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        New Message Board Archives >> Medications, Treatments, Therapies 2004 >> Floridian
        
(Message started by: catlind on Sep 23^rd, 2004, 8:56am)

Title: Floridian
Post by catlind on Sep 23^rd, 2004, 8:56am

Since you are the unofficial resident expert when it comes to the science and pharmacology of things, I wanted to get your thoughts on this.

In readers digest this month there was an article on a drug called Provigil. It's a drug used for wakefulness, primarily indicated for people with narcolepsy, but the thing that caught my attention was it's mode of affect. It works directly on the hypolthalamus and it's ability to regulate wake/sleep cycles.

I'm going to ask my doc if I can try this to see if it has any impact on CH. Any thoughts on how this drug's effect on the hypo might do anything for CH?

Cat

Title: Re: Floridian
Post by floridian on Sep 23^rd, 2004, 10:54am

Modanafil aka Provigil.

One article written in 2004 was titled "Modafinil: a drug in search of a mechanism." Nobody knows how it works, but it has some interesting activities.

Low doses in the morning may improve wakefulness throughout the day without affecting sleep. Some studies indicate it can help people with winter Seasonal Affective Disorder. Modafinil also seems to have anti-siezure anti-epileptic properties. It can counteract the sedating effects of topomax.

Too soon to say but it is an interesting med - it might help some people, but I don't know enough about it to reccommend it.

Title: Re: Floridian
Post by catlind on Sep 23^rd, 2004, 11:28am

kewl, thanks for the input, guess it's guinea pig time :)

Considering that anti-seizure and anti-epileptic drugs are effective for some in treating CH and that the hypo is definitely involved in CH, this might have a chance at working.

I'll see if the docs agree to this and I'll keep everyone posted.

Cat

Title: Re: Floridian
Post by karma on Sep 23^rd, 2004, 11:30am

For Sleep Apnea, My wife is prescribed a combo of provigil and wellbutron. Wellbutron is also known as Ziban

Title: Re: Floridian
Post by JJA on Sep 23^rd, 2004, 11:59am

If I may have some input as a neuroscientist...
The hypothalamus, despite its relatively small size, is made up of many nuclei. It controls a lot of things like hunger, thirst sleep, sexual behavior and is the "master" of all things endocrine. The chances that the unknown effect (as Floridian ponts out) of provigil will correct the abnormality of Ch seems pretty slim, but both do seem to be tied to the circadian rhythm and therefore the suprachiasmatic nucleus(SCN). I will also admit I knew nothing of provigil until the article appeared in readers digest so I'm no expert. We won't know until someone tries it. I hope your doctor lets you and I hope I eat my words.

Jesse

Title: Re: Floridian
Post by Lizzie2 on Sep 23^rd, 2004, 2:19pm

Here's a little more pharmacology info on Provigil.
This info comes from the chapter on CNS Stimulants and Attention-Deficit/Hyperactivity Disorder in the 5th edition of "Pharmacology for Nursing Care" By Richard Lehne

Quote:

Modafinil

Modafinil [Provigil] is a CNS stimulant indicated only for narcolepsy, a disorder characterized by excessive daytime sleepiness and sudden attacks of sleep. In patients with narcolepsy, modafinil increases wakefulness, but only to about 50% of the level seen in normal people. In contrast, methylphenidate and dextroamphetamine increase wakefulness to about 70% of normal. Modafinil is not an amphetamine, and its mechanism of action in narcolepsy is unknown. The drug has been used investigationally to augment the effects of antidepressants. In addition, modafinil is being used off-label to ward off sleepiness. Users have remained awake for 2 to 3 days with no apparent ill effects, including the cardiovascular and CNS stimulation associated with amphetamines.

Modafinil is rapidly absorbed from the GI tract. Plasma levels peak in 2 to 4 hours. Food decreases the rate of absorption but not the extent. Elimination is by hepatic metabolism followed by renal excretion. The half-life is about 15 hours.

Modafinil is generally well tolerated. The most common adverse effects are headache, nausea, nervousness, diarrhea, and rhinitis. Modafinil does not disrupt nighttime sleep. In clinical trials, only 5% of patients dropped out because of undesired effects. Subjective effects--euphoria; altered perception, thinking, and feeling--are like those of other CNS stimulants. Because of its subjective effects, modafinil is regulated as a Schedule IV substance. Physical dependence and withdrawal have not been reported.

Modafinil inhibits some forms of cytochrome P450 (CYP) and induces others. Induction of CYP4A4 may accelerate the metabolism of oral contraceptives, cyclosporine, and certain other drugs, thereby causing their levcels to decline. Caution should be exercised.

Modafinil is available in 100- and 200-mg tablets. The usual dosage is 200mg/day given as a single dose in the morning. Dosage should be decreased by 50% in patients with severe hepatic dysfunction. Dosage reduction may also be needed in the elderly.

I apologize in advance for any typos! I had the textbook laying on my lap and was staring straight at it the whole time I was typing! Hope this helps a little bit...

Title: Re: Floridian
Post by Kris_in_SJ on Sep 23^rd, 2004, 9:51pm

If I remember right, there have been similar threads regarding meds like Adderal and Ritalin and how they might affect the CH cycle.

Seems to me that this drug might be similar, but along with everyone else here, am anxious to learn if it can help some of us.

Keep us informed!

Kris