Nuvigil

armodafinil

(ar-mo-daf-i-nil) ,

Nuvigil

(trade name) Pregnancy Category: C

Indications

Action

Pharmacokinetics

Time/action profile (blood levels)

ROUTE	ONSET	PEAK	DURATION
PO	unknown	2 hr	unknown

Contraindications/Precautions

Adverse Reactions/Side Effects

Central nervous system

• suicidal ideation (life-threatening)
• dizziness (most frequent)
• headache (most frequent)
• insomnia (most frequent)
• aggression
• anxiety
• delusions
• hallucinations
• mania

Cardiovascular

• ↑ BP

Gastrointestinal

• nausea (most frequent)
• dry mouth

Dermatologic

• Stevens-Johnson SYndrome (life-threatening)
• rash

Miscellaneous

• multi-organ hypersensitivity (life-threatening)
• allergic reactions including anaphylactoid reactions and angioedema (life-threatening)

Interactions

Drug-Drug interaction

Since armodafinil is partially metabolized by the CPY3A4 enzyme system, concurrent use of drugs that induce the CYP3A system, including carbamazepine, phenobarbital, and rifampin may ↓ levels and effectiveness. Concurrent use of drugs that inhibit the CYP3A system, including ketoconazole and erythromycin may ↑ levels and effectiveness.Armodafinil also induces the CYP3A system and may ↓ effectiveness of hormonal contraceptives (additional or alternative methods recommended, cyclosporine (dose adjustment may be necessary, midazolam and triazolam (excess sedation may occur, dose ↓ may be necessary).Armodafinil also inhibits the CYP2C19 system and may ↑ effects of phenytoin, diazepam, propranolol, omeprazole, and clomipramine (dose ↓ and monitoring for toxicity recommended).Use cautiously with MAO inhibitors and other CNS stimulants.

Route/Dosage

Availability (generic available)

Nursing implications

Nursing assessment

• Observe and document wakefulness and frequency of narcoleptic episodes.
• If concurrent CPAP is used, assess CPAP adherence periodically during therapy.
• Assess for psychiatric symptoms (mania, delusions, hallucinations, suicidal ideation, aggression) periodically during therapy; may require discontinuation.
• Monitor BP periodically during therapy.

Potential Nursing Diagnoses

Disturbed thought process (Indications)
Deficient knowledge, related to disease process and medication regimen (Patient/Family Teaching)

Implementation

• Oral: Administer as a single dose in the morning.
  • If used for shift work disorder, take daily dose 1 hr prior to start of work shift.

Patient/Family Teaching

• Instruct patient to take medication as directed. Advise patients that level of wakefulness may not return to normal. If used as an adjunct to CPAP, encourage patient to continue to use CPAP and other modalities. Inform patient that armodafinil does not take the place of getting enough sleep. Instruct patient to read Patient Information Leaflet prior to therapy.
• Advise patient that sharing this medication with others, even those with the same symptoms, is dangerous and illegal.
• Medication may impair judgment. Caution patient to avoid driving or other activities requiring alertness until response to medication is known.
• Instruct patient to notify health care professional immediately if rash, hives, mouth sores, blisters, peeling skin, swelling of face, eyes, lips, tongue, or throat, trouble swallowing or breathing, hoarse voice, or other allergic reactions occur. Patients should also notify health care professional if depression, anxiety, hallucinations, mania, thoughts of suicide or other mental problems (mania, delusions, hallucinations, suicidal ideation, aggression), or heart problems, including chest pain, occur.
• Instruct patient to notify health care professional of all Rx or OTC medications, vitamins, or herbal products being taken and consult health care professional before taking any new medications. Advise patient to avoid alcohol use during therapy.
• Advise patient to use nonhormonal methods of contraception during and for 1 mo following discontinuation of therapy. Instruct patient to notify health care professional promptly if pregnancy is planned or suspected or if breastfeeding.

Evaluation/Desired Outcomes

• Decrease in narcoleptic symptoms and an enhanced ability to stay awake. Evaluate effects of therapy periodically to determine long term usefulness.