askST: What are modafinil and armodafinil? Why is it dangerous to take them without doc’s prescription?

SINGAPORE – The Health Sciences Authority (HSA) has urged the public

not to buy or consume products that contain modafinil or armodafinil

without a prescription from a doctor.

This came as nine people suffered serious skin reactions after taking the drugs.

Both medicines are unregistered in Singapore, but can be obtained in some other countries with a prescription.

Six people developed Stevens-Johnson syndrome (SJS) – a life-threatening skin condition that causes blistering and severe peeling of the skin and mucous membranes – while three others had toxic epidermal necrolysis (TEN), a more severe form of SJS.

One man suffered severe oral ulcers that left him unable to eat and speak for days, while another had severe blisters that covered 60 per cent of his body, including his face and genital areas.

Here is what you need to know about these medicines and skin conditions, as explained by dermatologists.

Q: What are modafinil and armodafinil, and what conditions are they meant to treat?

A: These medicines are prescribed to treat narcolepsy and attention deficit hyperactivity disorder (ADHD) in some countries, although they are not registered in Singapore, said Associate Professor Lee Haur Yueh.

According to SingHealth’s website, narcolepsy causes excessive daytime drowsiness and sleep attacks, which causes a person to fall asleep at inopportune moments. ADHD is characterised by symptoms of inattention, hyperactivity, and impulsivity.

“Individuals have taken them without prescription to boost their mental focus,” said Prof Lee, a senior consultant at Singapore General Hospital’s (SGH) dermatology department.

Q: How many cases of SJS and TEN does Singapore see each year?

A: SGH is the national referral centre for SJS and TEN in Singapore, and the hospital typically sees between 10 and 15 cases each year, said Prof Lee.

As these conditions are considered very rare – with about two cases occurring per million people – Prof Lee said it is “striking” to see so many cases that stem from consuming modafinil and armodafinil.

“It suggests that these are very high-risk drugs for developing SJS and TEN,” he added, making a reference to the nine people who had contracted these conditions in the past year.

Q: How do these conditions manifest?

A: Patients may experience painful and blistering skin rashes, which can develop into eroded patches of skin, said Dr Heng Yee Kiat, a senior consultant at the National Skin Centre.

Skin erosion refers to the partial or complete loss of the epidermis – the outermost layer of the skin.

However, initial symptoms of these conditions are more flu-like, with fever, sore throat, eye redness and the erosion of mucous membranes in the mouth and around the genital areas, said Prof Lee.

“Over the course of a few days, the skin rash blisters and separates, leaving the skin surfaces raw and extremely painful,” he said. “Due to the extensive skin loss, patients are very ill, are at risk of severe infections and organ failure.”

The mortality rate is up to 25 per cent, and many patients would require specialised care in the burns unit, he added.

Q: What is the treatment and recovery process like, and how long does it take?

A: Treating SJS and TEN includes pushing fluids into the patient’s veins to prevent dehydration, applying creams and dressing to protect the skin, and giving painkillers to ease the pain.

The road to recovery is slow and painful, said Dr Heng. It usually takes several weeks, depending on the severity of the condition.

The patient’s daily activities such as drinking, eating and showering will also be affected. In-hospital care and pain relief is usually needed, he added.

Even after the skin has recovered, patients often suffer from longer-term skin problems such as pigmentation, scarring and itching.

However, the long-term issues are not just confined to the skin, and can include problems with the eyes, mouth or teeth, said Dr Heng. At least 50 per cent of survivors have long-term eye complications, said Prof Lee.

“Psychiatric conditions such as post-traumatic stress disorder, depression and anxiety are also well-recognised to occur as a result,” he added.

Q: Why are these medicines effective in treating some patients, but can cause a severe skin reaction in others?

A: Though cases of SJS and TEN have been reported in other countries, Asians might be genetically predisposed to suffering severe reactions from consuming modafinil and armodafinil, said Prof Lee.

Q: Are there other risks in consuming modafinil and armodafinil without a doctor’s prescription?

A: HSA said the medicines can cause other serious reactions such as heart problems, hypertension, and psychiatric conditions such as anxiety, hallucinations or mania.

“Additionally, modafinil and armodafinil carry a potential risk of dependency due to their stimulant effects on the brain,” said the agency.

It also advised the public not to obtain or use the two medicines from any illegal, unknown, unregistered or unreliable sources, as they could be harmful.

“Do not share or supply potent prescription medicines to your friends or relatives, even if their medical conditions may appear similar to yours,” said HSA.

“The medicines may not be suitable or safe for them, and their medical condition may need to be assessed first and managed by a doctor.”

Those found guilty of supplying and selling modafinil and armodafinil without HSA’s authorisation can be fined up to $50,000, jailed for up to two years, or both.

People who have any information on the illegal sale and supply of these medicines can contact the agency’s enforcement branch.