I have a question about modafinil which I’m well-aware should be addressed to a doctor, but I did ask it to a doctor, and didn’t get a meaningful answer. Given that I have a minor (I think?) heart condition (a year ago, for about a week, I had sinus bradycardia at 50bpm, sinus tachycardia at 169bpm, occasional wrenching feelings in my chest accompanying 3 beats salvo premature ventricular contractions and premature atrial contractions, no atrial ventricular block, no sustained ventricular tachycardia), what are the chances that taking modafinil (given that it is a stimulant) will damage/kill me? I’m a 22-year old man, and to the best of my knowledge have no other relevant health conditions to take into account.
I’m asking LessWrong because I want a probabilty estimate I can base expected utility calculations off of, not an “I can’t prescribe that because I’m afraid of malpractice lawsuits.”, and because I suspect this question is easier than it sounds and the doctor I talked to was just being cautious because (as he said) he wasn’t familiar with modafinil.
I think this is spectacularly hard to get a robust estimate of, but my wild uninformed guess is your chances of dying of it interacting with your heart condition are less than 25%, and probably less than 5%. (I try not to pull probabilities higher or lower than 5%/95% out of the air—I need a model for that.) That’s for the simple case where you don’t get addicted and take ever-higher doses or start taking other stimulants too or start smoking, etc.
The only hard information I can get a handle on is that the US manufacturer lists existing cardiovascular conditions as a potential contraindication. I suspect this is on general principles (stimulants are known to make them worse, modafinil is a stimulant, sort-of) rather than on hard data about problems caused.
Reporting systems for drug side effects are haphazard and leaky at best, and it’s very hard to do decent analysis. Unusual combinations that aren’t very deadly just aren’t going to show up in the research.The fact that we haven’t heard that it’s deadly does, though, put something of a ceiling on just how bad it could be (my 25% above).
Most medics would reckon taking stimulants you don’t have to when you have a known cardiovascular condition is unwise. (Although some of them do it themselves in early career.) Quantifying ‘unwise’ is tricky. There’s the general issue of data I just mentioned. Then there’s trying to think it through. On the plus side, modafinil is less likely to cause problems for CV patients in the way that other more general CNS stimulants are known to; but on the minus side, we don’t properly understand how it does work.
Doctors are by nature very cautious: “first, do no harm” and all that. You might come to a different cost/benefit decision.
FWIW, I wouldn’t take it in your shoes. But I don’t take it myself, despite having no contraindications. I’m extremely risk averse, particularly about my own life, and place more emphasis on quantity than quality compared to most people (on hedonic adaptation grounds).
a year ago, for about a week, I had sinus bradycardia at 50bpm, sinus tachycardia at 169bpm, occasional wrenching feelings in my chest accompanying 3 beats salvo premature ventricular contractions and premature atrial contractions
Everyone has these, the question is why, how many and for how long. What “condition” were you diagnosed with?
Everyone has odd heartbeats. Only a small minority of them can be noticed without instrumentation. Having an occasional wrenching feeling isn’t a sign of pathology, and most people have them. I have them. You can also have sensations in you chest that have nothing to do with arrhythmias.
I wasn’t diagnosed with any cause of these. I complained of wrenching feelings in my chest (If I remember correctly, at worst like once a day) for about a week once a year ago, they hooked up a halter monitor, and this is what they said I had. The doctor who did this said they were basically harmless, it’s just the second doctor (who I tried to get modafinil from) that thought they contraindicated it.
Well, as I said everyone has them. The number of premature ventricular contractions and whether they happen in groups would be the most interesting figure. I can imagine if you had many they would have told you so.
How many you noticed might have nothing to do with how many you actually had, and you noticing something might not have anything to do with actually having arrhythmia.
Modafinil has not been evaluated in patients with a recent history of myocardial infarction or unstable angina, and such patients should be treated with caution.
In clinical studies of PROVIGIL, signs and symptoms including chest pain, palpitations, dyspnea, and transient ischemic T-wave changes on ECG were observed in three subjects in association with mitral valve prolapse or left ventricular hypertrophy. It is recommended that PROVIGIL tablets not be used in patients with a history of left ventricular hypertrophy or in patients with mitral valve prolapse who have experienced the mitral valve prolapse syndrome when previously receiving CNS stimulants. Such signs may include but are not limited to ischemic ECG changes, chest pain, or arrhythmia. If new onset of any of these symptoms occurs, consider cardiac evaluation.
Blood pressure monitoring in short-term (<3 months) controlled trials showed no clinically significant changes in mean systolic and diastolic blood pressure in patients receiving PROVIGIL as compared to placebo. However, a retrospective analysis of the use of antihypertensive medication in these studies showed that a greater proportion of patients on PROVIGIL required new or increased use of antihypertensive medications (2.4%) compared to patients on placebo (0.7%). The differential use was slightly larger when only studies in OSAHS were included, with 3.4% of patients on PROVIGIL and 1.1% of patients on placebo requiring such alterations in the use of antihypertensive medication. Increased monitoring of blood pressure may be appropriate in patients on PROVIGIL.
