US guidelines indicate a 200 mg standard dose and a 400 mg maximum dose, with very very few patients taking 600 mg and 800 mg. Clinic trials have shown there is little to no benefit of a 400 mg dose over a 200 mg dose including those with narcolepsy, and there are numerous first-hand accounts from users reporting 400 mg results in excessive tiredness, headaches, nausea, and other accentuated side effects whereas 200 mg provides the desired vigilance. While there are patients who take 800 mg per day, it is naive and irresponsible to recommend someone jump to an abnormally-high dose when the drug has already proven to not react as expected and they have not yet even taken a full regular dose at once in the proper manner. Keep in mind that while off-label uses for modafinil include stimulation and focus at 200 mg, the drug is specifcially designed for people with narcolepsy, so there is absolutely no logical reason to presume he needs a higher than average dose if he has the condition the drug was intended to be used for. You can stand by your recommendation, but we stand by the factual evidence countering your opinion.
I stand corrected on the 800mg dose guidelines. Also, 800mg+ dosages appear to elevate blood pressure and heart rate.
Recommending an additional 200mg is neither naive nor irresponsible. Once again, the logic behind suggesting a higher dose was because the lower dosages are not showing efficacy! The first thing a doctor does if a patient is not responding to a medicine is up the dosage, especially considering no side effects were reported at the previous dosage. If he had side effects, my opinion would be different.
He experiences "no effect" from it, even at 200mg. It's either he stops taking it completely or tries a higher dose before doing so. I'm suggesting the latter.
Just because the dose is outside your use and comfort range does not make it dangerous. You mention, "there are numerous first hand accounts of tiredness, headaches, nausea from users reporting 400mg dosages". May I state that most medical literature typically lists 400mg dosages as "well-tolerated" (see link) in study participants. Well-tolerated, meaning that side effects occur in only a fraction of the sample population. Also, even if he did experience these symptoms, they are not severe and would only be temporary. If this was tachycardia and hypertension, this would be a different story.
The "desired vigilance" and "average dose" of 200mg makes no sense in relation toward someone who is a non-responder at these dosages. I always advocate taking the lowest necessary dosage to prevent tolerance. This being said, 400mg appears to be hugely better than for treating daytime sleepiness than a 200mg dose.
Dose Effects of Modafinil in Sustaining Wakefulness in Narcolepsy Patients With Residual Evening Sleepiness
All four modafinil dosing regimens improved the overall clinical condition (CGI-C) after 3 weeks of treatment, relative to baseline (F3). With respect to late-afternoon/evening sleepiness, the proportion of patients rated as "much improved" or "very much improved" was highest among those receiving the modafinil 600-mg and 400-mg split-dose regimens: 92% and 80%, respectively, compared with 70% of patients in the 400-mg once-daily group and 27% of patients in the 200-mg once-daily group. The proportion of patients rated as being at least "improved" was significantly higher in the modafinil 600-mg split-dose (100%), 400-mg split-dose (90%) and the 400-mg once-daily (91%) groups than in the 200-mg once-daily group (55%, p<0.01).
→ source (external link)
You've stated that your post is based in "factual evidence" which implies that mine were not. You've implied cautionary statements, (e.g., calling a dose "abnormal") without backing them up. If anything my aforementioned posts were implicitly more factual than your own. I simply gave advice, there was no need to assume it to be reckless, debase it, and turn it into an argument.