[RedERRN]

I have recently run across patients who are post-cath that have an order for PO Provigil 200mg BID. I have yet to ask a cardiologist the reasoning behind this, but I have researched the uses of Provigil. All I can find is that Provigil is used for narcolepsy and correction of circadian rhythms in those who do shift work (labeled uses) and in post-traumatic brain injury patients to help restore neurologic function. I have asked and asked other nurses (including the director of our CVU) and pharmacists and no one else know the reasoning either. Have any of you run across this? Why is Provigil being used in select post heart cath patients? Thanks for any input.

[dianah]

I did a cursory search w/Google and www.vivisimo.com.
Didn't come up w/much, except for a link from the mfr, from 2003, adding an indication for its use: obstructive sleep apnea (OSA).
It may be that while pts were sedated they exhibited sx of OSA and were put on Provigil for that.
http://www.cephalon.com/newsroom/new...aspx?ID=460618

Other than this, I couldn't find any other indication.

Maybe ask the MDs who are prescribing it?

I'm curious now . . .

[Marchantia]

Hey whats the Generic Name for this drug, or is this the Generic name?

[RedERRN]

Provigil's generic name is Modafinil. According to the prescribing information found at provigil.com,

"PROVIGIL (modafinil) is a wakefulness-promoting agent for oral administration." and
"The precise mechanism(s) through which modafinil promotes wakefulness is unknown. Modafinil has wake-promoting actions like sympathomimetic agents including amphetamine and methylphenidate, although the pharmacologic profile is not identical to that of sympathomimetic amines. At pharmacologically relevant concentrations, modafinil does not bind to most potentially relevant receptors for sleep/wake regulation, including those for norepinephrine, serotonin, dopamine, GABA, adenosine, histamine-3, melatonin, or benzodiazepines. Modafinil also does not inhibit the activities of MAO-B or phosphodiesterases II-V."


What makes it even more suprising to me that Provigil is being prescribed post-cath is what the website has to say about cardiovascular side-effects:

"In clinical studies of PROVIGIL, signs and symptoms including chest pain, palpitations, dyspnea and transient ischemic T-wave changes on ECG were observed in three subjects in association with mitral valve prolapse or left ventricular hypertrophy. It is recommended that PROVIGIL tablets not be used in patients with a history of left ventricular hypertrophy or in patients with mitral valve prolapse who have experienced the mitral valve prolapse syndrome when previously receiving CNS stimulants. Such signs may include but are not limited to ischemic ECG changes, chest pain, or arrhythmia. Modafinil has not been evaluated or used to any appreciable extent in patients with a recent history of myocardial infarction or unstable angina, and such patients should be treated with caution. Blood pressure monitoring in short-term (<3 months) controlled trials showed no clinically significant changes in mean systolic and diastolic blood pressure in patients receiving PROVIGIL as compared to placebo. However, a retrospective analysis of the use of antihypertensive medication in these studies showed that a greater proportion of patients on PROVIGIL required new or increased use of antihypertensive medications (2.4%) compared to patients on placebo (0.7%). The differential use was slightly
larger when only studies in OSAHS were included, with 3.4% of patients on PROVIGIL and 1.1% of patients on placebo requiring such alterations in the use of antihypertensive medication. Increased monitoring of blood pressure may be appropriate in patients on PROVIGIL."

Of course, I have yet to ask one of the cardiologists who is prescribing this WHY they are prescribing it - I also haven't had to give it since my original post

[HJS27]

Did anyone find out why the Cards were prescribing Provigil post cath?