SINGAPORE — Three people were hospitalised for serious adverse reactions after taking medication used to treat narcolepsy to improve their alertness, the Health Sciences Authority (HSA) said on Monday (Nov 6).

Those who suffer from narcolepsy find it hard to stay awake for long periods of time.

The drugs in question — modafinil and armodafinil — are potent medicines that are not registered in Singapore but are available in some countries as prescription medicines, HSA said in a press release.

If there is a clinical need, doctors may apply to HSA to bring in modafinil or armodafinil for their patients’ medical conditions such as narcolepsy.

Patients would have to be under strict medical supervision, the authority added.

One of the victims, a man in his 30s, developed Stevens-Johnson syndrome — a life-threatening skin condition with blistering and severe peeling of the skin — after taking modafinil. He was hospitalised, the authority said.

He obtained the product from his friend and took it once to improve alertness.

Over the next few days, he developed a fever, multiple mouth ulcers and conjunctivitis (red eyes). He also had a severe rash that started on the neck and spread to other parts of his body.

The other victims were two men in their 30s who had taken armodafinil.

One of them got the drug from a friend so that he may stay awake during the day. After taking the drug a few times, he developed multiple mouth ulcers and his mouth became inflamed. He experienced pain when swallowing and was unable to eat or talk, and also developed conjunctivitis. He was later hospitalised.

The other man developed Stevens-Johnson syndrome and was hospitalised. He bought armodafinil from an illegal peddler in Geylang and took it for over a month to stay alert while working.

He experienced a severe skin reaction that started with a fever and rash. This progressed to skin blistering and multiple mouth ulcers. The severe and painful rashes then spread to the whole body.

SERIOUS SIDE EFFECTS

HSA said that 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."

The two drugs can cause serious side effects such as heart problems, hypertension, and psychiatric conditions including anxiety, hallucinations or mania, it added.

Serious skin reactions have also been reported, which can lead to hospitalisation, serious complications or even death.

Those who recover may suffer from long-term complications including skin scarring, hair loss and visual impairment such as increased sensitivity to light and blindness, HSA said.

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.

HSA advised consumers to be cautious when obtaining health products from unfamiliar sources, even if they are recommended by friends or relatives, because one cannot be certain what these products contain and where and how they were made.

Unless authorised by HSA for use in special circumstances by a doctor for patients under the doctor's care, the supply and sale of an unregistered health product such as modafinil or armodafinil is an offence under the Health Products Act. 

Anyone convicted of doing so may face a fine of up to S$50,000 or up to two years’ jail, or both.

Members of the public who have any information on the illegal sale and supply of modafinil or armodafinil may contact HSA’s enforcement branch at 6866 3485 or email hsa_is [at] hsa.gov.sg.