Modafinil

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Modafinil

Modafinil is a psychostimulant primarily used in the treatment of a variety of sleep disorders.

Common Trade Names: Provigil, Alertec, Modavigil

Modafinil is a non-amphetamine central nervous system (CNS) stimulant that is typically used for its wakefulness-promoting properties. It works by selectively targeting neuronal pathways in the brain’s sleep/wake centers.1 Its primary clinically important property is its being a weak dopamine reuptake inhibitor, which makes it effective at inducing wakefulness and alertness.2

The drug is listed as a Schedule IV controlled substance under the federal drug scheduling system. It has accepted medical use for treatment in the US, and it is described as having a low potential for abuse and dependence.3, 4

Why Do People Use Modafinil?

Modafinil is prescribed medically to promote wakefulness or to reduce extreme sleepiness brought about by narcolepsy, obstructive sleep apnea (OSA), shift work sleep disorder (SWSD), and other types of sleep disorders.5

Off-prescription, modafinil is typically used as a cognitive-enhancing drug, an effect that is usually advertised on online forums. In part, the drug is preferred by users because of the low number of perceived risks versus the high number of perceived benefits.6

People who abuse the drug do so for the following reasons:6

  • To enhance their cognitive capabilities
  • To address psychiatric disorders
  • To experience psychoactive and euphoric effects

On the other hand, modafinil is also being studied for its potential to help address the symptoms of dependence to and withdrawal from amphetamine and cocaine.7, 8, 9

How Is Modafinil Abused?

Modafinil usually comes in tablet form and is medically prescribed to be taken orally once a day, in the morning.5  Conversely, modafinil is abused by users in a number of ways, including the following:

  • Taking higher doses than is medically acceptable
  • Taking the drug for longer than necessary
  • Using another person’s prescription to obtain the drug for one’s own use
  • Crushing tablets and inhaling (snorting) the drug to achieve desired effects more quickly or to increase potency

While modafinil is generally considered to be less addictive than other powerful stimulants, as a Schedule IV drug, it still poses a risk for abuse and dependence. In addition to inducing wakefulness and alertness, the drug can also cause euphoric effects similar to those produced by amphetamines.

Modafinil Drug Interactions

Modafinil can interact with certain medications, which can cause adverse reactions to the user. These include:1, 10

  • CYP3A4/5 substrates: Modafinil can hasten the elimination of drugs that are substrates for CYP3A4/5. It can reduce the effectiveness of steroidal contraceptives and bring down the blood level of cyclosporine. CYP3A4/5 substrates include substances such as steroidal contraceptives, cyclosporine, midazolam, and triazolam.
  • CYP2C19 substrates: Modafinil can slow down the elimination of drugs that are substrates for CYP2C19, leading to higher systemic exposure. CYP2C19 substrates include substances like phenytoin, diazepam, propranolol, omeprazole, and clomipramine.
  • Warfarin
  • Monoamine Oxidase (MAO) Inhibitors

Modafinil Side Effects

Using modafinil can cause the following immediate adverse side effects:5

  • Back pain
  • Burning, tingling, or numbness of the skin
  • Confusion
  • Constipation
  • Diarrhea
  • Insomnia (difficulty falling asleep or staying asleep)
  • Difficulty seeing or pain in the eyes
  • Dizziness
  • Drowsiness
  • Dryness in the mouth
  • Excessive thirst
  • Flushing
  • Gas
  • Headache
  • Heartburn
  • Loss of appetite
  • Nausea
  • Nosebleed
  • Sweating
  • Tightness of the muscles or difficulty moving
  • Uncontrollable shaking of a part of the body
  • Unusual tastes
  • Wakefulness

In case you or another person experiences severe or prolonged effects, or if you experience the effects below, you should be seen by a medical professional immediately:

  • Anxiety
  • Blisters
  • Pain in the chest
  • Depression
  • Difficulty breathing or difficulty swallowing
  • Fast, pounding, or irregular heartbeat
  • Feeling of being frenzied or being of abnormally excited mood
  • Hallucinating or seeing things or hearing voices that do not exist
  • Hives
  • Hoarseness
  • Itching
  • Sores in the mouth
  • Peeling of the skin
  • Rashes
  • Swelling of the body parts, including the face, throat, tongue, lips, eyes, hands, feet, ankles, or lower legs
  • Thoughts of self-harm

