New stimulant being marketed directly to the public

The Medical Letter on Drugs and Therapeutics, published by The Medical Letter, Inc., of New Rochelle, New York, is a twice monthly nonprofit publication. I rely (and have relied for about twenty-five years) on this publication for accurate and unbiased information on pharmaceuticals.

The August 9, 2010 issue reports that the non-amphetamine stimulant armodafinil (brand name Nuvigil by Cephalon) is being promoted directly to to the public for excessive daytime sleepiness related to shift work. Armodafinil is related to modafinil (Provigil), which was approved by the FDA in 1988 for treatment of excessive sleepiness associated with narcolepsy. Modafinil is also used to treat excessive sleepiness caused by other conditions. There have been media reports that modafinil is being used by college students to stay awake, as well as by military personnel to endure lengthy missions.

Interestingly, The Medical Letter reports that the mechanism of action of armodafinil or modafinil to counter excessive sleepiness is unknown.

In clinical studies, common adverse side effects include nausea, dizziness, insomnia, and headache.

The Medical Letter cites reports of euphoria and illicit use of modafinil by students. The Letter states that armodafinil and modafinil increase dopamine levels in the brain, including the nucleus accumbens, and that drugs that increase dopamine in this part of the brain have a potential of abuse.

Armodafinil is a Schedule IV drug.

Frankly, I expect a certain portion of the population to seek out armodafinil and modafinil for not only their therapeutic benefits in treating excessive sleepiness, but for euphoric effects. After all, as DREs know, what can be used, can be abused.