[CQ-Contest] Re: keep awake drugs

Jim Rhodes rhodes at evertek.net
Sun Jan 5 17:41:05 EST 2003

What should I discuss with my healthcare provider before taking modafinil?

• Before taking modafinil, tell your doctor if you have
left ventricular hypertrophy (enlarged left heart ventricle);
·chest pain, irregular heartbeats, or other symptoms of mitral valve 
prolapse due to central nervous system stimulant use;
·a recent history of a heart attack
·high blood pressure;
·unstable angina;
·a history of mental illness;
·kidney disease; or
·liver disease.
• You may not be able to take modafinil, or you may require a dosage 
adjustment or special monitoring during treatment if you have any of the 
conditions listed above.

Seems to have most of the problems of amphetamines.

At 10:21 AM 1/5/03, Salina Physician Anesthesia wrote:
>With the recent flap about one of our planes in Afganistan shooting some 
>friendly Canadians while the pilots were on some performance enhancing 
>drug and some past discussion of such for contesting, here are a few 
>references from the medical literature of yet another drug.  Personally, a 
>few extra contacts aren't worth the effort just as with my bad coronaries, 
>Viagra definitely wouldn't be!  Of course, as the last line would indicate 
>that not all should try this stuff...but all the contesters I know are 
>sane, normal and definitely not psychotic.
>1)  Psychopharmacology (Berl) 2002 Jan;159(3):238-47. Maintaining alertness
>and performance during sleep deprivation: modafinil versus caffeine.
>Wesensten NJ, Belenky G, Kautz MA, Thorne DR, Reichardt RM, Balkin TJ.
>Department of Neurobiology and Behaviour, Division of Neuropsychiatry,
>Walter Reed Army Institute of Research, 503 Robert Grant Avenue, Silver
>Spring, MD 20910-7500, USA. nancy.wesensten at na.amedd.army.mil
>RATIONALE: The performance and alertness effects of modafinil were
>evaluated to determine whether modafinil should replace caffeine for
>restoring performance and alertness during total sleep deprivation in
>otherwise healthy adults. OBJECTIVES: Study objectives were to determine
>(a) the relative efficacy of three doses of modafinil versus an active
>control dose of caffeine 600 mg; (b) whether modafinil effects are
>dose-dependent; and (c) the extent to which both agents maintain
>performance and alertness during the circadian trough. METHODS: Fifty
>healthy young adults remained awake for 54.5 h (from 6:30 a.m. day 1 to
>1:00 p.m. on day 3) and performance and alertness tests were administered
>bi-hourly from 8:00 a.m. day 1 until 10:00 p.m. day 2. At 11:55 p.m. on day
>2 (after 41.5 h awake), subjects received double blind administration of
>one of five drug doses: placebo; modafinil 100, 200, or 400 mg; or caffeine
>600 mg ( n=10 per group), followed by hourly testing from midnight through
>12:00 p.m. on day 3. RESULTS: Performance and alertness were significantly
>improved by modafinil 200 and 400 mg relative to placebo, and effects were
>comparable to those obtained with caffeine 600 mg. Although a trend toward
>better performance at higher modafinil doses suggested a dose-dependent
>effect, differences between modafinil doses were not significant.
>Performance enhancing effects were especially salient during the circadian
>nadir (6:00 a.m. through 10:00 a.m.). Few instances of adverse subjective
>side effects (nausea, heart pounding) were reported. CONCLUSIONS: Like
>caffeine, modafinil maintained performance and alertness during the early
>morning hours, when the combined effects of sleep loss and the circadian
>trough of performance and alertness trough were manifest. Thus, equivalent
>performance- and alertness-enhancing effects were obtained with drugs
>possessing different mechanisms of action. However, modafinil does not
>appear to offer advantages over caffeine (which is more readily available
>and less expensive) for improving performance and alertness during sleep
>loss in otherwise normal, healthy adults.
>3)  Psychopharmacology (Berl) 2002 Nov 1; [epub ahead of print] Cognitive
>enhancing effects of modafinil in healthy volunteers. Turner DC, Robbins
>TW, Clark L, Aron AR, Dowson J, Sahakian BJ. Department of Psychiatry,
>University of Cambridge, School of Clinical Medicine, Addenbrooke's
>Hospital, Hills Road, Cambridge CB2 2QQ, UK.
>RATIONALE. Modafinil, a novel wake-promoting agent, has been shown to have
>a similar clinical profile to that of conventional stimulants such as
>methylphenidate. We were therefore interested in assessing whether
>modafinil, with its unique pharmacological mode of action, might offer
>similar potential as a cognitive enhancer, without the side effects
>commonly experienced with amphetamine-like drugs. OBJECTIVES. The main aim
>of this study was to evaluate the cognitive enhancing potential of this
>novel agent using a comprehensive battery of neuropsychological tests.
>METHODS. Sixty healthy young adult male volunteers received either a single
>oral dose of placebo, or 100 mg or 200 mg modafinil prior to performing a
>variety of tasks designed to test memory and attention. A randomised
>double-blind, between-subjects design was used. RESULTS. Modafinil
>significantly enhanced performance on tests of digit span, visual pattern
>recognition memory, spatial planning and stop-signal reaction time. These
>performance improvements were complemented by a slowing in latency on three
>tests: delayed matching to sample, a decision-making task and the spatial
>planning task. Subjects reported feeling more alert, attentive and
>energetic on drug. The effects were not clearly dose dependent, except for
>those seen with the stop-signal paradigm. In contrast to previous findings
>with methylphenidate, there were no significant effects of drug on spatial
>memory span, spatial working memory, rapid visual information processing or
>attentional set-shifting. Additionally, no effects on paired associates
>learning were identified. CONCLUSIONS. These data indicate that modafinil
>selectively improves neuropsychological task performance. This improvement
>may be attributable to an enhanced ability to inhibit pre-potent responses.
>This effect appears to reduce impulsive responding, suggesting that
>modafinil may be of benefit in the treatment of attention deficit
>hyperactivity disorder.
>6) Narendran R, Young CM, Valenti AM, Nickolova MK, Pristach CA. Is
>psychosis exacerbated by modafinil? Arch Gen Psychiatry. 2002
>Mar;59(3):292-3. Department of Psychiatry, School of Medicine and
>Biomedical Sciences, State University of New York at Buffalo, 462 Gilder
>St, Buffalo, NY 14215 schizomania at yahoo.com
><http://archpsyc.ama-assn.org/issues/v59n3/ffull/ylt0302-5.html> Letter to
>the Editor
>Modafinil (Provigil; Cephalon Inc, West Chester, Pa) is indicated to
>improve wakefulness in patients with excessive daytime sleepiness
>associated with narcolepsy. The stimulant drug methylphenidate, which
>promotes wakefulness, has been reported to be useful in treating severe and
>persistent sedation associated with clozapine treatment.1 However,
>controversy has surrounded the routine use of such stimulant drugs to treat
>clozapine-induced sedation because of the potential risk of exacerbating
>psychosis (due to the drugs' dopaminergic activity) and worsening movement
>disorders.2 We herewith report on the possible exacerbation of psychosis by
>modafinil in a clozapine-treated patient with schizophrenia. 
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>CQ-Contest at contesting.com

Jim Rhodes K0XU
jim at rhodesend.net

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