July 5, 2015
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Nuvigil

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Nuvigil




Side Effects
Interactions

SIDE EFFECTS

The following serious adverse reactions are described below and elsewhere in the labeling:

Clinical Trials Experience

Because clinical trials are conducted under widely varying conditions, adverse reaction rates observed in the clinical trials of a drug cannot be directly compared to rates in the clinical trials of another drug and may not reflect the rates observed in practice.

NUVIGIL has been evaluated for safety in over 1,100 patients with excessive sleepiness associated with OSA, SWD, and narcolepsy.

Most Common Adverse Reactions

In the placebo-controlled clinical trials, the most common adverse reactions ( ≥ 5%) associated with the use of NUVIGIL more frequently than in placebo-treated patients were headache, nausea, dizziness, and insomnia. The adverse reaction profile was similar across the studies.

Table 1 presents the adverse reactions that occurred at a rate of 1% or more and were more frequent in NUVIGIL-treated patients than in placebo-treated patients in the placebo-controlled clinical trials.

Table 1: Adverse Reactions in Pooled Placebo-Controlled Clinical Trials* in OSA, Narcolepsy, and SWD with NUVIGIL (150 mg and 250 mg)

  NUVIGIL (%)
N=645
Placebo (%)
N=445
Headache 17 9
Nausea 7 3
Dizziness 5 2
Insomnia 5 1
Anxiety 4 1
Diarrhea 4 2
Dry Mouth 4 1
Depression 2 0
Dyspepsia 2 0
Fatigue 2 1
Palpitations 2 1
Rash 2 0
Upper Abdominal Pain 2 1
Agitation 1 0
Anorexia 1 0
Constipation 1 0
Contact Dermatitis 1 0
Decreased Appetite 1 0
Depressed Mood 1 0
Disturbance In Attention 1 0
Dyspnea 1 0
Hyperhydrosis 1 0
Increased Gamma-Glutamyltransferase 1 0
Increased Heart Rate 1 0
Influenza-Like Illness 1 0
Loose Stools 1 0
Migraine 1 0
Nervousness 1 0
Pain 1 0
Paresthesia 1 0
Polyuria 1 0
Pyrexia 1 0
Seasonal Allergy 1 0
Thirst 1 0
Tremor 1 0
Vomiting 1 0
* Adverse reactions that occurred in ≥ 1% of NUVIGIL-treated patients and greater incidence than that of placebo.

Dose-Dependent Adverse Reactions

In the placebo-controlled clinical trials which compared doses of 150 mg/day and 250 mg/day of NUVIGIL and placebo, the following adverse reactions were dose-related: headache, rash, depression, dry mouth, insomnia, and nausea. See Table 2 for additional information.

Table 2: Dose-Dependent Adverse Reactions in Pooled Placebo-Controlled Clinical Trials in OSA, Narcolepsy and SWD

  NUVIGIL 250 mg (%)
N=198
NUVIGIL 150 mg (%)
N=447
NUVIGIL Combined (%)
N=645
Placebo (%)
N=445
Headache 23 14 17 9
Nausea 9 6 7 3
Insomnia 6 4 5 1
Dry Mouth 7 2 4 < 1
Rash 4 1 2 < 1
Depression 3 1 2 < 1

Adverse Reactions Resulting in Discontinuation of Treatment

In placebo-controlled clinical trials, 44 of the 645 patients (7%) who received NUVIGIL discontinued due to an adverse reaction compared to 16 of the 445 (4%) of patients that received placebo. The most frequent reason for discontinuation was headache (1%).

Laboratory Abnormalities

Clinical chemistry, hematology, and urinalysis parameters were monitored in the studies. Mean plasma levels of gamma glutamyltransferase (GGT) and alkaline phosphatase (AP) were found to be higher following administration of NUVIGIL, but not placebo. Few patients, however, had GGT or AP elevations outside of the normal range. No differences were apparent in alanine aminotransferase (ALT), aspartate aminotransferase (AST), total protein, albumin, or total bilirubin, although there were rare cases of isolated elevations of AST and/or ALT. A single case of mild pancytopenia was observed after 35 days of treatment and resolved with drug discontinuation. A small mean decrease from baseline in serum uric acid compared to placebo was seen in clinical trials. The clinical significance of this finding is unknown.

