Its main action is mediated at the presynaptic level through the activation of histaminergic neurons in the brain, which are involved in a large variety of functions, including wakefulness, attention, and memory. Pitolisant is an H3 receptor antagonist/inverse agonist. In adults, armodafinil is approved by the FDA in treating both NT1 and NT2 patients. Studies show how the subjective sleepiness (calculated by Epworth Sleepiness Scale) decreased from 16.9 to 12.6 after 12 months of therapy. The clinical advice is to take a single dose of armodafinil in the morning, starting with 100 mg up to a maximum of 250 mg/day. The drug is an R-enantiomer of modafinil with a specific target, i.e., D2 receptor partial agonist. In adults, modafinil is approved by the FDA and EMA in treating both NT1 and NT2 patients. It is important to remember that modafinil decreases the efficacy of oral contraceptives thus, higher ethinylestradiol or alternative contraceptive methods are suggested. Typical side effects are headache, nausea, tension /anxiety, and insomnia. Ĭompared with other stimulants, modafinil has less abuse potential and is generally well tolerated. After several weeks, it can be progressively increased up to 200 + 200. Usually, the intake of modafinil starts with 100 mg (in the morning) to gradually move to a split dosing (100 + 100) in the morning (after breakfast) and at lunch time. Several pieces of evidence demonstrated that a dose of 200–400 mg/day of modafinil improved EDS, averagely increased sleep latencies on Maintenance of Wakefulness Test (MWT), and enhanced the subjective perception of improvement on Clinical Global Improvement of Change (CGI-C). Modafinil selectively stimulates wake-generating sets in the hypothalamus thanks to an increase of dopamine in the extracellular concentration, but the exact mechanism of action is still unknown.
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