Agitation and psychosis associated with dementia with lewy bodies exacerbated by modafinil use.
Dementia with Lewy bodies (DLB) is commonly associated with excessive daytime somnolence (EDS). Modafinil is a wakefulness-promoting agent that is considered to have limited interaction with the dopaminergic system. As individuals with DLB are predisposed to psychotic symptoms that might be exacerbated by dopaminergic stimulation, modafinil is considered to be an attractive option for the treatment of EDS in DLB. We describe 2 cases in which administration of modafinil exacerbated agitation and hallucinations in DLB, and we also review data that may explain the mechanisms underlying this effect. In both cases, psychotic symptoms emerged concomitantly with modafinil administration and remitted following its discontinuation. Although definitive data regarding the benefits and adverse effects of modafinil for the treatment of EDS in DLB await controlled prospective randomized studies, our observations warrant caution regarding its use in this context.
Department of Psychiatry, State University of Londrina, Brazil. eduardostp@hotmail.com
Eduardo
E
Prado
Pongsatorn
P
Paholpak
Myha
M
Ngo
Verna
V
Porter
Liana G
LG
Apostolova
Rogério
R
Marrocos
John M
JM
Ringman
D000368:Aged; D000369:Aged, 80 and over; D017109:Akathisia, Drug-Induced; D001559:Benzhydryl Compounds / Q000009:adverse effects* / Q000627:therapeutic use; D000697:Central Nervous System Stimulants / Q000009:adverse effects* / Q000627:therapeutic use; D006970:Disorders of Excessive Somnolence / Q000188:drug therapy* / Q000209:etiology; D006801:Humans; D020961:Lewy Body Disease / Q000150:complications / Q000523:psychology; D008297:Male; D000077408:Modafinil; D011605:Psychoses, Substance-Induced
D001559:Benzhydryl Compounds; D000697:Central Nervous System Stimulants; D000077408:Modafinil