Toxicity from modafinil ingestion.
BACKGROUND
Modafanil, a non-amphetamine stimulant, is used for narcolepsy, sleep apnea, and shift work sleep disorder. There is little available information on the toxicity of modafinil overdose.


METHODS
We performed a retrospective multi-poison center chart review of patients from 11 states who had a single substance ingestion of modafanil with follow up to a known outcome for the years 2000-2007. Data collected included age, gender, dose ingested, clinical effects, length of hospital stay, and medical outcome.


RESULTS
There were 137 patients, of whom 85 (63%) were female. Ages ranged from 1 to 82 years with a mean and median of 22 years (+18) and 20 years, respectively, with 43 patients (31%) aged <6 years. Most frequently reported clinical effects were tachycardia (n = 38), insomnia (n = 33), agitation (n = 27), dizziness (n = 25), and anxiety (n = 24). Forty-five patients were managed at home and 92 in a health-care setting, with only 23 (17%) requiring a medical admission. Therapies included benzodiazepines (n = 14), diphenhydramine (n = 5), beta-blockers (n = 3), haloperidol (n = 2), IV fluid hydration (n = 2), and one each of nitroglycerin, epinephrine, benztropine, and promethazine.


CONCLUSIONS
In this case series, clinical effects of modafinil overdoses were generally mild with predominantly tachycardia and CNS toxicity. However, clinically significant effects warranting specific therapy occurred in a minority of patients.
Spiller
Henry A
HA
Kentucky Regional Poison Center, Louisville, USA. henry.spiller@nortonhealthcare.org
Borys
Douglas
D
Griffith
Jill R K
JR
Klein-Schwartz
Wendy
W
Aleguas
Alfred
A
Sollee
Dawn
D
Anderson
Deborah A
DA
Sawyer
Tama S
TS
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001559:Benzhydryl Compounds / Q000506:poisoning*; D000697:Central Nervous System Stimulants / Q000506:poisoning*; D002648:Child; D002675:Child, Preschool; D062787:Drug Overdose; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D008875:Middle Aged; D000077408:Modafinil; D020258:Neurotoxicity Syndromes / Q000209:etiology / Q000628:therapy; D011039:Poison Control Centers / Q000706:statistics & numerical data; D012189:Retrospective Studies; D013610:Tachycardia / Q000139:chemically induced / Q000628:therapy; D013997:Time Factors; D014481:United States; D055815:Young Adult
D001559:Benzhydryl Compounds; D000697:Central Nervous System Stimulants; D000077408:Modafinil