Provigil (Modafinil) is a medication used to treat excessive sleepiness caused by certain sleep disorders. These sleep disorders are narcolepsy, obstructive sleep apnea/hypopnea syndrome and shift work sleep disorders. Provigil has severalconcerning side effects such as chest pain, dizziness, difficulty breathing, heart palpitations, irregular and/or fast heartbeat, increased blood pressure, tremors or shaking movements, anxiety, nervousness, rapidly changing mood, problems with memory, blurred vision or other vision changes to name a few. Many drugs interact with Provigil which include over-the-counter medications, prescription medications, nutritional supplements, herbal products, alcohol containing beverages and caffeine. The use of Provigil needs careful supervision. Provigil may affect concentration, function or may hide signs that an individual is tired. It is recommended that until an individual knows how Provigil affects him/her, they may not drive, use machinery or do any activity that requires mental alertness.

Last Updated : April 1, 2014

Yes. Drivers who have uncomplicated, elective Percutaneous Coronary Intervention (PCI), with or without stenting, to treat stable angina may return to work as soon as one week after the procedure. Criteria for return to work after PCI include:

• Examination and approval by the treating cardiologist;
• Asymptomatic;
• No injury to the vascular access site;
• ETT three to six months post PCI. In the CMV driver this requires exercising to workload capacity of at least six METS (through Bruce Stage II or equivalent), attaining a heart rate >85% of predicted maximum (unless on beta blockers), a rise in SBP >20mmHg without angina, and having no significant ST segment depression or elevation. Stress radionuclide or echocardiography imaging should be performed for symptomatic individuals, individuals with an abnormal resting echocardiogram, or those drivers who fail to obtain the minimal standards required from the standard ETT;
• Annual medical qualification examination;
• Negative ETT at least every other year (criteria above) and Tolerance of all cardiovascular medication. The driver should not experience orthostatic symptoms, including light-headedness; a resting SBP<95mmHg systoloc; or a systolic blood pressure decline > 20mmHg upon standing.

Last Updated : April 1, 2014

The certificate is valid for 2 years. In addition, drivers with specific medical conditions require more frequent certification:
Hypertension (high blood pressure) stable on treatment 1 year
Heart disease 1 year
Qualified under 391.64 the original diabetes and vision waiver program 1 year
New insulin and vision exemption program 1 year
Driving in exempt intra-city zone 1 year
Determination by examiner that condition requires more frequent monitoring, such as diabetes mellitus or sleep disorders.

Last Updated : April 1, 2014

This is the Medical Examiner's decision.

Last Updated : April 1, 2014

FMCSA medical guidelines for hypertension are based on the Sixth Report of the Joint National Committee on Prevention, Detection, Evaluation and Treatment of High Blood Pressure (JNC 6 - 1997). The prior cardiovascular guidelines were based on an earlier JNC report.
The medical standard (49 CFR 391.41 (b) (6) permits qualification of CMV drivers if the driver has no current clinical diagnosis of high blood pressure likely to interfere with his/her ability to operate a motor vehicle safely. FMCSA provides guidelines to assist the Medical Examiner in determining if a person is physically qualified to operate a motor vehicle.

Last Updated : April 1, 2014

A driver with a diagnosis of hypertension on treatment should have at least an annual certification.

A CMV driver with a Blood pressure (BP) 140/90 may be certified for 2 years.
First time BP elevated:

• Stage 1 - BP 140-159/90-99 Certification Period 1 year
• Stage 2 - BP 160-179/100-109 Certification Period 3 months as one time certification. Within the 3 months, if the blood pressure is below 140/90, the driver may receive 1 year certification.
• Stage 3 - BP Reading >180/110 Disqualified. When the blood pressure is less than 140/90, the driver can be certified at 6 month intervals.

Last Updated : April 1, 2014