Talk:Modafinil/Archive 2

Rewrite

This article looks like it has been written by a million different authors with complete disregard for what had already been written at the time of their additions. The pharmacology section is extremely difficult to read with a structure that appears haphazard and careless. I have just added a few sentences into this article and provided references. If I have the time, I am planning to do an overhaul of some the sections but was curious to know if anyone else had any specific objections or concerns. Neuroeconomist (talk) 11:26, 23 May 2010 (UTC)

Take a look at it now. I did a major rehaul a couple of days ago and people are already improving on it. Dnavarro (talk) 05:16, 10 July 2012 (UTC)

PROFMAD

Modafinil Dependence: The number of psychoactive compounds, which produce neither euporia (however mild), and/or alleviate symptoms significantly (for the patient), will create a situation where they will crave the drug on stopping. In the case of euphoria ( a Victorian concept bred out of sin), should be curtailed as rapidly as the physician is able. Modafinil, is a CNS stimulant, it does produce euphoria, though generally not as profound as the amphetamines, or cocaine. It is significantly stronger than caffeine, though with a 15 hour t1/2, CMax takes 2-3 days, thus often 'missed'. It does appear to have a 'ceiling' effect (unlike the literature states) in terms of positive medical changes, its dose dependant ones are more linked to its (low) toxicological nature.

Modafinil, licenced for narcolepsy, night-shift sleep patterns, and sleep dyspnoea, is also finding value in bipolar illness', ADHD (including adult.ansd fortunately, it would seem, slowly, many others. Being a CNS stimulant unfortunately will greatly hinder the drug's use/potential, & limit its variety of uses considerably (at least at present). This group of drugs belongs to those shelved under the 'Demon Classification'.

Diazepam, is perhaps the most classic example, of perfect drug tailoring, but not used where or when necessary, so frequently, it borders on malpractise.

The opposite extreme we find the AP's, which will be administered (forcefully, if necessary), indefinitely, without review, in extremely large doses, until death makes them part. Another topic, which is so sinister, one should be careful they complainest not, lest they are 'cured' with them. Diazepam, addictive,and return of symptoms on withdrawal, mostly a 'rebound effect', as much as dependence. Yet, they must be curtailed ASAP. The chronic & often severe underlying anxiety disorder they were originally prescibed for, still flourishing.

Now, let us use Clozapine as an example of the clinician's madness, when it comes to drugs for 'nutters'(the professionals description - not mine). If 800mg day, (perhaps due to a haematological crisis),has to be stopped, symptom re-occurence, is due to the illness being treated, and dependency, rarely even considered. Another AP fills the gap whilst clinical values return enough for re-instatement of the clozapine.

Modafinil, lies somewhere in between. It is too expensive, with its relatively low euphoricity to make it a major black market player, yet once started it is difficult to stop. No overt physical symptoms, but after 48 hours of rest & recuperation, a slowing is noticed, and normal function only usually returns once either that, or another sufficiently strong CNS stimulant is re-instated. Therefore, is it a drug of dependence, or one which enstated for a specific medical condition it has been developed to treat, simply allows for a return of symptoms.

One thing is clear. Whether modafinil has depedence liablity (mostly pschological- or not, it is not one which is significantly high,and may indeed be largely due to the re-occurence of the cheronic illnesses it was developed for. Drugs are controlled more because of their cross over into the grey/bl;ack market, than because they are intrinsically more dangerous. Fortunately, modafinil still seems mainly on the 'right side of the fence. I'm sure it got a lot of politicians through election night (we are talking about the nice ones here).

+++++PROFMAD+++++Profmad (talk) 01:03, 15 June 2010 (UTC)

Wrong 3D structure or wrong 2D structure

3D structure shows one specific enantiomer, while the 2D structure looks like a racemate (no stereochemistry at the sulfur atom shown). Best regards, --Jü (talk) 11:39, 24 February 2011 (UTC)

Neither image is wrong. The drug is used as a racemate, so it is perfectly appropriate for the 2D structure to omit depicting stereochemistry. As for the 3D structure, there is no way to avoid presenting an image with one stereochemical configuration or the other, so the standard practice is to simply depict one of them, which is what is done here. — Preceding unsigned comment added by 148.177.1.216 (talk) 19:43, 12 October 2011 (UTC)

Users

Might be interesting to compile a list of people who use it; for example psychologist Geoffrey Miller lists Provigil as one of "The things I find most exciting about consumer capitalism" (pg 17, Spent 2011). --Gwern (contribs) 18:32 12 October 2011 (GMT)

stupid idea. 93.130.44.104 (talk) 20:28, 22 December 2013 (UTC)

Stavigile in Brazil

Over here it's sold as Stavigile, dunno if there are other names besides this. It's listed at http://www.libbs.com.br/products/ . --TiagoTiago (talk) 03:47, 6 November 2011 (UTC)

When Modafilil was developed?