Modafinil’s Long-Term Effects

Modafinil’s effectiveness in long-term use has not been thoroughly studied, and the development of dependence on the substance is rare. 8 At the same time, there are only a handful of cases that indicate the drug as a trigger for the onset or worsening of psychotic symptoms.11, 12

Researchers propose that dependence on the drug can be attributed to the blockade in dopamine uptake, thereby increasing the concentration of dopamine in certain areas of the brain.13

Symptoms of Modafinil Overdose

The elimination half-life of 200 to 400 mg of modafinil is between 9 and 14 hours, and medically, it is typically given only as a single dose.3 Abusing the drug by taking more of the acceptable daily dose or by taking it more frequently can lead to overdose. A person who has overdosed on modafinil may exhibit the following symptoms and will require the immediate assistance of a medical professional:5

  • Agitation
  • Chest pain
  • Confusion
  • Diarrhea
  • Irregular heartbeat (fast, slow, or pounding)
  • Hallucinations or seeing things or hearing voices that do not exist
  • Nausea
  • Nervousness
  • Restlessness
  • Uncontrollable shaking of a part of the body

Signs of Modafinil Addiction

Cases of modafinil dependence are considered to be rare.9 Still, people who use the drug should make a point of evaluating their relationship with it and be proactive in identifying the signs and symptoms of substance use disorder as indicated in the Fifth Edition of the Diagnostic and Statistical Manual for Mental Disorder (DSM-5).14 For modafinil abuse, these can include the following:

  • Using modafinil for longer than intended or consuming larger amounts of the substance
  • Repeatedly attempting and failing to cut down or reduce use of modafinil
  • Allocating a lot of time to acquire modafinil, to use it, and to recover from its effects
  • Experiencing cravings to use modafinil
  • Neglecting personal, social, and professional responsibilities in favor of using modafinil
  • Continuing the use of modafinil even though it causes relationship problems
  • Neglecting important activities or interests in favor of using modafinil
  • Continuing to use modafinil even when it puts oneself or others in danger
  • Continuing to use modafinil even when physical or psychological problems may be made worse by drug use
  • Needing higher doses of modafinil to attain the desired effects
  • Experiencing withdrawal symptoms upon stopping the use of modafinil

It’s important to note that addiction and dependence are not one and the same. It’s entirely possible for a person to become dependent on a drug without developing an addiction to it. Dependence is defined as being unable to function normally without the drug, as the body has gotten used to the presence of the drug. Addiction, on the other hand, refers to the uncontrollable compulsion to seek and use the drug.

Modafinil Withdrawal Symptoms

According to a particular case study on a person who has developed a rare case of dependence on modafinil, the drug’s withdrawal symptoms can include the following:9

  • Increased sense of body warmth
  • Lethargy
  • Low mood
  • Sleep disturbance

Modafinil Detoxification

One of the first steps in overcoming drug abuse is detoxification or the process of eliminating the drug from your body. This can be a difficult time for a person in recovery, as you are likely to feel withdrawal symptoms after abstaining from using modafinil. Signing up for a supervised detoxification program will allow you to go through this process in a safe and more comfortable manner, under the supervision of medical professionals.

To lessen the withdrawal symptoms, your doctor may slowly reduce the dosage of the drug you are taking until you are capable of functioning normally without using it. At the same time, you may also be provided with medications and other treatment modalities that will address the withdrawal symptoms that you are experiencing during the detoxification process.

Getting Treatment for Modafinil Addiction

Overcoming stimulant addiction is possible with the right treatment plan and a strong support network. People who have developed substance use disorders often have the option to undergo inpatient or outpatient treatment programs.

