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Patients with a historical past of drug and/or stimulant abuse should be closely followed throughout therapy with modafinil. Some beta-adrenergic receptor blocking brokers (i.e., non-cardioselective beta-blockers) are contraindicated in patients with bronchial asthma or with a history of bronchial asthma, or extreme chronic obstructive pulmonary disease. In patients who experience an exacerbation of angina following discontinuation of beta-blocker therapy, the remedy should usually be reinstituted, not less than quickly, together with other clinically applicable measures. Therapy with AR antagonists ought to be administered cautiously in such patients and in these predisposed to hypovolemic or hyponatremic states (e.g., patients on diuretic therapy, especially if high doses were used or if lately instituted; those on dietary salt restriction; renal dialysis patients). Therapy with thiazide diuretics needs to be administered cautiously in patients with impaired hepatic operate or progressive liver illness, and discontinued promptly if signs of impending hepatic coma seem (e.g., tremors, confusion, and elevated jaundice). Therapy with thiazide diuretics ought to be administered cautiously in patients with or predisposed to fluid and electrolyte depletion, together with patients with primary or secondary aldosteronism (could have low potassium levels); these with extreme or extended diarrhea or vomiting; and people with poor nutritional standing.
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