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Ask PWH about: Side effects Any variability in their use of modafinil, armodafinil, or pitolisant Short “medicine holidays” of one or a few days to prevent tolerance are unlikely to change the effects of P450 inducers, so maintain any higher doses of hormones Weeks-long medicine holidays will lower the P450 inducer effects, so consider temporarily lowering to the usual hormone doses A P450 inducer’s effect may last for several weeks, because they increase enzyme activity by a slow process (for more info, see Brodie, 2012): Modafinil and armodafinil’s effects may last for 1 month after a person stops taking them, according to their FDA labels Pitolisant’s effect may last for 21 days after stopping it, according to its FDA label A P450 inhibitor’s effect goes away faster: Clarithromycin’s effect may last for more than 1 day after stopping it (Herrington, 2015) Grapefruit juice’s effect may last for up to 2 to 7 days after stopping it (Imai, 2014) Use the tables below and shared decision-making

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