armodafinil

Adjunctive therapy

Brands: Nuvigil

Last reviewed 2025-12-30

Reviewed by PsychMed Editorial Team.

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Quick answers

What is armodafinil?
Armodafinil (brand Nuvigil) is a wakefulness-promoting medication indicated to improve wakefulness in adults with excessive sleepiness associated with narcolepsy, obstructive sleep apnea (OSA), or shift work disorder (SWD) (label).
What is Nuvigil?
Nuvigil is a brand name for armodafinil.
What is Nuvigil (armodafinil) used for?
Label indications include: Improve wakefulness in adults with excessive sleepiness associated with narcolepsy, obstructive sleep apnea, or shift work disorder (label).
What drug class is Nuvigil (armodafinil)?
Wakefulness-promoting agent (R-enantiomer of modafinil) indicated for excessive sleepiness in narcolepsy, obstructive sleep apnea (as adjunct to primary therapy), and shift work disorder; Schedule IV with clinically important rash/hypersensitivity warnings and CYP-mediated interaction potential.
What strengths does Nuvigil (armodafinil) come in?
Tablets: 50 mg, 150 mg, 200 mg, and 250 mg (label).

Snapshot

Class: Adjunctive therapy
Common US brands: Nuvigil
Therapeutic drug monitoring not routinely recommended.
Last reviewed: 2025-12-30

Label indications

Improve wakefulness in adults with excessive sleepiness associated with narcolepsy, obstructive sleep apnea, or shift work disorder (label).

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Clinical Highlights

Armodafinil (brand Nuvigil) is a wakefulness-promoting medication indicated to improve wakefulness in adults with excessive sleepiness associated with narcolepsy, obstructive sleep apnea (OSA), or shift work disorder (SWD) (label). It is the longer-acting R-enantiomer of modafinil. Clinical decision-making often parallels modafinil (activation vs insomnia, interaction review, and psychiatric monitoring), while recognizing armodafinil’s longer duration may affect timing and tolerability (label/clinical).

A rare but safety-critical risk is serious rash and hypersensitivity reactions; discontinuation is recommended at the first sign of rash unless clearly not drug-related (label).
Psychiatric adverse reactions (including anxiety, agitation, mania, hallucinations, or suicidal ideation) have been reported; monitoring is particularly important in bipolar-spectrum illness, psychosis, or high baseline anxiety (label/clinical).
The compare view, armodafinil evidence feed, and armodafinil print page help review activation, insomnia, and interaction profiles across wake-promoting options.

Dosing & Formulations

Tablets: 50 mg, 150 mg, 200 mg, and 250 mg (label). Narcolepsy or OSA: 150–250 mg once daily in the morning (label).

Shift work disorder: 150 mg once daily taken approximately 1 hour prior to the start of the work shift (label).
For OSA, armodafinil is not a substitute for primary therapies; it is typically used when residual sleepiness persists despite a documented OSA management plan (label/clinical).
Because of the longer duration, late-day dosing increases insomnia risk; morning (or pre-shift) dosing is a core practical safeguard (label/clinical).

Monitoring & Risks

Serious rash/hypersensitivity is the key “must not miss” safety issue; most serious cases occur early in treatment, but timing is not fully predictive (label). Blood pressure and heart rate increases can occur; baseline assessment and periodic monitoring are common, especially with comorbid cardiovascular disease or other stimulants (label/clinical).

Psychiatric monitoring is important: worsening anxiety, agitation, mania, or psychosis can occur, and risk appears higher with a prior psychiatric history (label/clinical).
OSA patients should continue primary therapy (e.g., PAP); persistence of excessive sleepiness should prompt reassessment for adherence and other contributors (label/clinical).
As a Schedule IV medication, misuse/diversion risk is typically addressed via clinical history, refill monitoring, and clear treatment goals (clinical).

Drug Interactions

CYP3A4 induction can reduce exposure to substrates such as steroidal contraceptives; counseling about reduced hormonal contraceptive effectiveness is an important safety step (label). CYP2C19 inhibition can increase exposure to substrates such as diazepam, propranolol, omeprazole, and some tricyclic antidepressants; interaction review is important in polypharmacy (label/clinical).

Combined use with other activating agents (stimulants, some SNRIs) can increase anxiety, insomnia, and cardiovascular effects; monitoring is a common practical step (clinical).

Practice Notes

Before initiating wake-promoting therapy, clinicians often document a differential for sleepiness (sleep restriction, sedating medications, circadian misalignment, untreated OSA) and reassess after addressing reversible factors (clinical). In psychiatric augmentation discussions (fatigue/residual sleepiness), benefits are variable; time-limited trials with explicit symptom targets can reduce “polypharmacy creep” (clinical).

When insomnia worsens, adjusting dose timing, reducing dose, or switching agents is often considered rather than escalating stimulant burden (clinical).

References

NUVIGIL (armodafinil) tablets prescribing information — DailyMed (2025)
Treatment of central disorders of hypersomnolence: an American Academy of Sleep Medicine clinical practice guideline — Journal of Clinical Sleep Medicine (2021)
Treatment OF Central Disorders OF Hypersomnolence: AN American Academy OF Sleep Medicine Systematic Review, Meta Analysis, AND Grade Assessment — Journal of Clinical Sleep Medicine (2021)
The efficacy and safety of armodafinil as treatment for adults with excessive sleepiness associated with narcolepsy — Current Medical Research and Opinion (2006)