Provigil/Nuvigil

[slycaper]

What do you guys think about Provigil/Nuvigil for those difficult weans with little to no spontaneous breaths in neuro intact patients? Any success with it?

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[jdh71]

Any data to support it?

 

[europeman]

I use It a lot on my tbi patients that don't wake up after reasonable amount time. Seems to work 1/50 ish times.... Maybe....

 

[ORL10]

Not much data, but I have done it to promote sleep-wake cycles along with melatonin (plus all the basic measures) in patients with delirium and in some at risk patients. Our "delirium expert" psychiatrist believes it is effective for whatever that is worth.

 

[jdh71]

Ok. No good evidence. Does it make sense?

 

[Bostonredsox]

Any data to support it?

this. i have seen it a lot in particular from the neuro guys for persistent altered/depressed mental status....have seen very little data to support it. or any success from it.

 

[ORL10]

physiologic sense yeah but we know how that goes. Its mechanism of action doesn't seem to have been completely solved, but it apparently stimulates wakefulness by a multitude of mechanisms i.e; increasing phasic activity in the locus coeruleus and not necessarily like a traditional amphetamine-like stimulant. Pubmed it; better than me trying to remember Maldanado's lecture on it.

So then taking a giant leap of faith and using it in patients with hypoactive delirium (most of our ICU patients) may potentially improve wakefulness and therefore improve LOS, vent days PT/OT participation etc... Again theory, physiology and reality rarely coincide and since few medications have demonstrated improved patient outcomes you will mostly be right if you take the pessimist approach to medicine versus the youthful optimistism that most had as med students.

here is an RCT that is suppose to recruit soon:

http://clinicaltrials.gov/ct2/show/NCT02028260

 

[jdh71]

physiologic sense yeah but we know how that goes. Its mechanism of action doesn't seem to have been completely solved, but it apparently stimulates wakefulness by a multitude of mechanisms i.e; increasing phasic activity in the locus coeruleus and not necessarily like a traditional amphetamine-like stimulant. Pubmed it; better than me trying to remember Maldanado's lecture on it.

So then taking a giant leap of faith and using it in patients with hypoactive delirium (most of our ICU patients) may potentially improve wakefulness and therefore improve LOS, vent days PT/OT participation etc... Again theory, physiology and reality rarely coincide and since few medications have demonstrated improved patient outcomes you will mostly be right if you take the pessimist approach to medicine versus the youthful optimistism that most had as med students.

here is an RCT that is suppose to recruit soon:

http://clinicaltrials.gov/ct2/show/NCT02028260

I think we often don't give enough to credit to those interventions that make physiologic sense.