Tako‐Tsubo Cardiomyopathy Following Modafinil Use

Acute dilated cardiomyopathy and myocardial injury after combined 4‐fluoroamphetamine and modafinil ingestion

“…Markedly depressed ejection fraction in this case did not require hemodynamic support with pharmaceuticals or mechanical assistance as described in single case reports of cardiomyopathy from modafinil or 4-fluoroamphetamine. [7,8] …”

“…Markedly depressed ejection fraction in this case did not require haemodynamic support with pharmaceuticals or mechanical assistance as described in single case reports of cardiomyopathy from modafinil or 4-fluoroamphetamine. [7,8] Modafinil is not a phenylethylamine. The mechanism of toxicity has not been clearly defined, but it appears to increase extracellular serotonin, norepinephrine and dopamine in the neocortex, as well as decreasing GABA and increases glutamate release.…”

“…There are few data on fluoroamphetamines or modafinil causing acute cardiomyopathy other than single case reports. [7, 8] We describe a patient who self-reported using 4-fluoroamphetamine, methylphenidate and modafinil recreationally who developed acute cardiomyopathy with cardiac injury. With innovative methods of laboratory confirmation, the true exposure was revealed and likely etiology of the cardiomyopathy was delineated.…”

Non-ST elevation myocardial ischemia in a patient on modafinil

“…Modafi nil is associated with palpitations, chest pain, arrhythmias, and cardiomyopathy. 1,3,4 The CV risk of modafi nil has been reported previously, particularly in patients with OSA, in studies that have documented adverse reactions such as hypertension and arrhythmias. 5,6 The patient in this case report did not have any history of OSA, documented or suspected.…”

Efectos adversos a nivel cardiovascular y neurológico asociados al consumo de modafinilo

“…Al igual que un gran número de otros medicamentos neuropsiquiátricos, el consumo de modafinilo está contraindicado en pacientes con cardiopatías debido a la inhibición de la recaptación de catecolaminas en las neuronas presinápticas, lo cual favorece el desarrollo de anormalidades transitorias como el aturdimiento miocárdico por catecolamina, caracterizado por el movimiento de la pared ventricular izquierda. Este evento de insuficiencia cardiaca es conocido como cardiomiopatía Tako-Tsubo o Síndrome del corazón roto por estrés (aneurisma ventricular izquierdo agudo); estudios posteriores como el elaborado por Aytas O. y Dilek H. en 2015, evidenciaron los riesgos específicos a nivel cardiovascular debido al consumo de modafinilo, siendo la cardiomiopatía Tako-Tsubo 18 y la taquicardia ventricular polimórfica 19 , considerados como casos aislados derivados de la administración de fármacos simpáticamente activos, como epinefrina y dobutamina 20 ; ya que en un estudio aleatorio controlado con placebo los pacientes no presentaron aumento significativo de la frecuencia cardiaca usando bajas dosis de modafinilo (100 mg), por lo cual para pacientes con síndrome de taquicardia postural no generó eventos graves. La tolerancia al fármaco a largo plazo aún debe ser estudiada en estos casos de frecuencia cardiaca elevada con deterioro cognitivo 21 .…”