Following the hospitalisation of a woman, in her 30s, the Health Sciences Authority (HSA) has issued a public health warning against the drug modafinil, a potent prescription drug used to improve alertness. The woman had been taking modafinil, which she obtained from a friend, on alternate days – as a means to improve her alertness, and had continued to do so for the past three weeks. Initially fine, she eventually developed an itchy rash, which proceeded to spread throughout her whole body. Her condition further exacerbated as she developed mouth ulcers, conjunctivitis, a painful throat and severe skin peeling. She was eventually hospitalised following her worsening condition. It was later diagnosed that the woman had developed Stevens-Johnson syndrome, a dangerous skin reaction, due to modafinil administration. Modafinil – the good, bad and ugly Modafinil was originally used to treat excessive sleepiness and has since become an abused drug to improve alertness Officially sold under the brand name, Provigil, modafinil is a prescription drug available in several countries. Nonetheless, it has yet to be registered locally in Singapore. The primary function of the drug is to reduce excessive sleepiness linked with medical conditions such as narcolepsy, sleep apnea or shift work problems. Narcolepsy patients suffer from excessive daytime sleepiness; hence, the need for modafinil. However, when administered by normal individuals, the drug is often taken as a “cognitive enhancer” to improve focus and memory, HSA reports. Being a prescription-only drug, modafinil comes with a host of side effects including Stevens-Johnson syndrome and a more severe form of the skin reaction known as toxic epidermal necrolysis. These skin reactions are so severe that hospitalisation is necessary to avoid fatal outcomes. Even then, lasting side effects, such as scarring and blindness, may linger. Cardiac problems, hypertension, anxiety, hallucinations or mania are some of the other side effects of modafinil. Despite its unregulated status, modafinil can be easily purchased from various online avenues and continues to be abused, despite its clear health risks. Earlier reports have also suggested that school children as young as 16 years old have been abusing modafinil to improve their academic performance. The use of modafinil is so widespread that a simple search on the internet immediately yields articles touting the benefits of this “smart drug”, as one of the top results. Moreover, the drug is so easily obtainable from online vendors – both locally and abroad. Unfortunately, many of the vendors online selling modafinil often sell derivatives following the release of generic versions in 2012. Locally, vendors can be found on the online shopping platform, Carousell, or the messaging service, Telegram. Fortunately, these vendors have since been taken down following the warning issued by the HSA. Strengthening efforts to combat issue Aside from their health risks, the HSA has also warned that continued use of modafinil can lead to potential risk of dependency. “Self-medication with modafinil for these purposes is not appropriate and can be harmful. Due to the stimulant effects it has on the brain, modafinil carries a potential risk of dependency,” cautioned the agency. While this may only be the first recorded incident of severe reactions towards modafinil, the HSA is already looking into solutions to put a stop to the issue. The sale and supply of modafinil, an unregistered health product, is an offense under the Health Products Act. If convicted, guilty parties could face a fine of up to SGD50,000 or a jail term of up to two years, or both. Source
