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Sleep Medicine Clinics Jun 2020Excessive daytime sleepiness (EDS) is related to medical and social problems, including mental disorders, physical diseases, poor quality of life, and so forth.... (Review)
Review
Excessive daytime sleepiness (EDS) is related to medical and social problems, including mental disorders, physical diseases, poor quality of life, and so forth. According to the International Classification of Sleep Disorders, Third Edition, diseases that result from EDS are narcolepsy type 1, narcolepsy type 2, idiopathic hypersomnia, hypersomnia due to a medical disorder, and others. EDS is usually treated using amphetamine-like central nervous system stimulants or modafinil and its R-enantiomer, armodafinil, wake-promoting compounds unrelated to amphetamines; a variety of new drugs are under development. The side effects of some stimulants are potent and careful selection and management are required.
Topics: Central Nervous System Stimulants; Disorders of Excessive Somnolence; Humans; Idiopathic Hypersomnia; Modafinil; Narcolepsy; Quality of Life; Sleepiness
PubMed: 32386693
DOI: 10.1016/j.jsmc.2020.02.006 -
Advances in Pharmacology (San Diego,... 2024Modafinil is a central nervous system stimulant approved for the treatment of narcolepsy and sleep disorders. Due to its wide range of biochemical actions, modafinil has...
Modafinil is a central nervous system stimulant approved for the treatment of narcolepsy and sleep disorders. Due to its wide range of biochemical actions, modafinil has been explored for other potential therapeutic uses. Indeed, it has shown promise as a therapy for cognitive disfunction resulting from neurologic disorders like ADHD, and as a smart drug in non-medical settings. The mechanism(s) of actions underlying the therapeutic efficacy of this agent remains largely elusive. Modafinil is known to inhibit the dopamine transporter, thus decreasing dopamine reuptake following neuronal release, an effect shared by addictive psychostimulants. However, modafinil is unique in that only a few cases of dependence on this drug have been reported, as compared to other psychostimulants. Moreover, modafinil has been tested, with some success, as a potential therapeutic agent to combat psychostimulant and other substance use disorders. Modafinil has additional, but less understood, actions on other neurotransmitter systems (GABA, glutamate, serotonin, norepinephrine, etc.). These interactions, together with its ability to activate selected brain regions, are likely one of the keys to understand its unique pharmacology and therapeutic activity as a CNS stimulant. In this chapter, we outline the pharmacokinetics and pharmacodynamics of modafinil that suggest it has an "atypical" CNS stimulant profile. We also highlight the current approved and off label uses of modafinil, including its beneficial effects as a treatment for sleep disorders, cognitive functions, and substance use disorders.
Topics: Humans; Modafinil; Central Nervous System Stimulants; Benzhydryl Compounds; Dopamine; Substance-Related Disorders
PubMed: 38467484
DOI: 10.1016/bs.apha.2023.10.006 -
Breast Care (Basel, Switzerland) Jun 2021A large proportion of breast cancer patients who undergo adjuvant radiotherapy suffer from radiotherapy-induced fatigue. The possible causative factors of this specific... (Review)
Review
BACKGROUND
A large proportion of breast cancer patients who undergo adjuvant radiotherapy suffer from radiotherapy-induced fatigue. The possible causative factors of this specific side effect are diverse.
SUMMARY
Prevalence, duration, and severity of radiotherapy-induced fatigue are dependent on the type of radiotherapy, as well as on the irradiated volume, dose scheme, on the number of radiation fields, the combination with other treatments, diurnal rhythm, smoking, and time-to-hospitalization. Recommended treatments include non-pharmacologic interventions, such as physical and psychosocial interventions. Pharmacologic therapies include treatment with methylphenidate and modafinil. In addition to its early detection with standardized instruments, adequate education to breast cancer patients about risks and predisposing factors of radiotherapy-induced fatigue is essential. Multidimensional strategies help to maintain the patients' quality of life and therefore guarantee treatment adherence and efficacy.
KEY MESSAGES
Radiotherapy-induced fatigue is an underreported, underdiagnosed, and undertreated side effect. This review provides an overview of radiotherapy-induced fatigue in breast cancer patients receiving adjuvant radiotherapy.
PubMed: 34248464
DOI: 10.1159/000509410 -
Science Advances Jun 2023To understand how pharmacological interventions can exert their powerful effects on brain function, we need to understand how they engage the brain's rich...
To understand how pharmacological interventions can exert their powerful effects on brain function, we need to understand how they engage the brain's rich neurotransmitter landscape. Here, we bridge microscale molecular chemoarchitecture and pharmacologically induced macroscale functional reorganization, by relating the regional distribution of 19 neurotransmitter receptors and transporters obtained from positron emission tomography, and the regional changes in functional magnetic resonance imaging connectivity induced by 10 different mind-altering drugs: propofol, sevoflurane, ketamine, lysergic acid diethylamide (LSD), psilocybin, N,N-Dimethyltryptamine (DMT), ayahuasca, 3,4-methylenedioxymethamphetamine (MDMA), modafinil, and methylphenidate. Our results reveal a many-to-many mapping between psychoactive drugs' effects on brain function and multiple neurotransmitter systems. The effects of both anesthetics and psychedelics on brain function are organized along hierarchical gradients of brain structure and function. Last, we show that regional co-susceptibility to pharmacological interventions recapitulates co-susceptibility to disorder-induced structural alterations. Collectively, these results highlight rich statistical patterns relating molecular chemoarchitecture and drug-induced reorganization of the brain's functional architecture.
