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: Excessive daytime sleepiness in adults with narcolepsy or obstructive sleep apnea (OSA)

or Preventive treatment of migraine in adults (episodic and chronic)

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None (3)

None (237)

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Research material (131) · Classic Psychedelic (70) · Stimulant (43) · Opioid (29) · Sedative-Hypnotic (29) · Phenethylamine (26) · Tryptamine (26) · Botanical (23) · Benzodiazepine (22) · Anticonvulsant (19) · Dissociative (19) · Antidepressant (18) · Antiparkinsonian (16) · Antipsychotic (16) · Empathogen (16) · Analgesic (15) · Neuroleptic (15) · Cathinone (14) · Lysergamide (13) · Nootropic (13)

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5-HT2A agonist (27) · GABAA positive allosteric modulator (22) · None (14) · Monoamine releasing agent (11) · CB1/CB2 agonist (7) · Potent mu-opioid receptor agonist (6) · Sodium channel blocker (6) · Dopamine/norepinephrine reuptake inhibitor (5) · GABAA potentiator; NMDA antagonist (5) · Phenothiazine D2 antagonist (5) · Potent 5-HT2A agonist (5) · 5-HT1B/1D agonist (4) · LSD analogue; 5-HT2A agonist (4) · Mu-opioid receptor agonist (4) · Muscarinic receptor antagonist (4) · Prodrug of LSD; 5-HT2A agonist (4) · Selective norepinephrine reuptake inhibitor (4)

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None (396) · 12.5 mg PO once or twice daily. Titrate gradually: 25-50 mg/day increments every 1-2 days as tolerated. Target dose 300-450 mg/day in divided doses (BID or TID). Most patients stabilize between 200-600 mg/day. Therapeutic plasma level guide: target trough clozapine ≥350 ng/mL. (1) · 225 mg SC monthly, or 675 mg SC every 3 months (quarterly) (1) · 25 mg (1) · 40 mg SC every other week (most adult indications); IBD induction 160 mg week 0, 80 mg week 2, then 40 mg every other week (1) · 70 mg SC monthly; may increase to 140 mg monthly (1) · Narcolepsy: 75 mg PO once daily upon awakening, titrate every 3 days. OSA: 37.5 mg PO once daily, titrate. (1)

None (393) · 225 mg/1.5 mL prefilled syringe or autoinjector (1) · 25 mg, 50 mg, 100 mg tablets; oral concentrate 20 mg/mL (1) · 40 mg/0.4 mL or 40 mg/0.8 mL prefilled syringe and autoinjector pen; 10, 20, 80 mg pediatric/induction strengths (1) · 70 mg/mL or 140 mg/mL prefilled autoinjector (1) · 75 mg, 150 mg tablets (1) · Clozaril 25 mg and 100 mg tablets; FazaClo orally disintegrating tablets (12.5/25/100/150/200 mg); Versacloz oral suspension 50 mg/mL. All brands subject to identical REMS ANC monitoring requirements. Generic tablets widely available. (1) · Lithium carbonate: immediate-release capsules (150 mg, 300 mg, 600 mg) and tablets (300 mg); extended-release tablets (300 mg, 450 mg). Lithium citrate: oral solution (8 mEq/5 mL, equivalent to 300 mg lithium carbonate per 5 mL) for patients unable to swallow tablets. (1) · Oral tablets 50 mg (ReVia, Depade, generics); Vivitrol extended-release IM suspension 380 mg single-dose vial; Contrave (naltrexone 8 mg + bupropion 90 mg ER tablets); compounded 1, 2, 3, 4.5 mg tablets/capsules for LDN (1) · Tablets: 100 mg, 200 mg (scored). [[Armodafinil]] (Nuvigil), the R-enantiomer of modafinil, is available separately as 50 mg, 150 mg, 200 mg, and 250 mg tablets. (1)

None (393) · 140 mg/month (1) · 150 mg/d (1) · 200 mg/d (1) · 40 mg every week (selected indications); otherwise 40 mg every other week (1) · 400 mg/day.'"`UNIQ--ref-0000006C-QINU`"' (1) · 50 mg/day oral; 380 mg/4 weeks IM (Vivitrol); 32 mg + 360 mg naltrexone/bupropion daily (Contrave maximum after titration) (1) · 675 mg/quarter (1) · 900 mg/day (split into BID or TID dosing). Clinical practice rarely exceeds 600 mg/day; seizure risk increases substantially above 600 mg/day and requires consideration of prophylactic anticonvulsant.'"`UNIQ--ref-0000004A-QINU`"' (1) · No defined absolute maximum; dosing is guided by serum level monitoring. Levels above 1.5 mEq/L carry increasing toxicity risk. Levels consistently above 1.2 mEq/L are generally not maintained in clinical practice.'"`UNIQ--ref-00000052-QINU`"' (1)

