Drug Interaction Report

In single-dose pharmacokinetic studies, healthy volunteers given modafinil (200 mg) with dextroamphetamine (10 mg) or methylphenidate (40 mg) exhibited a delay in the absorption of modafinil by approximately 1 hour. The mechanism of interaction is unknown. No other alterations in the pharmacokinetics of any of the drugs were observed. Although not studied, the interaction is likely to also occur with the various prodrug, racemic, and enantiomeric formulations of these drugs (e.g., amphetamine, lisdexamfetamine, dexmethylphenidate, armodafinil).

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GENERALLY AVOID: Alcohol may exacerbate the adverse central nervous system effects of psychoactive drugs, including methylphenidate.

GENERALLY AVOID: Consumption of alcohol while taking certain sustained-release formulations of methylphenidate may cause rapid release of the drug, resulting in increased systemic levels of methylphenidate. In vitro studies have been conducted using Metadate CD 60 mg and Ritalin LA 40 mg capsules, as well as Concerta 18 mg tablet. At an alcohol concentration of 40%, an increase in the release rate of methylphenidate was observed in the first hour for Metadate CD and Ritalin LA, resulting in 84% and 98% of the methylphenidate being released, respectively. In contrast, there was no increased release of methylphenidate in the first hour for Concerta. These results are considered to be representative of the other available strengths of the corresponding product.

MANAGEMENT: Patients treated with methylphenidate should be advised to avoid alcohol or medications that contain alcohol.

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Administration with food may delay the absorption of modafinil (the racemate) and armodafinil (the R-enantiomer) without significantly affecting their overall bioavailability. According to the product labeling, modafinil's absorption may be delayed by approximately one hour if taken with food. Similarly, the time to reach peak plasma concentration (Tmax) of armodafinil may be delayed by approximately 2 to 4 hours in the fed state.

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The recommended maximum number of medicines in the 'stimulants' category to be taken concurrently is usually one. Your list includes two medicines belonging to the 'stimulants' category:

• Jornay PM (methylphenidate)
• Nuvigil (armodafinil)

Note: In certain circumstances, the benefits of taking this combination of drugs may outweigh any risks. Always consult your healthcare provider before making changes to your medications or dosage.

The recommended maximum number of medicines in the 'cerebral stimulants' category to be taken concurrently is usually one. Your list includes two medicines belonging to the 'cerebral stimulants' category:

• Jornay PM (methylphenidate)
• Nuvigil (armodafinil)

Note: In certain circumstances, the benefits of taking this combination of drugs may outweigh any risks. Always consult your healthcare provider before making changes to your medications or dosage.