In the "Off Label Usage" section of the article it is written that "Modafinil and its chemical precursor adrafinil were developed by Lafon Laboratories, a French company acquired by Cephalon in 2001." And in the "Toxicity" section there is a link to the article, Bastuji and Jouvet (1988), dated by 1988. Where is the mistake? Krasss (talk) 05:35, 27 January 2012 (UTC)

Acquired in 2001, not developed in 2001.LeadSongDog come howl! 15:21, 7 June 2012 (UTC)

Off-label use

There are two different sections for Off-label Use, plus a section for "other uses". Surely these can be combined into one section? — Preceding unsigned comment added by 142.205.241.254 (talk) 19:13, 17 April 2012 (UTC)

Adult ADHD

As with some other drugs that aren't particulary favored by pharma marketing money, it may be useful to research sources in european journals. I'm not a MD but know closely half a dozen, and modafinil is widely prescribed for "distractibility" features in general, even if it's hard to validate a dx of AADHD. — Preceding unsigned comment added by 177.142.166.161 (talk) 20:31, 3 July 2012 (UTC)

Reader feedback: I wanted to know all the gen...

98.217.122.182 posted this comment on 4 June 2013 (view all feedback).

I wanted to know all the generic names of the drug.

Any thoughts?

Qwh (talk) 10:37, 14 June 2013 (UTC)

By definition there is one and only one International Nonproprietary Name: modafinil. In contrast, there are a large number of brand names and these are already listed in the article (see Modafinil#Availability). Boghog (talk) 10:54, 14 June 2013 (UTC)

thank you love Qwh (talk) 09:55, 20 June 2013 (UTC)

Alcohol interaction claim removed

I removed the following unsourced claim from the article. It has been flagged for nearly a year and I can find no supporting evidence for the claim, which isn't a good thing in healthcare-related articles upon which people may depend to help them make good decisions.

* should not be taken with alcohol, a recent study conducted showed slight euphoria, increased blood pressure, heart rate and some subjects also presented with mild to moderate effects mimicking amphetamines.{{citation needed|date=September 2012}}

— UncleBubba ^{( T @ C )} 03:35, 29 August 2013 (UTC)

Modafinil neuromodulatory actions in the brain

This section is filled with a dearth of quality and well-referenced information. However, for the layperson, it is way too in-depth. I propose that the sections 2.1-2.11 are placed in a collapse-able window. This should help to separate the easily digestible information from the higher level information. WikiTryHardDieHard (talk) 04:06, 5 October 2013 (UTC)

Patent nonsense in Pharmacodynamics

" Modafinil's effect is mediated, at least in part, by a CaMKII-dependent exocytosis of gap junctions between GABAergic interneurons and possibly even glutamatergic pyramidal cells."

This is nonsense - gap junctions don't use exocytosis, that's what distinguishes them from other synapses. Someone who can access the listed ref needs to reword or toss this. — Preceding unsigned comment added by 24.205.239.229 (talk) 17:07, 4 November 2013 (UTC)

Memory Harmed not Helped

While it is anecdotal, many with Narcolepsy talk of difficulty with memory while taking Modafinil. — Preceding unsigned comment added by 76.103.106.142 (talk) 19:04, 21 March 2014 (UTC)

I've definitely heard of that happening from long-term use of amphetamines, but this is the first time I've read about it for modafinil, although if they do share similarities in their mechanisms of action it's certainly not impossible that it could cause that. There are a number of other things to consider though, such as the fact that narcolepsy itself (and ADHD, to a lesser extent) causes problems with memory, and that disrupted sleep patterns in general also have a negative effect on cognition (which would in theory contribute to memory problems with the use of any stimulant). In any case, you'd need to find some sources to back this up; a cursory glance at the studies that have been published seems to suggest the opposite conclusion, however. -Mojace (talk) 01:13, 3 September 2014 (UTC)

Military and law enforcement - Maryland Paramedics

I added a verification needed tag to the source that is used to support the statement that tactical paramedics may self administer up to 200mg, an initial word search could not find the information. I subsequently removed this tag as a different tool was able to find the information cited, my appologies. User:inthedryer

Cognitive Enhancement Paragraph

Some information in the Cognitive Enhancement medical use section was omitted. New controversy about the surge of media coverage of modafinil suggests misleading information was widely distributed. It was learned that the "increasing rate of modafinil abuse" is unfounded by reliable standards. The initial report indicated an increase of students abusing drugs for the purpose of staying awake (n=2000, 1 in 5 reported yes). The article lists modafinil as a substance 1 in 5 students admit to abusing, when this is not the reality. 1 in 5 students admits to taking a drug to help them study, sure, but of that 20%, almost all incidences are mixed amphetamine salts followed by methylphenidate. Modafinil is (even behind research chemicals like 4-FA) almost never abused. 64.134.175.221 (talk) 16:03, 26 February 2015 (UTC)

clean up

i did some work to clean this up today but it needs more work on medical uses. one-off clinical trials are cited as support various off-label uses... needs digging into and fixing. Jytdog (talk) 17:19, 18 July 2015 (UTC)

"Smartdrug" status

http://www.iflscience.com/health-and-medicine/narcolepsy-medication-could-be-safe-smart-drug Xan81 (talk) 18:30, 24 August 2015 (UTC)

Not a reliable source per WP:MEDRS Jytdog (talk) 19:13, 24 August 2015 (UTC)

