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Süheyla Doğan Bulut, Rıza Gökçer Tulacı, Semanur Türkoğlu, Serdar Bulut and Sibel Örsel

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ABSTRACT

Modafinil is employed for the treatment of narcolepsy and other sleep disorders like idiopathic hypersomnia. Modafinil is involved in the modulation of orexin, a hypothalamic neuropeptide that regulates wakefulness. It also indicated that the drug interferes with the activity of additional neurotransmitters like hypocretin, histamine, gamma-aminobutyricacid, glutamate and norepinephrine. Modafinil can also block the dopamine transporter by increasing brain dopamine levels. Common side effects of modafinil include headache, nausea, nervousness, anxiety and trouble sleeping. Other side effects are affective lability, hyposexuality, personality change, aggression, abnormal dreams, irritability, suicidal ideas, mania, hypomania and psychotic exacerbation. In this case report, we present a 45 year old woman with idiopathic hypersomnia which is characterized primarily excessive day time sleepiness. Before modafinil treatment ESS (Epworth Sleepiness Scale) score of patient was 13. Treatment with Modafinil 200 mg daily within two weeks produced a subjective improvement in her daytime sleepiness (ESS score after treatment is 4). But one week after the start of modafinil treatment, her sexual desire increased. Before this treatment, her sexual intercourse frequency was 1-2 times per week and after this treatment she wanted coitus every day. She has continual thoughts about sexuality. She didn’t have any additional medication use or medical condition that increase sexual desire. Modafinil dose was decreased 100 mg/daythen to 50 mg/day. Her ESS score was 7 and daytime sleepiness had no effect on her life. After decreasing modafinil treatment her sexual desire returned to normal. Hypersexuality has not been reported as a side effect of modafinil yet. The pathophysiological mechanism of modafinil induced hypersexuality is not clear. In conclusion, clinicians should be aware of this rare significant side effect of modafinil and should maintain treatment with the lowest possible dose.

KEYWORDS

Modafinil, hypersexuality, idiopathic hypersomnia.

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