ADD Medication and Treatment Reviews

Modafinil

Brand name: Provigil

What is Modafinil?

Modafinil is a wakefulness-promoting prescription drug that reduces the extreme sleepiness that accompanies  sleep disorders including narcolepsy, obstructive sleep apnea, and shift work disorder (SWD). It is sometimes used off-label to treat symptoms of ADHD in adults 18 years of age and older. This use is not approved by the FDA, but some research has shown improvement in ADHD symptoms when compared to a placebo. According to the FDA, modafinil is a federally controlled substance (C-IV) because it can be abused or lead to dependence. The safety and effectiveness for children has not been established.

Armodafanil (Nuvigil) is a drug similar to modafinil that could potentially have similar effects, but its impact on ADHD in adults has not yet been studied.

How to Use Modafinil

Before starting or refilling a modafinil prescription, read the medication guide included with your pills, as it may be updated with new information.

This guide should not replace a conversation with your doctor, who has a holistic view of your medical history, other diagnoses, and other prescriptions. If you have questions, ask your doctor or pharmacist before you begin taking the medication.

Dosage for Modafinil

As with all medications, follow your modafinil prescription instructions exactly. If a patient experiences upset stomach as a side effect, this medication can be taken with food.

Tablets are available in 100mg and 200mg dosages.

The recommended dosage is 200mg, taken orally, once daily in the morning (or just prior to beginning work for people with SWD). A reduced dose is recommended for elderly patients and patients with severe hepatic impairment.

Do not drink alcohol while taking this medication, as the use of modafinil with alcohol has not been studied.

Side Effects Associated with Modafinil

The most common side effects of modafinil are as follows: headache, back pain, nausea, nervousness, stuffy nose, diarrhea, feeling anxious, trouble sleeping, dizziness, and upset stomach.

Other serious side effects include: a serious rash or allergic reaction including Stevens-Johnson Syndrome; rapid swelling beneath the skin; new mental health problems such as depression, anxiety, aggression, hallucinations, and thoughts of suicide; and symptoms of a heart problem including chest pain, abnormal heartbeat, and trouble breathing. In rare cases, modafinil can create a multi-organ hypersensitivity reaction, which can be life-threatening. Stop taking modafinil and seek medical attention immediately if you experience any of these serious side effects.

Taking modafinil may impair your ability to drive, operate machinery, or perform other potentially dangerous tasks. If side effects are bothersome, or do not go away, talk to your doctor. Most people taking this medication do not experience any of these side effects.

Report to your doctor any heart-related problems or a family history of heart or blood pressure problems. Patients with structural cardiac abnormalities and other serious heart problems have experienced cardiac arrest while taking modafinil. Stimulants, like modafinil, can increase blood pressure and heart rate. Physicians should monitor these vital signs closely during treatment. Call your doctor immediately if you experience warning signs such as chest pain, shortness of breath, or fainting while taking modafinil.

Also disclose to your physician all mental health issues including any family history of psychosis, depression, or mania. Modafinil may create new or exacerbate existing mania, delusions, hallucinations, suicidal ideation, and aggression. Call your doctor immediately if you experience new or worsening mental health symptoms including depression or mania.

Elderly or debilitated patients with impaired hepatic or renal function should use caution and be observed closely when taking modafinil.

Stimulants like modafinil have a low potential for abuse and addiction. It is a “Schedule IV drug,” a designation that the Drug Enforcement Agency uses for drugs with a low potential for abuse. Other Schedule IV drugs include Xanax, Klonopin, and Valium. People with a history of drug abuse should use caution when using this medication. Taking the medication exactly as prescribed can reduce potential for abuse.

The above is not a complete list of potential side effects. If you notice any health changes not listed above, discuss them with your doctor or pharmacist.

Precautions Associated with Modafinil

Store modafinil in a secure place out of the reach of children, and at room temperature. Do not share your modafinil prescription with anyone, even another person with ADHD. Sharing prescription medication is illegal, and can cause harm.

You should not take modafinil if you have any of the following conditions: allergy or hypersensitivity to modafinil, armodafinil or any of the ingredients in modafinil medications.

If you’re thinking of becoming pregnant, discuss the use of Modafinil with your doctor. Animal studies indicate a potential risk of fetal harm. It is not known if modafinil is passed through breastmilk, so it is recommended that mothers do not nurse while taking it.

The safety of Modafinil for children under age 17 has not been established.

Interactions Associated with Modafinil

Before taking Modafinil, discuss all other active prescription medications with your doctor.

Use caution when taking modafinil concurrently with MAOIs. Certain illegal drugs such as methamphetamine and MDMA/ecstasy can interact with modafinil.

Modafinil can decrease the effectiveness of hormonal birth control including pills, shots, patches, vaginal rings, and intrauterine devices (IUDs) – while taking modafinil, and for one month after stopping modafinil. Talk to your doctor about the birth control choices that can reduce the risk of becoming pregnant while taking modafinil.

Modafinil can increase the speed at which certain medications are processed by your body, which could decrease their effectiveness.  Examples of medications that could be affected include: cyclosporine.

Modafinil can increase concentrations of certain medications in the body, including omeprazole, phenytoin and diazepam.

Caffeine can increase the side effects of modafinil.

Share a list of all vitamin or herbal supplements, and prescription and non-prescription medications you take with the pharmacist when you fill your prescription, and let all doctors and physicians know you are taking modafinil before having any surgery or laboratory tests. The above is not a complete list of all possible drug interactions.

Sources

http://www.provigil.com/PDFs/prescribing_info.pdf
https://www.fda.gov/downloads/drugs/drugsafety/ucm231722.pdf
https://www.ncbi.nlm.nih.gov/pubmed/16623645

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