Read the Nuvigil (armodafinil) Side Effects Center for a complete guide to possible side effects

DRUG INTERACTIONS

Effects of NUVIGIL on CYP3A4/5 Substrates

The clearance of drugs that are substrates for CYP3A4/5 (e.g., steroidal contraceptives, cyclosporine, midazolam, and triazolam) may be increased by NUVIGIL via induction of metabolic enzymes, which results in lower systemic exposure. Dosage adjustment of these drugs should be considered when these drugs are used concomitantly with NUVIGIL [see CLINICAL PHARMACOLOGY].

The effectiveness of steroidal contraceptives may be reduced when used with NUVIGIL and for one month after discontinuation of therapy. Alternative or concomitant methods of contraception are recommended for patients taking steroidal contraceptives (e.g., ethinyl estradiol) when treated concomitantly with NUVIGIL and for one month after discontinuation of NUVIGIL treatment.

Blood levels of cyclosporine may be reduced when used with NUVIGIL. Monitoring of circulating cyclosporine concentrations and appropriate dosage adjustment for cyclosporine should be considered when used concomitantly with NUVIGIL.

Effects of NUVIGIL on CYP2C19 Substrates

Elimination of drugs that are substrates for CYP2C19 (e.g., phenytoin, diazepam, propranolol, omeprazole, and clomipramine) may be prolonged by NUVIGIL via inhibition of metabolic enzymes, with resultant higher systemic exposure. Dose reduction of these drugs may be required when these drugs are used concomitantly with NUVIGIL.

Warfarin

More frequent monitoring of prothrombin times/INR should be considered whenever NUVIGIL is coadministered with warfarin [see CLINICAL PHARMACOLOGY].

Monoamine Oxidase (MAO) Inhibitors

Caution should be used when concomitantly administering MAO inhibitors and NUVIGIL.

Drug Abuse And Dependence

Controlled Substance

NUVIGIL contains armodafinil, a Schedule IV controlled substance.

Abuse

Although the abuse potential of armodafinil has not been specifically studied, its abuse potential is likely to be similar to that of modafinil. In humans, modafinil produces psychoactive and euphoric effects, alterations in mood, perception, thinking and feelings typical of other CNS stimulants. In in vitro binding studies, modafinil binds to the dopamine reuptake site and causes an increase in extracellular dopamine, but no increase in dopamine release. Modafinil is reinforcing, as evidenced by its self-administration in monkeys previously trained to self-administer cocaine. In some studies, modafinil was also partially discriminated as stimulant-like. Physicians should follow patients closely, especially those with a history of drug and/or stimulant (e.g., methylphenidate, amphetamine, or cocaine) abuse. Patients should be observed for signs of misuse or abuse (e.g., incrementation of doses or drug-seeking behavior).

The abuse potential of modafinil (200, 400, and 800 mg) was assessed relative to methylphenidate (45 and 90 mg) in an inpatient study in individuals experienced with drugs of abuse. Results from this clinical study demonstrated that modafinil produced psychoactive and euphoric effects and feelings consistent with other scheduled CNS stimulants (methylphenidate).

Read the Nuvigil Drug Interactions Center for a complete guide to possible interactions

Last reviewed on RxList: 4/27/2015
This monograph has been modified to include the generic and brand name in many instances.

Side Effects
Interactions

Nuvigil - User Reviews

Nuvigil User Reviews

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Report Problems to the Food and Drug Administration

 

You are encouraged to report negative side effects of prescription drugs to the FDA. Visit the FDA MedWatch website or call 1-800-FDA-1088.


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