Topics: Humans; Brain; Ketamine; Membrane Transport Proteins; Methylphenidate; Modafinil
PubMed: 37315149
DOI: 10.1126/sciadv.adf8332 -
Zhejiang Da Xue Xue Bao. Yi Xue Ban =... Aug 2020Narcolepsy is the most common cause of excessive daytime sleepiness (EDS) following obstructive sleep apnea. Its treatment aims to reduce EDS and cataplexy, improve... (Review)
Review
Narcolepsy is the most common cause of excessive daytime sleepiness (EDS) following obstructive sleep apnea. Its treatment aims to reduce EDS and cataplexy, improve nighttime sleep disturbance, sleep paralysis and sleep-related hallucinations. Pitolisant (a histamine H3 receptor antagonist) and solriamfetol (a norepinephrine reuptake inhibitor) have recently been approved effective for narcolepsy in the United States and the European Union. Pitolisant has proved to be effective for both EDS and cataplexy. Besides being effective on EDS, solriamfetol seems to have advantages in abuse potential and withdrawal syndrome. As potential treatments for EDS and cataplexy associated with narcolepsy, several new drugs are being developed and tested. These new drugs include new hydroxybutyrate preparations (controlled release sodium hydroxybutyrate FT218, low sodium hydroxybutyrate JZP-258), selective norepinephrine reuptake inhibitor (AXS-12), and modafinil combined with astroglial junction protein inhibitor (THN102). This paper reviews the recently approved drugs and potential treatments for narcolepsy.
Topics: Carbamates; Cataplexy; Drug Development; Humans; Narcolepsy; Phenylalanine; Piperidines
PubMed: 32985153
DOI: 10.3785/j.issn.1008-9292.2020.08.17 -
Maedica Sep 2022Antidepressants are the most common treatment for major depression. Also, psychotherapy is used for the treatment of depression. Tricyclic antidepressants are among the...
Antidepressants are the most common treatment for major depression. Also, psychotherapy is used for the treatment of depression. Tricyclic antidepressants are among the most frequently used medications to treat depression, with many known side effects. Therefore, checking and replacing other suitable drugs is essential in order to reduce side effects. Thus, the present study aimed to compare the efficacy of Modafinil and Citalopram in the treatment of patients with major depressive disorder. This interventional study was performed in 2019 on 30 people aged 18 to 65 years who had been diagnosed with a major depressive disorder based on DSM-5 criteria as well as the Hamilton Depression Rating Scale (HDRS), on which they got a score above 25. Subjects were randomly divided into two groups: the first group received Modafinil tablets (200 mg once daily, in the morning) and the second group Citalopram (20-40 mg/day). A Chi-square test was used to analyze the qualitative findings, and an independent t-test was used to compare quantitative data. The results showed that changes in HDRS score were significant over time (P <0.05). The mean difference in HDRS scores was significant in all stages among the study subjects (P <0.05). However, there were no significant differences in HDRS scores between groups in terms of gender, age, marital status, education, occupation, and economic status, either before treatment or three and six weeks after treatment. This was the first comparative study of Modafinil and Citalopram efficacy in treating patients with major depressive disorder. Larger-scale, longer-term clinical trials, including long-term discontinuation trials and placebo-controlled parallel treatment studies, are further necessary. Also, a larger sample size with a placebo comparison is recommended.
PubMed: 36540578
DOI: 10.26574/maedica.2022.17.3.607 -
Psychiatria Polska Feb 2020Eugeroics are a relatively new class of wakefulness-promoting agents. Thegroup includes adrafinil, modafinil and armodafinil. Modafinil is the most widely used and the... (Review)
Review
Eugeroics are a relatively new class of wakefulness-promoting agents. Thegroup includes adrafinil, modafinil and armodafinil. Modafinil is the most widely used and the best studied agent. Indications for the use of modafinil include the treatment of narcolepsy, shift-work sleep disorders and excessive daytime sleepiness associated with obstructive sleep apnea. Many studies show the utility of modafinil and armodafinil in the treatment of depression - both in monotherapy andas potentiation therapy if needed. Modafinil has proven to be effective in the treatment of residual symptoms of unipolar and bipolar depression such as fatigue, excessive sleepiness and some cognitive impairment. Research on armodafinil points to its effectiveness mainly in augmentation therapy of depression in the course of bipolar disorder. There are also reports on the effectiveness of eugeroics in special cases - seasonal depression, atypical depression with hyperphagia, apathy in the course of depression or as an isolated symptom, cancer-related fatigue in patients receiving chemotherapy, fatigue and excessive sleepiness in neurological diseases. Eugeroics due to their high selectivity of action in the CNS have a low addictive potential compared with other stimulants. The risk of manic switch is comparable to placebo. In general, they are well-tolerated and safe. The purpose of this paper is to review the literature on the use of eugeroics in the treatment of affective disorders.
Topics: Adult; Antidepressive Agents; Central Nervous System Stimulants; Depressive Disorder, Major; Evidence-Based Medicine; Female; Humans; Male; Modafinil; Mood Disorders; Treatment Outcome; Wakefulness-Promoting Agents
PubMed: 32447354
DOI: 10.12740/PP/OnlineFirst/90687 -
The Medical Letter on Drugs and... Oct 2019
Review
Topics: Animals; Antimalarials; Diarrhea; Humans; Insect Bites and Stings; Malaria; Travel; Travel-Related Illness
PubMed: 31599872
DOI: No ID Found -
Journal of Human Lactation : Official... May 2023
Topics: Female; Humans; Animals; Modafinil; Milk; Breast Feeding; Psychiatric Status Rating Scales; Benzhydryl Compounds; Double-Blind Method; Central Nervous System Stimulants; Treatment Outcome
PubMed: 37073877
DOI: 10.1177/08903344231156361