Collaborative Antwerp Psychiatric Research Institute (CAPRI), University of Antwerp, Antwerp, Belgium.
Expert Opin Drug Metab Toxicol. 2012 Sep;8(9):1189-97. doi: 10.1517/17425255.2012.708338. Epub 2012 Jul 18.
Bipolar disorder is a psychiatric illness with recurring episodes of mania and depression. Armodafinil , the R-enantiomer of modafinil, approved for treating excessive sleepiness associated with narcolepsy, obstructive sleep apnea and shift work disorder, is possibly effective as an adjunctive treatment for bipolar depression.
This review covers the pharmacokinetics of armodafinil, with an emphasis on its use in bipolar depression. Its clinical efficacy in the treatment of bipolar depression is evaluated, along with current data regarding its safety and tolerability.
One placebo-controlled trial is available, in which armodafinil was efficacious as an adjunctive treatment in bipolar depression. Armodafinil shows a linear pharmacokinetic profile over a broad dose range of 50 - 400 mg (maximal plasma concentration and area under concentration-time curve). Compared with modafinil, an equivalent dose of armodafinil attains higher blood concentrations 4 - 6 h post-dose. The possibility of drug interactions is generally low, although interactions have been shown with some drugs used in bipolar disorder, through mild CYP3A4-induction and CYP2C19-inhibition. Armodafinil is well tolerated and presents a possible new treatment option for bipolar depression. However, further investigation is still needed in order to confirm its efficacy and to clarify its role in the treatment of bipolar depression.
双相情感障碍是一种反复发作的躁狂和抑郁的精神疾病。阿莫达非尼，莫达非尼的 R-对映体，被批准用于治疗与嗜睡症、阻塞性睡眠呼吸暂停和轮班工作障碍相关的过度嗜睡，可能对双相抑郁的辅助治疗有效。
本综述涵盖了阿莫达非尼的药代动力学，重点介绍了其在双相抑郁中的应用。评估了其在治疗双相抑郁中的临床疗效，以及关于其安全性和耐受性的最新数据。
目前只有一项安慰剂对照试验可用，其中阿莫达非尼作为双相抑郁的辅助治疗有效。阿莫达非尼在 50-400mg 宽剂量范围内呈现线性药代动力学特征（最大血浆浓度和浓度-时间曲线下面积）。与莫达非尼相比，等剂量的阿莫达非尼在给药后 4-6 小时达到更高的血药浓度。药物相互作用的可能性通常较低，尽管已显示与一些用于治疗双相情感障碍的药物存在相互作用，通过轻度 CYP3A4 诱导和 CYP2C19 抑制。阿莫达非尼耐受性良好，为双相抑郁提供了一种新的可能治疗选择。然而，仍需要进一步研究以确认其疗效，并阐明其在治疗双相抑郁中的作用。
