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Comments on the New Scientist Article
> 2/19/2006 8:34:10 PM

Thanks for posting. It is a fascinating read, especially the drugs in the pipe line issue. The usage of amphetamines by the military has been prevalent since before WWII and is not at all surprising. Provigil (Modafinil) is an interesting drug that I have thus far chosen to not prescribe because of the amphetamine like properties. However, as the article describes the exact mechanism of action is yet to be determined and this remains a source of caution. It is a very interesting medication that warrants close following. It is being used by Sleep Disordered patients especially for Excessive Daytime Sleepiness and is likely far safer for this purpose then the amphetamine derivative drugs like Ritalin and Adderall. It is also used to improve wakefulness in patients with excessive daytime sleepiness associated with narcolepsy and shift work sleep disorder (SWSD); adjunctive therapy for obstructive sleep apnea/hypopnea syndrome (OSAHS). Provigil is also being used off label for Attention-deficit/hyperactivity disorder (ADHD); treatment of fatigue in MS and other disorders as well as closed-head brain injury and excessive daytime sleepiness and in patients with somnolence due to sedating psychiatric drugs. It is also being used as an augmentation treatment in refractory depression in the same way amphetamines have been used for decades. Reports of its use in post-stroke depression and in Chronic Fatigue Syndrome are predictable usages for this drug as well and the usage in ALS and Fibromyalgia show promise.

The class of this drug is IV as opposed to the amphetamines which carry a II class which states that the DEA believes this drug to be less addictive and dangerous. The rapid growth of this drug will lead to more research and development by drug companies, I am concerned that like the "Diet Doctors" class IV drugs Phentermine and Tenuate that Provigil represents just one more stimulant drug that falls into the Class IV drug category that lowers the barriers for prescription and increases the potentials for widespread abuse.

I believe that the physician who chooses to prescribe this drug needs to be cautious about the potential for abuse and careful about the reason for prescribing this drug especially for off label usage.

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