Reply to "Modafinil and Antipsychotic-Induced Sedation"

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In July 2002, I reported a case of modafinil-associated clozapine toxicity wherein treatment of clozapine-induced sedation was accompanied by a doubling of serum clozapine levels and signs of toxicity.² It was hypothesized that there was a possible metabolic interaction between modafinil and clozapine, perhaps inhibition of cytochrome P450 2C19 by modafinil, raising serum clozapine levels.