I’m not sure we have large enough numbers to give meaningful analysis. I could give a 25% (+/- 22) confidence that you’d likely experience elevated blood pressure, but you’d experience far greater harm from everyday stress or lack-of-exercise. There’s a nice big list of serious adverse effects, but two or four out of seven hundred people doesn’t seem very useful.
Dietary and psychiatric concerns may also be relevant.
I have a question about modafinil which I’m well-aware should be addressed to a doctor, but I did ask it to a doctor, and didn’t get a meaningful answer. Given that I have a minor (I think?) heart condition (a year ago, for about a week, I had sinus bradycardia at 50bpm, sinus tachycardia at 169bpm, occasional wrenching feelings in my chest accompanying 3 beats salvo premature ventricular contractions and premature atrial contractions, no atrial ventricular block, no sustained ventricular tachycardia), what are the chances that taking modafinil (given that it is a stimulant) will damage/kill me? I’m a 22-year old man, and to the best of my knowledge have no other relevant health conditions to take into account.
I’m asking LessWrong because I want a probabilty estimate I can base expected utility calculations off of, not an “I can’t prescribe that because I’m afraid of malpractice lawsuits.”, and because I suspect this question is easier than it sounds and the doctor I talked to was just being cautious because (as he said) he wasn’t familiar with modafinil.
I think this is spectacularly hard to get a robust estimate of, but my wild uninformed guess is your chances of dying of it interacting with your heart condition are less than 25%, and probably less than 5%. (I try not to pull probabilities higher or lower than 5%/95% out of the air—I need a model for that.) That’s for the simple case where you don’t get addicted and take ever-higher doses or start taking other stimulants too or start smoking, etc.
The only hard information I can get a handle on is that the US manufacturer lists existing cardiovascular conditions as a potential contraindication. I suspect this is on general principles (stimulants are known to make them worse, modafinil is a stimulant, sort-of) rather than on hard data about problems caused.
Reporting systems for drug side effects are haphazard and leaky at best, and it’s very hard to do decent analysis. Unusual combinations that aren’t very deadly just aren’t going to show up in the research.The fact that we haven’t heard that it’s deadly does, though, put something of a ceiling on just how bad it could be (my 25% above).
Most medics would reckon taking stimulants you don’t have to when you have a known cardiovascular condition is unwise. (Although some of them do it themselves in early career.) Quantifying ‘unwise’ is tricky. There’s the general issue of data I just mentioned. Then there’s trying to think it through. On the plus side, modafinil is less likely to cause problems for CV patients in the way that other more general CNS stimulants are known to; but on the minus side, we don’t properly understand how it does work.
Doctors are by nature very cautious: “first, do no harm” and all that. You might come to a different cost/benefit decision.
FWIW, I wouldn’t take it in your shoes. But I don’t take it myself, despite having no contraindications. I’m extremely risk averse, particularly about my own life, and place more emphasis on quantity than quality compared to most people (on hedonic adaptation grounds).
Everyone has these, the question is why, how many and for how long. What “condition” were you diagnosed with?
I don’t have that kind of thing enough to notice. Do you mean everyone has odd heartbeats, but some can only be noticed with instrumentation?
Everyone has odd heartbeats. Only a small minority of them can be noticed without instrumentation. Having an occasional wrenching feeling isn’t a sign of pathology, and most people have them. I have them. You can also have sensations in you chest that have nothing to do with arrhythmias.
I wasn’t diagnosed with any cause of these. I complained of wrenching feelings in my chest (If I remember correctly, at worst like once a day) for about a week once a year ago, they hooked up a halter monitor, and this is what they said I had. The doctor who did this said they were basically harmless, it’s just the second doctor (who I tried to get modafinil from) that thought they contraindicated it.
And how long was the Holter monitoring? How many episodes of arrhythmias?
3 days, unknown number of arrhythmias. (Roughly one that I noticed per day over the whole week, don’t remember how many happened with the monitor on),
Well, as I said everyone has them. The number of premature ventricular contractions and whether they happen in groups would be the most interesting figure. I can imagine if you had many they would have told you so.
How many you noticed might have nothing to do with how many you actually had, and you noticing something might not have anything to do with actually having arrhythmia.
Yes, modafinil elevates heart rate and blood pressure. But probably not as much as caffeine.
The FDA’s analysis says (pdf warning) :
I’m not sure we have large enough numbers to give meaningful analysis. I could give a 25% (+/- 22) confidence that you’d likely experience elevated blood pressure, but you’d experience far greater harm from everyday stress or lack-of-exercise. There’s a nice big list of serious adverse effects, but two or four out of seven hundred people doesn’t seem very useful.
Dietary and psychiatric concerns may also be relevant.