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Comments on the New Scientist Article
> 2/19/2006 10:12:38 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 sincebefore WWII and is not at all surprising. Provigil (Modafinil) isan interesting drug that I have thus far chosen to not prescribebecause of the amphetamine like properties. However, as the articledescribes the exact mechanism of action is yet to be determined andthis remains a source of caution. It is a very interesting medicationthat warrants close following. It is being used by Sleep Disorderedpatients especially for Excessive Daytime Sleepiness and is likely farsafer for this purpose then the amphetamine derivative drugs like Ritalin and Adderall.It is also used to improve wakefulness in patients with excessivedaytime sleepiness associated with narcolepsy and shift work sleepdisorder (SWSD); adjunctive therapy for obstructive sleepapnea/hypopnea syndrome (OSAHS). Provigil is also being used off labelfor Attention-deficit/hyperactivity disorder (ADHD); treatment offatigue in MS and other disorders aswell as closed-head brain injury and excessive daytime sleepiness andin 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 DEAbelieves this drug to be less addictive and dangerous. The rapid growthof this drug will lead to more research and development by drugcompanies, I am concerned that like the "Diet Doctors" class IV drugs Phentermine and Tenuatethat Provigil represents just one more stimulant drug that falls intothe Class IV drug category that lowers the barriers for prescriptionand increases the potentials for widespread abuse.

I believethat the physician who chooses to prescribe this drug needs to becautious about the potential for abuse and careful about the reason forprescribing this drug especially for off label usage.