Three people in Singapore have been hospitalized for serious adverse reactions after consuming modafinil and armodafinil obtained without a medical prescription, apparently in hopes of cognitive enhancement. Modafinil and armodafinil US Food and Drug Administration cleared for the treatment of narcolepsy, obstructive sleep apnea, and shift work sleep disorder. There is some evidence the drugs may enhance cognition in the non-sleep deprived, though the science is mixed.

Further reading: In Healthy People, Modafinil Won’t Make You Smarter—It Will Do the Opposite

Singapore’s Health Sciences Authority is alerting members of the public not to obtain or consume products containing modafinil or armodafinil that are not prescribed by a doctor or used under close medical supervision. 

Serious Skin Reactions, Mouth Ulcers After Inappropriate Narcolepsy Drug Consumption

After taking modafinil without a prescription, a man in his 30s developed Stevens-Johnson syndrome, a life-threatening skin condition with blistering and severe peeling of the skin, and a known possible side effect of the drug. He was hospitalized. 

The man had obtained modafinil from a friend, taking it once “to improve alertness.” Over the next few days, he started to feel unwell with fever, multiple mouth ulcers, and conjunctivitis, accompanied by a severe rash that started on the neck and subsequently spread to other parts of the body.

After taking armodafinil without a prescription, two other men in their 30s developed serious adverse reactions. One of them had obtained armodafinil from a friend to “stay awake during the day.” After taking it a few times, he developed multiple mouth ulcers, inflammation of the mouth, experienced pain when swallowing, and was unable to eat or talk. He also developed conjunctivitis. He too was hospitalised.

The other man who took armodafinil developed Stevens-Johnson syndrome and was hospitalized. He had obtained it from an illegal peddler in Geylang, Singapore, and had taken it for over a month to stay alert while working. He had a severe skin reaction that started with fever and rash and progressed to skin blistering and multiple mouth ulcers. The severe painful rashes subsequently spread to the whole body. 

Risks of Modafinil and Armodafinil

Modafinil and armodafinil are not registered in Singapore but are available in some countries, including the United States, as prescription medicines. If there is a clinical need, doctors can apply to Singapore’s Health Sciences Authority to bring in modafinil or armodafinil for their patients’ medical conditions, such as narcolepsy, and patients would have to be under strict medical supervision.

Modafinil and armodafinil can cause serious side effects such as heart problems, hypertension, and psychiatric conditions including anxiety, hallucinations, or mania. Serious skin reactions including Stevens-Johnson syndrome and toxic epidermal necrolysis have also been reported, which can lead to hospitalization, serious complications, or even death. Those who recover may experience long-term complications including skin scarring, hair loss, and visual impairment such as increased sensitivity to light and blindness. Other vital organs including the lungs may also be permanently affected. Modafinil and armodafinil also carry a potential risk of dependency due to their stimulant effects on the brain.

Self-Medicating and Illegal Sales

There have been reports of individuals taking modafinil or armodafinil for the purpose of improving alertness or as “cognitive enhancers” to improve focus and memory. Self-medication with modafinil or armodafinil for these purposes is not appropriate and can be harmful.

In Singapore, the supply and sale of unregistered health products such as modafinil or armodafinil is an offense under the country’s Health Products Act. If convicted, the person can face a fine of up to $50,000, a jail term of up to 2 years, or both.

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