapy

5. Advice patients to inform their doctor if they are breast feeding an infant.

Pregnancy-
Use armodafinil during pregnancy only if the potential justifies the potential
risk to the fetus

Lactation-
Excercise caution when armodafinil are administered to a breast feeding woman

Children-
Safety and efficacy of use of armodafinil in patients younger than 17 years of age
has not been established

Elderly-
Excercise caution. Clearance of armodafinil may be reduced in elderly patients