  • Inpatient treatment for modafinil addiction: This treatment program requires the patient to live in a designated facility for a particular length of time, during which they’ll be under the guidance of medical professionals. Inpatient treatment programs are often recommended to patients with moderate to severe addiction and those who have demonstrated non-compliance with their recovery plan. Staying in an in-house facility gives the patient a better chance of avoiding the triggers that may be present in their home or neighborhood.
  • Outpatient treatment for modafinil addiction: Often recommended for milder cases of substance use disorder, outpatient treatment programs will typically require patients to attend regular sessions in a facility. During this time, the patient can continue living at home and attending to their social, academic, or professional responsibilities.

When undergoing an addiction treatment program, patients may receive psychosocial and behavioral intervention. Some examples of these are individual and group therapy sessions, contingency management therapy, motivational incentives therapy, cognitive behavioral therapy (CBT), and family behavior therapy.

Begin Your Journey to Recovery

Better Addiction Care is here to help you overcome modafinil abuse. Take the first step to reclaiming your control over your life today by getting in touch with our recovery support advisors.

Call us at 1-800-429-7690 so we can assist you in finding the best rehab centers in your locality. We can also help you verify your insurance status or assist you in finding other financing options if you don’t have insurance.

Improve your chances of recovery by finding the right help through Better Addiction Care.

Origins and History of Modafinil

Modafinil was first identified as an active metabolite in the drug adrafinil in the late 1970s in France. By the early 1980s, the drug started being prescribed as an experimental treatment to patients who suffer from narcolepsy and idiopathic hypersomnia. Taking the drug resulted in a significant decrease in sleep attacks and excessive daytime sleepiness among patients. During the Gulf War, modafinil was used by the French army. Eventually, the drug was officially registered in France in 1992.15

In 1998, modafinil was approved by the U.S. Food and Drug Administration for the treatment of narcolepsy, becoming available in the country as Provigil. The next year, the drug was labeled as a Schedule IV controlled substance.3 Then, in 2003, the drug’s application was extended to the treatment of shift work sleep disorder and obstructive sleep apnea.

Resources

  1. Robertson P, Hellriegel E. (2003). Clinical Pharmacokinetic Profile of Modafinil. Clinical Pharmacokinetics.
  2. Greenblatt, K. & Adams, N. (2021). Modafinil. StatPearls.
  3. U.S. Drug Enforcement Administration, Diversion Control Division. (1999). Placement of Modafinil into Schedule IV.
  4. U.S. Drug Enforcement Administration. (2020). Drugs of Abuse, a DEA Resource Guide (2020 Edition).
  5. U.S. National Library of Medicine, MedlinePlus. (2016). Modafinil.
  6. Teodorini, R.D. et al. (2020). The Off-Prescription Use of Modafinil: An Online Survey of Perceived Risks and Benefits. PLOS ONE.
  7. Heinzerling, K. (2003). Chapter 48 – Medication Development for Amphetamine Dependence. Interventions for Addiction, ed. by Miller P.
  8. McGregor, C. et al. (2005). Open-Label Pilot Trials of Mirtazapine and Modafinil in Inpatient Methamphetamine Withdrawal: Symptoms and Sleep Patterns. U.S. National Institutes on Drug Abuse.
  9. Krishnan R, Chary K V. (2015). A Rare Case Modafinil Dependence. Journal of Pharmacology and Pharmacotherapeutics.
  10. RXList. (2020). Provigil.
  11. Aronson, J.K., ed. (2016). Meyler’s Side Effects of Drugs (16th Ed.). The International Encyclopedia of Adverse Drug Reactions and Interactions.
  12. Murillo-Rodriguez E. et al. (2017). An Overview of the Clinical Uses, Pharmacology, and Safety of Modafinil. ACS Chemical Neuroscience.
  13. Volkow, N.D. et al. (2009). Effects of Modafinil on Dopamine and Dopamine Transporters in the Male Human Brain: Clinical Implications. The Journal of the American Medical Association.
  14. American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders (5th ed.).
  15. 15 Billiard, M. & Broughton, R. (2018). Modafinil: Its Discovery, the Early European and North American Experience in the Treatment of Narcolepsy and Idiopathic Hypersomnia, and its Subsequent Use in Other Medical Conditions. Sleep Medicine.

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