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Neoral and Nuvigil

Determining the interaction of Neoral and Nuvigil and the possibility of their joint administration.

Check result:

Neoral <> Nuvigil

Relevance: 28.09.2022 Reviewer: Shkutko P.M., M.D., in

In the database of official manuals used in the service creation an interaction registered by statistical results of studies was found, which can either lead to negative consequences for the patient health or strengthen a mutual positive effect. A doctor should be consulted to address the issue of joint drug administration.

Consumer:

Ask your doctor before using cycloSPORINE together with armodafinil. Using these medications together can make cycloSPORINE less effective. Given the risk of organ rejection associated with low cycloSPORINE levels, caution is advised if cycloSPORINE must be taken with armodafinil. You may need a dose adjustment or special test if you use both medications. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.

Professional:

GENERALLY AVOID: Coadministration with modafinil (the racemate) or armodafinil (the R-enantiomer) may decrease the blood concentrations and efficacy of cyclosporine. The mechanism involves induction of intestinal CYP450 3A4-mediated first-pass metabolism by modafinil and armodafinil, with possible secondary induction of hepatic 3A4 metabolism. The interaction was suspected in a 41-year-old organ transplant recipient in whom cyclosporine blood levels were decreased by 50% one month following the addition of modafinil 200 mg/day. No other causes were apparent.

MANAGEMENT: Given the risk of organ rejection associated with inadequate immunosuppressant levels, modafinil or armodafinil should preferably be avoided in patients treated with cyclosporine. Caution is advised if the combination is given. Pharmacologic response and cyclosporine blood levels should be monitored more closely whenever modafinil or armodafinil is added to or withdrawn from therapy, and the cyclosporine dosage adjusted as necessary.

References

"Product Information. Provigil (modafinil)." Cephalon, Inc, West Chester, PA.
"Product Information. Nuvigil (armodafinil)." Cephalon Inc, West Chester, PA.
Cerner Multum, Inc. "Australian Product Information." O 0
Robertson P, Decory HH, Madan A, Parkinson A "In vitro inhibition and induction of human hepatic cytochrome P450 enzymes by modafinil." Drug Metab Dispos 28 (2000): 664-71
Doherty MM, Charman WN "The mucosa of the small intestine: how clinically relevant as an organ of drug metabolism?" Clin Pharmacokinet 41 (2002): 235-53

Neoral

Generic Name: cyclosporine

Brand name: Gengraf, Neoral, Sandimmune, Sandimmune

Synonyms: Neoral (Capsules, Modified)

What is Neoral?

Nuvigil

Generic Name: armodafinil

Brand name: Nuvigil

Synonyms: n.a.

What is Nuvigil?

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In the course of checking the drug compatibility and interactions, data from the following reference sources was used: Drugs.com, Rxlist.com, Webmd.com, Medscape.com.

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