None (391) · insufflated (1) · intramuscular (depot) (1) · Oral (7) · Oral only. No parenteral formulation (a major limitation in acute agitation requiring rapid tranquilization). (1) · PR (1) · Subcutaneous (3)

None (391) · 30–60 minutes (1) · 45-75 min (oral) (1) · Antimanic effects begin within 5-7 days of reaching therapeutic serum levels, with full response often requiring 2-3 weeks. For acute mania, a neuroleptic is typically added for rapid sedation while lithium takes effect.'"`UNIQ--ref-00000053-QINU`"' (1) · Anxiolysis classically 3-4 weeks, continuing improvement to 8-12 weeks (1) · Onset of preventive effect over weeks; some patients respond after first dose (1) · Oral peak plasma 1 hour; therapeutic opioid blockade within hours of first dose. IM Vivitrol: peak plasma 2-3 days; therapeutic blockade through the dosing interval. (1) · Oral peak plasma 2.5 hours. Clinical antipsychotic response typically emerges over weeks with continued titration; full response assessment requires 3-6 months at adequate therapeutic levels. (1) · Over weeks (1) · Peak plasma concentration in 2-4 hours after oral administration. Clinically perceptible wakefulness-promoting effects typically begin within 1-2 hours of dosing.<sup class="pcp-cn" title="This claim needs a citation.">[[[Pharmacopedia:Citation needed|citation needed]]]</sup> (1) · Symptomatic effect within weeks; full response by 12-24 weeks (1) · ~30-60 min (1)

None (391) · 2 weeks per dose (1) · 4-8 h (1) · 8–12 hours (1) · About 20 minutes (1) · Due to the half-life of 12 hours (wide range), dosing is BID or TID. Once-daily dosing produces higher peak/trough fluctuations and is generally not used except for a single end-of-day dose in stable patients. (1) · Effective duration approximately 12-15 hours at the 200 mg dose, consistent with the elimination half-life. A single morning dose generally sustains wakefulness throughout the day without substantially disrupting nighttime sleep onset when taken early.'"`UNIQ--ref-0000006D-QINU`"' (1) · Long (1) · Monthly dosing (1) · Monthly or quarterly dosing (1) · Oral mu-blockade clinically meaningful for 24-72 hours; IM Vivitrol blockade through 4 weeks. (1) · ~9 hours (1)

None (392) · 3–5 hours (1) · 9–12 minutes (intravenous) (1) · Approximately 18-24 hours after acute administration; may extend to 36-48 hours with chronic dosing as tissue compartments equilibrate. Serum trough levels should be drawn 12 hours after the last dose for accurate interpretation.'"`UNIQ--ref-00000055-QINU`"' (1) · Naltrexone parent ~4 hours (oral); 6-beta-naltrexol (active metabolite) ~13 hours. Vivitrol depot terminal half-life 5-10 days with sustained release from microspheres maintaining blockade for the 4-week dosing interval.'"`UNIQ--ref-0000004F-QINU`"' (1) · Not well characterized (1) · ~14 days'"`UNIQ--ref-00001103-QINU`"' (1) · ~26 h (sertraline; range 13-45 h, longer in females); ~62-104 h (N-desmethylsertraline, weakly active) (1) · ~28 days (1) · ~31 days (1) · ~7.1 hours (1)

None (392) · 70–90% (oral) (1) · Absolute bioavailability not precisely characterized; food modestly increases exposure (1) · Approximately 50-60% (oral; subject to first-pass metabolism); food does not significantly affect absorption.'"`UNIQ--ref-0000004C-QINU`"' (1) · Not formally established (1) · Not well characterized (1) · Oral bioavailability is not precisely established in the label but absorption is rapid and essentially complete. Food delays peak plasma concentration by approximately one hour but does not reduce the extent of absorption.'"`UNIQ--ref-0000006F-QINU`"' (1) · ~5-40% (oral, highly variable due to extensive first-pass metabolism; mean ~5-10% for parent naltrexone with the majority of pharmacologic effect coming from 6-beta-naltrexol). IM Vivitrol bypasses first-pass entirely.'"`UNIQ--ref-00000050-QINU`"' (1) · ~64% from SC depot'"`UNIQ--ref-00001104-QINU`"' (1) · ~82% SC (1) · ~95% (1)

None (396) · Category C'"`UNIQ--ref-0000008F-QINU`"' (1) · Limited data; avoid (2) · Limited data; pregnancy exposure registry available (1) · Not established (2)

None (394) · Not a controlled substance in the United States, European Union, United Kingdom, Canada, or Australia. Prescription-only in all of these jurisdictions due to the narrow therapeutic index and the need for serum monitoring. No abuse potential has been identified. (1) · Rx (2) · Rx, Schedule IV (US) (1) · Rx-only in US (1) · Schedule I (United States) (1) · [[USLegal:DEA Schedule I|Schedule I]] (United States) (2)

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