SINGAPORE: Three men in Singapore were hospitalised after they consumed unregistered medicines to stay alert and experienced serious adverse reactions.
The men had taken the medicines modafinil and armodafinil to improve alertness and subsequently developed a serious skin condition, mouth ulcers and conjunctivitis, the Health Sciences Authority (HSA) said on Monday (Nov 6).
The medicines were obtained from friends and an illegal peddler.
After taking modafinil, the first man, who is in his 30s, developed Stevens-Johnson syndrome and was hospitalised, HSA said in a media release.
Stevens-Johnson syndrome is a life-threatening skin condition marked by the blistering and severe peeling of the skin.
He had obtained the medicine from his friend and only took it once to improve alertness, HSA said.
Over the next few days, he started to feel unwell with a fever, multiple mouth ulcers and conjunctivitis, along with a severe rash which started on his neck and subsequently spread to other parts of his body.
The second man, who had taken armodafinil a few times, developed multiple mouth ulcers and inflammation of the mouth. He experienced pain when swallowing and was unable to eat or talk. He also developed conjunctivitis and was subsequently hospitalised.
The man had obtained the medicine from a friend to stay awake during the day.
The third man, who had also taken armodafinil, developed Stevens-Johnson syndrome and was hospitalised.
He had a severe skin reaction that started with a fever and a rash and progressed to skin blistering and multiple mouth ulcers. The severe, painful rash subsequently spread across his whole body.
The man had obtained the medicine from an illegal peddler in Geylang and had taken it for more than a month to stay alert while working, HSA said.
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RISKS OF TAKING MODAFINIL AND ARMODAFINIL
HSA advised members of the public against obtaining or consuming products containing modafinil or armodafinil that are not prescribed by a doctor or used under close medical supervision.
“Modafinil and armodafinil are potent medicines that are not registered in Singapore but are available in some countries as prescription medicines,” HSA said.
“If there is a clinical need, doctors can apply to HSA to bring in modafinil or armodafinil for their patients’ medical conditions, such as narcolepsy, and patients would have to be under strict medical supervision.”
“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 authority added.
HSA also said that 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, and can lead to hospitalisation, serious complications or even death, it added.
Toxic epidermal necrolysis is a more severe skin reaction where more than 30 per cent of the skin is affected.
The eyes may also be severely affected in both Stevens-Johnson syndrome and toxic epidermal necrolysis, HSA said.
“Those who recover may suffer from long-term complications including skin scarring, hair loss and visual impairment such as increased sensitivity to light – photophobia – and blindness. Other vital organs including the lungs may also be permanently affected,” HSA said.
“Modafinil and armodafinil also carry a potential risk of dependency due to their stimulant effects on the brain.”
Unless authorised by HSA for use in special circumstances by a doctor for patients under his or her care, the supply and sale of an unregistered health product such as modafinil or armodafinil is an offence under the Health Products Act.
Offenders face a fine of up to S$50,000 (US$37,000), up to two years in prison, or both.
Advisory on modafinil and armodafinil
In an advisory to consumers, HSA said:
• Modafinil and armodafinil are potent medicines that should be prescribed by a doctor and used under medical supervision. Inappropriate use of modafinil or armodafinil by individuals to stay alert or improve focus can be harmful.
• Be cautious when obtaining or purchasing health products from unfamiliar sources, even if they are recommended by friends or relatives. You cannot be certain about what these products contain, and where and how they were made.
• Do not supply potent prescription medicines to your friends or relatives. Even if someone’s medical condition appears to be similar to yours, your medicines may not be suitable or safe for them, and their condition may need to be managed by a doctor. You may be harming them instead of helping them.
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