A Case of Premature Ventricular Contractions With Modafinil

Mr. A, a 54-year-old Caucasian man in very good health, was administered modafinil, 100 mg every morning, which was soon increased to 200 mg in the morning and then 100 mg b.i.d. to combat fatigue and lack of concentration. Mr. A was not taking any medications; was free of alcohol, tobacco, and substance use; and consumed little caffeine. Modafinil worked rather well for him in that regard, but after 2.5 months, he developed PVCs, which he felt as a sinking feeling in his chest and associated skipped beats when his pulse was taken. No other symptoms, such as dizziness, sweating, chest pain, and shortness of breath, were present. Mr. A was very conscious of the PVCs and disturbed after experiencing them. The results of a physical examination were normal, and a 24-hour Holter monitor showed 1,695 PVCs.

Mr. A’s diagnosis was unifocal PVCs and a normal sinus rhythm with symptoms. Modafinil was discontinued, but it took 20 days for the PVCs to remit. After a PVC-free interval of a week, Mr. A was rechallenged with the same dose of modafinil. The PVCs returned after only 10 days of taking modafinil. It was again discontinued, and the PVCs subsided in a matter of 2 weeks. Mr. A has been PVC-free since (more than 1 year).