Concerning the addiction issue

This seems to be difficult for us to get straight. On one hand the drug has mechanistic affinities to some drugs abuse, and shares some functional properties with them; and the FDA classifies it as having the potential for addiction. On the other hand all the MEDRS-level medical sources I have come across say it presents a low risk of addiction, including the most authoritative recent reviews. How can we present this in a way that gets across both of those facts? Looie496 (talk) 20:10, 4 October 2015 (UTC)

Saying something isn't abused by a population is akin to saying something isn't used recreationally. It doesn't mean it's not addictive. You're misinterpreting the meaning of that statement. Seppi333 (Insert 2¢) 20:13, 4 October 2015 (UTC)

This is probably worth clarifying: if a drug is addictive, it's not addictive to a subset of a population. Addictive drugs can produce an addiction in anyone when taken at a high enough dose for a sufficiently long period; a person's genes merely affect how likely he/she is to misuse a drug (i.e., recreationally) and how rapidly an addiction develops. Analogously, a drug's addiction liability is a (subjective) measure of a combination of these two factors. Seppi333 (Insert 2¢) 20:30, 4 October 2015 (UTC)

According to our addiction article, "Addiction is a state characterized by compulsive engagement in rewarding stimuli, despite adverse consequences." By that definition, it is not true that addictive drugs can produce an addiction in anyone. There are drugs that are rewarding to some people but aversive to others; alcohol is an example. If you are using a different definition of addiction, can you clarify what definition you are using? Looie496 (talk) 12:29, 5 October 2015 (UTC)

Read the introduction this review - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3898681/ - though I'll emphasize the statement: Moreover, there is increasing evidence that, despite a range of genetic risks for addiction across the population, exposure to sufficiently high doses of a drug for long periods of time can transform someone who has relatively lower genetic loading into an addict.4. This directly supports the assertion that addictive drugs can produce an addiction an anyone. Seppi333 (Insert 2¢) 15:14, 5 October 2015 (UTC)

That same article also says, Only some individuals, however, succumb to addiction in the face of repeated drug exposure, while others are capable of using a drug casually and escaping an addiction syndrome. In any case, all the reviews of modafinil that I have seen state that it carries a low risk of addiction. Don't you think that fact should make its way into this article? (According to http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3286657/, no cases of modafinil addiction had been reported as of 2012.) Looie496 (talk) 16:00, 5 October 2015 (UTC)

I'm not saying that it doesn't have a low addiction liability. That statement you pointed out also doesn't contradict my assertion. Seppi333 (Insert 2¢) 16:06, 5 October 2015 (UTC)

Just to be perfectly clear, I'm taking issue with saying that this drug is not "addictive" in humans. That's all there is to it. Seppi333 (Insert 2¢) 16:08, 5 October 2015 (UTC)

@Looie496: I added the review you noted above and attempted to address your concern regarding its addiction liability with my recent edit (+added unrelated stuff w/ dependence liability). Are you agreeable with these changes: Special:diff/684262480/684288180? Seppi333 (Insert 2¢) 18:50, 5 October 2015 (UTC)

Yes, that looks good. I'm going to keep working on this article, because it's a hot topic and very widely read, but that seems to me to handle the addiction issue adequately, at least for the near future. I'm going to focus particularly on the literature relating to cognitive enhancement, because that seems to be where most of the interest lies. Looie496 (talk) 19:01, 5 October 2015 (UTC)

Glad that's resolved. I figured I'd mention that there's 2 MEDRS-quality reviews that cover the use modafinil for cognitive enhancement in nootropic (they cite the bullet entry on eugeroics in Nootropic#Stimulants). I know modafinil is also discussed in a few other reviews that are used on that page, though I forget which ones. In any event, if you do write a section on it in this article, it'd be good if you could use what you write here to expand the bullet entry there too. Seppi333 (Insert 2¢) 19:15, 5 October 2015 (UTC)

New content

I have removed this sentence from adverse effects: "Modafinil has been tested in numerous clinical trials, and the overall finding is that benefits outweigh adverse effects."

If someone wants to include the associated reference without using inappropriate non-neutral POV generalities (e.g. mention neuroenhancement, including subjects/scope/background, and limitations of the study/review), by all means include it. But for every patient/person there is a balance of risks and benefits, and modafinil is overtly not without ANY risks. So this sentence I removed is ridiculous and non-neutral in that it reflects either ignorance re clinical science or extreme bias.--Xris0 (talk) 18:18, 8 February 2016 (UTC)

well.... no drug is approved if the benefits do not outweigh the adverse effects. This drug has been approved for a long time, so there is nothing at all controversial about the statement. I agree that it doesn't say anything useful, though, and don't mind you having deleted it. The source however is very valuable - it is a recent indendendent meta-analysis - and should be used to generate useful content or update content based on older sources. I changed the section header to make it neutral, btw Jytdog (talk) 19:34, 8 February 2016 (UTC)

Unsourced, and off-topic spam

User:LocoLeo -- About this, there are no sources there - a Wikilink is not a source, and the content about stuff in India is completely off-topic spam. Jytdog (talk) 18:54, 17 July 2017 (UTC)