Modafinil (Provigil; Cephalon Inc, West Chester, Pa) is indicated to
improve wakefulness in patients with excessive daytime sleepiness associated
with narcolepsy. The stimulant drug methylphenidate, which promotes wakefulness,
has been reported to be useful in treating severe and persistent sedation
associated with clozapine treatment.1 However,
controversy has surrounded the routine use of such stimulant drugs to treat
clozapine-induced sedation because of the potential risk of exacerbating psychosis
(due to the drugs' dopaminergic activity) and worsening movement disorders.2 We herewith report on the possible exacerbation
of psychosis by modafinil in a clozapine-treated patient with schizophrenia.
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