Three men hospitalised after taking modafinil or armodafinil to stay awake; drugs were not prescribed

SINGAPORE – The Health Sciences Authority (HSA) warned the public on Monday not to consume modafinil or armodafinil that has not been prescribed by a doctor or used under close medical supervision, after three men were hospitalized between August and October after contracting them had used medications.

The three men, who were all in their 30s and took the drugs in an attempt to improve alertness, suffered serious side effects. They had obtained the drugs from friends or street vendors.

One man had received modafinil from a friend and took it only once. But over the next few days he started feeling unwell, with fever, multiple mouth ulcers and conjunctivitis. These were accompanied by a severe rash, which started in the neck and then spread to other parts of the body.

He was diagnosed with Stevens-Johnson Syndrome (SJS), a life-threatening skin condition involving blistering and severe peeling of the skin, and was hospitalized.

A second man was hospitalized with SJS after consuming armodafinil, which he obtained from an illegal peddler in Geylang.

This man had been taking the drug for over a month to stay alert while at work. He suffered a severe skin reaction that started with fever and rash and progressed to blisters on the skin and multiple ulcers in the mouth. The severe painful rash then spread to the entire body.

The third man was given armodafinil by a friend to stay awake during the day. After taking it a few times, he developed multiple ulcers in the mouth, an inflammation in the mouth, experienced pain when swallowing and could no longer eat or talk. He developed conjunctivitis and was subsequently hospitalized.

According to the United States National Center for Biotechnology Information, modafinil is a non-amphetamine central nervous system stimulant with wakefulness-promoting properties. It is used to treat conditions that cause excessive daytime sleepiness. In the US, it is approved by the Food and Drug Administration for the treatment of adults suffering from narcolepsy, sleep disorder, and obstructive sleep apnea. Armodafinil is also a ‘wake-up enhancer’ that can be used to treat the same conditions.

The HSA said modafinil and armodafinil are not registered in Singapore, although they are available as prescription medicines in some countries. They are powerful drugs that can cause serious side effects such as heart problems, high blood pressure, and psychiatric conditions including anxiety, hallucinations, or mania. Cases of serious skin conditions such as SJS and toxic epidermal necrolysis have also been reported, resulting in hospitalization, serious complications and even death, it added.

Those who recover may suffer from long-term complications, including scarring of the skin, hair loss and visual impairments such as increased sensitivity to light and blindness, the HSA said. Other vital organs, including the lungs, can also be permanently affected.

“There have been reports of individuals using modafinil or armodafinil for the purpose of improving alertness or as ‘cognitive enhancers’ to improve focus and memory. Self-medication with modafinil or armodafinil for these purposes is inappropriate and may be harmful,” the HSA warned. It added that both drugs “carry a potential risk of dependence due to their stimulant effects on the brain.”

“If there is a clinical need, physicians can apply to HSA to infuse modafinil or armodafinil for their patients’ medical conditions, such as narcolepsy, and patients should be under close medical supervision,” it explained.

The HSA advised consumers to be cautious about obtaining health products from unknown sources, even if recommended by friends or family members. It is not certain what these products contain, or where and how they are made.

Potent prescription drugs should not be shared or supplied to others, even if the medical conditions appear similar.

The authority also warned that the supply and sale of an unregistered health product, such as modafinil or armodafinil, is an offense under the Health Products Act unless the HSA has authorized its use by a doctor for patients under its care. If convicted, offenders can face a fine of up to $50,000, a prison sentence of up to two years, or both.

Members of the public with information on the illegal sale and supply of modafinil or armodafinil can contact HSA during business hours at 6866-3485 or email [email protected]