Cataplexy as a side effect of modafinil in a patient without narcolepsy

Abstract

Narcolepsy is a disease in which there is diurnal excessive sleepiness with sleep attacks and a prevalence in the general population of 1/4000 individuals. Classically, it is characterized by cataplexy, sleep paralysis, hypnagogic hallucinations and fragmented sleep. The use of modafinil in the treatment of narcolepsy is the first option of treatment for diurnal excessive sleepiness.Although considered a safe drug for use in patients with narcolepsy, being utilized for more than 20 years, modafinil possesses a series of side effects, some of them still not fully researched or described.Side effects such as headache, nausea, anxiety, insomnia, lumbago, diarrhea, dyspepsia, rhinitis and vertigo are the most frequent. However, the clinical follow-up of patients under treatment with modafinil must be intensive and the side effects ought to be noted and evaluated. The under-response to treatment or the unexpected side effects must always be directed to differential diagnostics.The objective of this article is to describe an unexpected side effect of the use of modafinil in a patient with incorrect diagnosis of narcolepsy.

Prevalence and incidence of narcolepsy symptoms in the US general population

“…Our findings suggest that, although infrequent, cataplexy still affects many people who do not have narcolepsy. It has been previously shown that certain diseases (eg, viral encephalopathy) [ 26 ] and/or medication use (eg, lamotrigine, clozapine, modafinil) can cause cataplexy [ [27] , [28] , [29] , [30] ]. Interestingly, hypersomnolence symptoms that resemble an on/off switch, such as sudden and irresistible sleep during the day or easily falling asleep anywhere, reflect other aspects of hypersomnolence with low (albeit significant) correlations with the ESS.…”

Orgasmolepsy in Narcolepsy Type 1 Responsive to Pitolisant: A Case Report

“…13 Secondly, all antidepressants used to treat cataplexy in patients with NT1 are known to be associated with decreased libido, erectile dysfunction, delayed orgasm or anorgasmia and delayed ejaculation. 14 Moreover, cataplexy, which has been described as an adverse reaction to modafinil in a patient without narcolepsy, 15 has also been reported as an uncommon side effect of pitolisant. 12 In our case, the patient has never reported changes in his sexual drive; partial cataplexy was already present when he started the treatment with modafinil and it remained unchanged for several years; orgasmolepsy appeared at a time of global worsening of the disease; finally, he clearly showed a dose-related response on both partial cataplexy and orgasmolepsy with pitolisant.…”

Clinical and Pharmacological Characteristics of the Drug Modafinil

“…Эффективность модафинила для лечения патологической сонливости была показана в плацебо-контролируемых исследованиях на пациентах как в амбулаторных, так и стационарных условиях. Рекомендуемой дозой для лечения является 200 мг [46,54,58,66].…”