Modafinil

INTRODUCTION

Indications

To improve wakefulness in patients with excessive daytime drowsiness due to narcolepsy, obstructive sleep apnea, or shift work sleep disorder.

Action

Produces CNS stimulation. Therapeutic Effects: Decreased daytime drowsiness in patients with narcolepsy and obstructive sleep apnea. Decreased drowsiness during work in patients with shift work sleep disorder.

Adverse Reactions/Side Effects

CNS: headache, amnesia, anxiety, cataplexy, confusion, depression, dizziness, insomnia, nervousness. EENT: rhinitis, abnormal vision, amblyopia, epistaxis, pharyngitis. Resp: dyspnea, lung disorder. CV: arrhythmias, chest pain, hypertension, hypotension, syncope, vasodilation. GI: nausea, abnormal liver function, anorexia, diarrhea, gingivitis, mouth ulcers, thirst, vomiting. GU: abnormal ejaculation, albuminuria, urinary retention. Derm: dry skin, herpes simplex. Endo: hyperglycemia. Hemat: eosinophilia. MS: joint disorder, neck pain. Neuro: ataxia, dyskinesia, hypertonia, paresthesia, tremor. Misc: infection.

PHYSICAL THERAPY IMPLICATIONS

Examination and Evaluation

• Monitor alertness in patients with narcolepsy; document the frequency and duration of sleeping episodes to help determine the effects of drug therapy

• Be alert for signs of adverse changes in mood and behavior, including anxiety, confusion, nervousness, depression, or memory loss. Report these signs to the physician.

• Assess heart rate, ECG, and heart sounds, especially during exercise (See Appendices G, H). Report any rhythm disturbances or symptoms of arrhythmias, including palpitations, chest discomfort, shortness of breath, fainting, and fatigue/weakness.

• Assess blood pressure (BP) and compare to normal values (See Appendix F). Report changes in BP, either a problematic decrease in BP (hypotension) or a sustained increase in BP (hypertension).

• Monitor any breathing problems, and report difficult/labored breathing, reduced pulse oximetry values, or other signs of lung dysfunction.

• Monitor for signs of eosinophilia such as fatigue, weakness, and myalgia. Report these signs to the physician.

• Be alert for signs of hyperglycemia, including confusion, drowsiness, flushed/dry skin, fruit-like breath odor, rapid/deep breathing, polyuria, loss of appetite, and unusual thirst. Patients with diabetes mellitus should check blood glucose levels frequently.

• Be alert for tremor, ataxia, abnormal muscle tone and movements (dyskinesias, hypertonia), extreme restlessness (akathisia), sudden loss of muscle tone (cataplexy), or other signs of motor dysfunction. Report problematic movement disorders to the physician.

• Assess signs of parasthesia such as numbness, tingling, and muscle weakness. Perform objective tests, including electroneuromyography and sensory testing to document any drug-related neuropathic changes.

• Assess any joint pain or neck pain to rule out musculoskeletal pathology; that is, try to determine if pain is drug-induced rather than caused by anatomic or biomechanical problems.

• Assess dizziness or syncope that might affect gait, balance, and other functional activities (See Appendix C). Report balance problems and functional limitations to the physician, and caution the patient and family/caregivers to guard against falls and trauma.

Interventions