![]() Stephen Stahl, MD, PhD: The stimulants work sometimes too well because they work rapidly. One of the only things we had for several years for that was stimulants. They do not have the same significant adverse effects on heart rate, blood pressure, and abuse potential that the stimulants have. These medications, I believe, have helped change the medicines when they came out-a new way to treat the success of daytime sleepiness. By doing that, they wake you up.ĭebra Stultz, MD: Yes. In so doing, they have a mild stimulant effect and boost the arousal neurotransmitter dopamine. But modafinil and its active enantiomer or armodafinil boost dopamine, but not norepinephrine transporters it doesn’t look like it. In treating people with modafinil, 1 of the first things you want to do is to say, “Am I blocking dopamine or any of these other neurotransmitters,” and stop those drugs if you can. It turns out that you can be in trouble if you block any of the arousal neurotransmitters. These are the more arousal neurotransmitters. You remember the old reticular activating system-dopamine, norepinephrine, not so much serotonin, but histamine, acetylcholine. If you don’t have orexins to boost arousal, you have to have medicines to boost arousal. ![]() Almost all the medicines are dedicated to boosting arousal. They’re weak stimulants in the sense that they probably don’t rapidly block the transporter and don’t completely block the transporter. Stephen Stahl, MD, PhD: Those are agents that would probably be best characterized as dopamine reuptake blockers. Do you want to start with modafinil and armodafinil? Debra Stultz, MD: Let’s talk about some medicines that we’ve used for narcolepsy. ![]()
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