30 year old female with narcolepsy & ADHD prescribed:
methlyphenidate 20mg (at 2pm, rx’ed by sleep medicine)
Klonopin 0.5mg bid (we are working on titrating off)
….still struggling with focus/attention in AM.
I would like to add in another 20mg in AM of methylphenidate to treat ADHD. Can someone talk with me about if this is okay given she is taking such a high dose of armodafanil. She is open to d/c’ing armodafanil as isn’t finding it helpful anymore, so I was going to reach out to her sleep doc to discuss but wanted to see if there was any issue in continuing both if necessary. Thoughts?
Hi Amelia. I agree with your plan of collaborating with sleep medicine before doing any changes.
Since patient is on higher Armodafinil dose of 500 mg (with max of 250 mg recommended for narcolepsy): I agree with tapering armodafinil and increasing methylphenidate (in collaboration with sleep medicine). This approach is safer compared to increasing methylphenidate on this high dose of armodafinil.