Retrospective Review of Modafinil Toxicity

• Published in: Clinical Toxicology Vol. 46; no. 7; p. 629
• Main Authors: Spiller, HA, Borys, D, Griffith, JRK, Aleguas, A, Sollee, D, Anderson, DA, Klein-Schwartz, W, Sawyer, T
• Format: Conference Proceeding
• Language: English
• Published: 01.08.2008
• Subjects: North America
• ISSN: 1556-3650

Background: Modafinil, a non-amphetamine stimulant, is used for narcolepsy, sleep apnea and shift work sleep disorder. There are no large case reports or case series on modafinil overdose. Methods: Retrospective multicenter case series from 11 States of all patients with a single substance ingestion of modafinil with follow up to a known outcome for the years 2000-2007. Results: There were 137 patients of which 85 (63%) were female. Ages ranged from 1 to 82 years with a mean and median of 22 years (+ 18) and 20 years respectively, with 43 patients (31%) < 6 years. Most frequently reported clinical effects were tachycardia (n=38), insomnia (n=33), agitation (n=23), dizziness (n=25) and anxiety (n=24). Forty-five patients were managed at home and 90 in a HCF, with only 23 (17%) requiring a medical admission. Medical outcomes vs dose ingested is provided in Table 1. Therapies included benzodiazepines (n=14), diphenhydramine (n=5), beta blockers (n=3), halo-peridol (n=2), IV fluid hydration (n=2) and one each of nitroglycerin, epinephrine, benztropine, and promethazine. Conclusion: Clinical effects of modafinil overdoses were generally mild with predominantly tachycardia and CNS toxicity. However, clinical effects warranting specific therapy did occur in a minority of patients. Home management for S200 mg in children less than or equal to 6 may be appropriate.