Background: Disorders of consciousness impair early recovery after aneurysmal subarachnoid hemorrhage (aSAH). Modafinil, a wakefulness-promoting agent, is efficacious for treating fatigue in stroke survivors, but data pertaining to its use in the acute setting are scarce. This study sought to assess the effects of modafinil use on mental status after aSAH.
Methods: Modafinil timing and dosage, neurological examination, intubation status, and physical and occupational therapy participation were documented. Repeated-measures paired tests were used for a before-after analysis of modafinil recipients. Propensity score matching (1:1 nearest neighbor) for modafinil and no-modafinil cohorts was used to compare outcomes.
Results: Modafinil (100-200 mg/day) was administered to 21% (88/422) of aSAH patients for a median (IQR) duration of 10.5 (4-16) days and initiated 14 (7-17) days after aSAH. Improvement in mentation (alertness, orientation, or Glasgow Coma Scale score) was documented in 87.5% (77/88) of modafinil recipients within 72 hours and 86.4% (76/88) at discharge. Of 37 intubated patients, 10 (27%) were extubated within 72 hours after modafinil initiation. Physical and occupational therapy teams noted increased alertness or participation in 47 of 56 modafinil patients (83.9%). After propensity score matching for baseline covariates, the modafinil cohort had a greater mean (SD) change in Glasgow Coma Scale score than the no-modafinil cohort at discharge (2.2 [4.0] vs. -0.2 [6.32], P = 0.003).
Conclusions: A temporal relationship with improvement in mental status was noted for most patients administered modafinil after aSAH. These findings, a favorable adverse-effect profile, and implications for goals-of-care decisions favor a low threshold for modafinil initiation in aSAH patients in the acute-care setting.
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http://dx.doi.org/10.1016/j.wneu.2024.02.056 | DOI Listing |
J Xenobiot
January 2025
Department of Social Sciences and Infectious Diseases, Faculty of Medicine, Wroclaw University of Science and Technology, 27 Wybrzeze Wyspianskiego Street, 50370 Wroclaw, Poland.
Cognitive enhancement through stimulants such as modafinil is becoming increasingly popular, with many individuals using prescription stimulants for non-medical purposes to improve alertness, attention, and mood. The misuse of such substances has raised concerns, particularly in forensic toxicology. The UHPLC-QqQ-MS/MS method was developed to quantify modafinil in evidentiary samples and biological materials.
View Article and Find Full Text PDFJ Addict Med
January 2025
From the Division of General Internal Medicine, San Francisco General Hospital, Department of Medicine, University of California San Francisco, San Francisco, CA (LWS); San Francisco Department of Public Health, San Francisco, CA (POC); Vital Strategies, New York, NY (KB, DC); Network for Public Health Law, Edina, MN (CSD); and New York University Grossman School of Medicine, New York, NY (CSD).
Stimulant use disorder (StUD) is a rapidly growing concern in the United States, with escalating rates of death attributed to amphetamines and cocaine. No medications are currently approved for StUD treatment, leaving clinicians to navigate off-label medication options. Recent studies suggest that controlled prescription psychostimulants such as dextroamphetamine, methylphenidate, and modafinil are associated with reductions in self-reported stimulant use, craving, and depressive symptoms.
View Article and Find Full Text PDFCan J Psychiatry
January 2025
Department of Psychiatry, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.
Plain Language Summary Stimulant addiction, such as addiction to drugs like amphetamines, is a growing public health concern, but there are very few effective medications to treat it. A recent study reviewed a drug called modafinil and found it didn't help reduce drug use, cravings, or improve treatment outcomes. This article discusses why treatments that work for other addictions, like opioids, are less effective for stimulants.
View Article and Find Full Text PDFInorg Chem
January 2025
Henan Key Laboratory of Polyoxometalate Chemistry, College of Chemistry and Molecular Sciences, Henan University, Kaifeng, Henan 475004, P. R. China.
Developing new photocatalysts for the selective oxidation of thioethers to high-value-added sulfoxides under low-oxygen mild conditions is a promising but challenging strategy. Here, a new polyoxometalate-based metal-organic framework (POMOF), , was successfully synthesized, wherein continuous π···π stacking interactions and direct coordination bonds not only strengthen the framework's stability but also accelerate electron transfer. A series of experiments and theoretical studies, including control experiments, kinetic studies, electrochemical spectroscopic analyses, and electron paramagnetic resonance, revealed the synergistic catalytic effect among Co(II) metal centers, BWO, and the photosensitizer TPT.
View Article and Find Full Text PDFPaediatr Drugs
January 2025
National Centre for Register-based Research, Aarhus University, Fuglesangs Allé 26, 8210, Aarhus V, Denmark.
Background And Objectives: Females of reproductive age are increasingly using attention deficit hyperactivity disorder (ADHD) medication, but its use during pregnancy and breastfeeding is largely unknown. The aim of this study is to examine the prevalence of ADHD medication fills during pregnancy and breastfeeding, including characteristics of these females and cohort differences over time.
Methods: We conducted a descriptive study using Danish nationwide registers.
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