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IMPORTANT SAFETY INFORMATION
Serious adverse events that may be associated with the use of NUVIGIL® (armodafinil) Tablets [C-IV] include: serious
rash, including Stevens-Johnson Syndrome, requiring hospitalization and discontinuation of treatment; angioedema
and hypersensitivity, including fatal multi-organ hypersensitivity reactions; psychiatric adverse experiences; persistent
sleepiness; and cardiovascular adverse events.
Read more Important Safety Information

Despite treatment for the underlying obstruction, many patients with OSA have residual sleepiness1,2

Treatment options for obstructive sleep apnea (OSA) include1

  • Continuous positive airway pressure (CPAP)
  • Weight loss
  • Therapies for nasal congestion or rhinitis
  • Oral or nasal devices
  • Surgery

Up to 50% of patients using CPAP for OSA still suffer from excessive sleepiness (ES)2*

The Multiple Sleep Latency Test (MSLT) is an objective test that determines a patient's underlying propensity to sleep by
measuring the time required to fall asleep in a 20-minute period, using polysomnography.2

The Epworth Sleepiness Scale (ESS) is a subjective questionnaire that helps physicians screen for ES. Patients are asked to rate their likelihood of dozing off or falling asleep during different daytime routine situations on a scale from 0 to 3. A total score of 10 or more suggests the need for further evaluation.2-4


    Percentage with normal and abnormal values after 3 months of CPAP treatment2

The American Academy of Sleep Medicine’s OSA practice parameter recommendations
suggest a wake-promoting agent as the standard of care for OSA patients with residual
ES despite effective CPAP treatment.5

*
Average CPAP use was 4.7 hours per night.2

ES was defined as an ESS score >10 or an MSLT value <7.5 minutes. Of the 137 patients with an ESS assessment at baseline,106 had an ESS
score >10. Of the 136 patients with an MSLT assessment at baseline, 85 had an MSLT value <7.5 minutes.2

IMPORTANT SAFETY INFORMATION

Contraindications: NUVIGIL is contraindicated in patients with a known hypersensitivity to modafinil or armodafinil or its inactive ingredients.

Serious rash: Serious rash, including Stevens-Johnson Syndrome, requiring hospitalization and discontinuation of treatment has been reported in association with the use of NUVIGIL or modafinil. There are no factors, including duration of therapy, that are known to predict the risk of occurrence or the severity of rash. Although benign rashes also occur with NUVIGIL, it is not possible to reliably predict which rashes will prove to be serious. NUVIGIL should ordinarily be discontinued at the first sign of rash unless the rash is clearly not drug-related.

NUVIGIL has not been studied in pediatric patients in any setting and is not approved for use in pediatric patients for any indication.

Angioedema and hypersensitivity reactions: Angioedema and hypersensitivity (with rash, dysphagia, and bronchospasm) were observed with NUVIGIL. Multi-organ hypersensitivity reactions, including at least one fatality in post-marketing experience, have occurred in close temporal association to the initiation of modafinil. Patients should be advised to discontinue NUVIGIL and immediately report to their physician any signs or symptoms suggesting multi-organ hypersensitivity, angioedema or anaphylaxis.

Psychiatric symptoms: Psychiatric adverse experiences have been reported in patients treated with NUVIGIL and modafinil. In controlled trials in adults administered NUVIGIL, psychiatric symptoms resulting in treatment discontinuation were anxiety, agitation, nervousness, irritability, and depression. Cases of suicidal ideation, mania, delusions, hallucinations, and aggression, some resulting in hospitalization, have been reported in patients treated with NUVIGIL or modafinil. Caution should be exercised when NUVIGIL is given to patients with a history of psychosis, depression, or mania. Consider discontinuing NUVIGIL if psychiatric symptoms develop.

Persistent sleepiness and CNS effects: Patients should be advised that their level of wakefulness may not return to normal. Although NUVIGIL has not been shown to produce functional impairment, any drug affecting the CNS may alter judgment, thinking or motor skills. Patients should be frequently reassessed for their degree of sleepiness and functional impairment and, if appropriate, advised to avoid driving or any other potentially dangerous activity.

Cardiovascular effects: Patients with a recent history of myocardial infarction or unstable angina should be treated with caution. NUVIGIL should not be used in patients with a history of left ventricular hypertrophy or in patients with mitral valve prolapse who have experienced mitral valve prolapse syndrome when previously receiving CNS stimulants. Small average increases in blood pressure and heart rate were observed in clinical trials. Increased monitoring of heart rate and blood pressure may be appropriate in patients on NUVIGIL. Caution should be exercised when prescribing NUVIGIL to patients with known cardiovascular disease.

Drug interactions: NUVIGIL may interact with drugs that are substrates for CYP3A4/5 or CYP2C19. Dose adjustment of these drugs may be required. The effectiveness of steroidal contraceptives may be reduced when used with NUVIGIL and for one month after discontinuation of therapy.

Common adverse reactions: In clinical trials, the most commonly reported adverse events (≥5%) associated with the use of NUVIGIL were headache, nausea, dizziness, and insomnia.

Drug abuse and dependence: NUVIGIL is a Schedule IV controlled substance because it has the potential to be abused or lead to dependence. Physicians should follow patients closely, especially those with a history of drug and/or stimulant abuse.

Physicians should be aware and inform their patients of the availability of the Medication Guide for NUVIGIL.

Please see Full Prescribing Information for NUVIGIL.

References:
  1. Sanders MH, Givelber RJ. Overview of obstructive sleep apnea in adults. In: Lee-Chiong T, ed. Sleep: A Comprehensive
    Handbook
    . Hoboken, NJ: John Wiley & Sons, Inc.; 2006:231-240.
  2. Weaver TE, Maislin G, Dinges DF, et al. Relationship between hours of CPAP use and achieving normal levels of sleepiness
    and daily functioning. Sleep. 2007;30(6):711-719.
  3. Johns MW. Reliability and factor analysis of the Epworth Sleepiness Scale. Sleep. 1992;15(4):376-381.
  4. Johns MW. A new method for measuring daytime sleepiness: the Epworth Sleepiness Scale. Sleep. 1991;14(6):540-545.
  5. Morgenthaler TI, Kapen S, Lee-Chiong T, et al. Practice parameters for the medical therapy of obstructive sleep apnea.
    Sleep. 2006;29(8):1031-1035.