Modafinil and armodafinil in schizophrenia.

What Might Be the Positive Spin-Offs Associated With Modafinil or Armodafinil Use in This Patient? Racemic modafinil and its R-isomer armodafinil are approved treatments for the excessive daytime drowsiness associated with narcolepsy, shift work, and obstructive sleep apnea1; therefore, either of these drugs could benefit Mr P. In schizophrenia, modafinil and armodafinil have been prescribed, studied, or suggested for off-label indications such as antipsychotic-induced drowsiness,2–4 antipsychotic-related weight gain,5,6 negative symptoms,3,4,7,8 and cognitive impairment.3,4,7,9,10 Favorable results for these off-label indications have mostly been described in anecdotal reports; with a few exceptions, the randomized controlled trials have generally found no advantage for these drugs over placebo. In summary, modafinil and armodafinil could be expected to improve daytime alertness in Mr P, but, realistically, cognitive and negative symptoms could improve only to the extent that they were worsened specifically by the daytime drowsiness.