Valbenazine
Contraindicated
Textbook
Potential loss of valbenazine efficacy.
Not recommended.
Source: G&G 14e · p372
Drug reference
Modafinil
Wakefulness-promoting agent (non-amphetamine stimulant) · Central Nervous System Stimulant (non-amphetamine type), Treatment for excessive sleepiness
Also known as Modalert, Modapro, Modafin
START
200 mg PO each morning (shift-work: 1 h pre-shift)
TYPICAL MAX
400 mg/day (limited added benefit)
STOP IF
Any rash/mucosal lesion (stop immediately — SCAR risk), psychosis/mania, severe CV symptoms
WATCH
Skin/mucosa, BP/HR, mood/psychiatric symptoms, contraceptive efficacy
CDSCO approvedSchedule HATC N06BA07
KDIGO 2024 + manufacturer label
- ONSET
- 1h · wakefulness onset
- PEAK
- 3h · Cmax
- t½
- 13h · plasma t½
- DURATION
- 14h · daytime effect
EXCRETION
Hepatic metabolism; ~80% renal metabolites
route + CYP
INTERACTIONS
12 major
incl. contraindicated
PREGNANCY
Avoid — IUGR/possible congenital malformation signal; effective non-hormonal contraception advised
FDA category + note
Top interactionssee all 12 →
- ValbenazineContraindicatedTextbookG&G 14e · p372
- AvapritinibSevereDatabaseDDInter
- AxitinibSevereDatabaseDDInter
- BedaquilineSevereDatabaseDDInter
Available in India
50 branded formulations. Look up specific brands in the Drugs workspace.
Mechanism
Promotes wakefulness; primary action is weak dopamine-transporter inhibition raising synaptic dopamine, with downstream effects on orexin, histamine, noradrenaline and glutamate/GABA networks. Lower abuse potential than classical stimulants.
Indications
Excessive daytime sleepiness in narcolepsyObstructive sleep apnoea (adjunct to CPAP)Shift-work sleep disorder
Dosing
- Adult
- 200 mg PO once each morning (OSA/narcolepsy); shift-work: 200 mg ~1 h before shift. Up to 400 mg/day (limited added benefit).
- Pediatric
- Not approved (paediatric SJS/TEN signal).
- Renal adjustment
- No established adjustment (limited data in severe impairment).
- Hepatic adjustment
- Severe hepatic impairment: reduce dose by ~50%.
- Geriatric
- Consider lower dose (reduced elimination).
- Max dose
- 400 mg/day
Pharmacokinetics
Onset
~1 h
Peak effect
2–4 h
Duration
~12–15 h
Half-life
~12–15 h
Bioavailability
Well absorbed (absolute BA not defined; tablet)
Protein binding
~60%
Metabolism
Hepatic (amide hydrolysis; CYP3A4 minor); moderate CYP3A4 inducer, CYP2C19 inhibitor
Excretion
Renal (~80% as metabolites; <10% unchanged)
Contraindications
- Hypersensitivity/prior rash to modafinil or armodafinil
- Caution: significant cardiac disease (LVH, mitral valve prolapse, recent MI/unstable angina), history of psychosis
Side effects
Common
HeadacheNauseaNervousness/anxiety, insomniaDizzinessDecreased appetite
Serious
- Severe cutaneous reactions: SJS/TEN, DRESS
- Psychiatric: psychosis, mania, suicidal ideation
- Hypersensitivity multi-organ reaction
- Palpitations/tachycardia, raised BP
Pregnancy & lactation
Pregnancy
Avoid — IUGR/possible congenital malformation signal; effective non-hormonal contraception advised
Lactation
Limited data; avoid or monitor infant
Drug interactions
Avapritinib
Severe
Database
Drug interaction classified as: metabolism
Source: DDInter
Axitinib
Severe
Database
Drug interaction classified as: metabolism
Source: DDInter
Bedaquiline
Severe
Database
Drug interaction classified as: metabolism
Source: DDInter
Benzhydrocodone
Severe
Database
Drug interaction classified as: metabolism
Source: DDInter
Bosutinib
Severe
Database
Drug interaction classified as: metabolism
Source: DDInter
Brigatinib
Severe
Database
Drug interaction classified as: metabolism
Source: DDInter
Butorphanol
Severe
Database
Drug interaction classified as: metabolism
Source: DDInter
Capmatinib
Severe
Database
Drug interaction classified as: metabolism
Source: DDInter
Citalopram
Severe
Database
Drug interaction classified as: metabolism.
Source: DDInter
Cobimetinib
Severe
Database
Drug interaction classified as: metabolism
Source: DDInter
Daclatasvir
Severe
Database
Clinical effect not specified
Source: DDInter
Related guidelines
Chronic obstructive pulmonary disease
GOLD · Pulmonology · 2025
Hypertensive disorders of pregnancy
FOGSI · Obstetrics & Gynaecology · 2019
Substance use disorders
NIMHANS · Psychiatry · 2022
Alcohol use disorder
MOHFW · Psychiatry · 2021
Generalised anxiety disorder and panic disorder
NICE · Psychiatry · 2020
Ask House about Modafinil
Continue into a citation-backed clinical answer with the drug context already attached.
Sources: KD Tripathi 7e, Goodman & Gilman 14e, Harrison 22e, Katzung·Verified: 2026-05-19 · House clinical team·Cockpit curated: 2026-05-19