The European Medicines Agency has recommended restricting the use of modafinil-containing medicines. “The medicine should only be used to treat sleepiness associated with narcolepsy,” a press release from the agency stated. “Doctors and patients should no longer use the medicine for the treatment of idiopathic hypersomnia, excessive sleepiness associated with obstructive sleep apnoea and chronic shift work sleep disorder.”

Modafinil is a wakefulness promoting agent, currently licensed in 21 countries in Europe. It is available under the following brand names, Modasomil, Modiodal, Provigil, and Vigil, and as generic drugs.

The review by the Agency’s Committee for Medicinal Products for Human Use (CHMP) was initiated because of a number of safety concerns relating to psychiatric disorders, skin and subcutaneous tissue reactions, as well as significant off-label use and potential for abuse.

On the basis of the available data, the Committee concluded that the benefits of these medicines outweighed their risks only in the therapeutic indication narcolepsy, a chronic sleep disorder characterized by excessive daytime sleepiness. For all other indications, the Committee found that the risk for development of skin or hypersensitivity reactions and neuropsychiatric disorders outweighed the evidence for clinically important efficacy. Therefore, the Committee concluded that all other indications should be withdrawn from the marketing authorizations of these medicines.

The CHMP also identified particular cardiovascular risks with modafinil and recommended that use of the medicine be contraindicated in patients with uncontrolled moderate to severe hypertension and in patients with cardiac arrhythmias.

There are some reports that modafinil is being used recreationally for “performance enhancement.” However, the data seen by the Committee did not allow it to make firm recommendations regarding this risk. The CHMP has requested that the marketing authorization holders continue to provide further information to monitor the potential for abuse.

The CHMP’s recommendations have been forwarded to the European Commission for the adoption of a binding decision.