Modafinil for ADHD: Medication Overview

What Is Modafinil?

Modafinil, commonly known by the brand name Provigil, is part of the class of drugs known as eugeroics. This class of medications are wake-promoting drugs, also known as dopamine reuptake inhibitors.^{1, 2, 3} The exact function of modafinil is unknown. One way it works is by increasing dopamine in the brain, leading to enhanced wakefulness and improved attention.  Modafinil is approved by the U.S. Food and Drug Administration (FDA) for the treatment of narcolepsy, shift work sleep disorder, and obstructive sleep apnea.

The medication has also been used off-label for the treatment of other disorders, including ADHD, fatigue in depression, fatigue in multiple sclerosis, and bipolar depression.^{3, 4} Off-label means the medication is being used for a purpose not approved by the FDA. A healthcare provider may choose to use a medication off-label if, in their professional judgment, they feel the medication will still benefit an individual.

Is Modafinil Similar to Adderall?

Modafinil and Adderall are similar in that both medications can enhance wakefulness and improve attention. However, the medications work differently in the brain, with modafinil working more selectively than other stimulant medications. While the workings of modafinil are not fully known, it likely works by increasing dopamine in certain parts of the brain.² Adderall, a stimulant medication, increases both dopamine and norepinephrine throughout the brain.

Is Modafinil Just Caffeine?

Modafinil and caffeine are distinctly different and have different effects on the body and brain. Modafinil is a prescription medication that increases certain chemicals in the brain, particularly dopamine, leading to improved wakefulness. Caffeine, on the other hand, is a natural stimulant found in coffee, tea, and other beverages. Caffeine prevents the action of adenosine, a chemical that promotes sleep and relaxation. The effects of caffeine on ADHD symptoms are still being studied.

How Does Modafinil Work for ADHD?

Modafinil works by improving the function of certain chemicals in the brain, such as dopamine. This leads to improved wakefulness and attention. Dopamine plays a major role in ADHD. By increasing dopamine in the brain, modafinil can improve attention and impulse control.

Modafinil Dosage for ADHD

Modafinil dosages can vary based on several factors, such as age, weight, medical history, and individual response to the medication. The dosage for treating ADHD usually differs from the dosage used to treat sleep disorders. Physicians often start with a lower dose and make adjustments based on the individual’s response. Lower doses may be paradoxically better than higher doses for the treatment of ADHD.³

Modafinil is available in the following forms and strengths:^{2, 3}

• 100 mg scored tablet
• 200 mg scored tablet

How to Take Modafinil for ADHD

Modafinil is typically taken once a day in the morning due to its stimulant effects. For FDA-approved uses, the starting dose is often 200 mg. However, when used off-label for ADHD, it is typically started at a lower dose, such as 50-100 mg. Lower doses may be more effective than higher doses in some patients.³ However, some individuals may still require a higher dose to see improvements in their ADHD symptoms.

How Should I Take Modafinil?

It is important to follow the recommendations from your healthcare provider and pharmacist when taking this medication. The medication is usually taken once a day with or without food. It is typically taken in the morning when used for the treatment of ADHD.

What Happens If I Miss a Dose of Modafinil?

If you miss a dose of modafinil, you should skip the missed dose, as taking it late in the day may impact your ability to fall asleep. Wait until your regular dosing schedule to take the next dose. Never double your dose to make up for a missed one.

Side Effects of Modafinil

Modafinil can cause a variety of side effects. Many side effects are mild and will resolve over time as your body adjusts to the medication. However, some side effects can be severe or persistent, requiring follow-up with your healthcare provider. Some side effects may require immediate medical attention.

Common Side Effects of Modafinil

The most common side effects of modafinil are mild and will resolve with time. However, it is important to monitor for side effects from the medication and to discuss them with your physician if they become severe or are not going away.

Common side effects of modafinil include:^{1, 2}

• Headache
• Nausea
• Nervousness
• Anxiety
• Back pain
• Stuffy nose
• Dizziness

*All medications, including modafinil, can cause side effects which can be mild or serious. This is not a comprehensive list of all possible side effects. You should talk with your doctor about any questions you have and to understand the potential side effects and benefits of any medication.

Serious Side Effects of Modafinil

While most side effects are mild, taking modafinil can cause serious side effects that require immediate medical attention. It is important to be aware of these possibilities and to monitor them closely. Some individuals may be at a higher risk for developing severe side effects than others, and it is important to discuss this with your healthcare provider.

Serious side effects of modafinil may include:^{1, 2}

• Allergic reactions
• Chest pain
• Difficulty breathing
• Hallucinations
• Severe depression
• Anxiety symptoms
• Suicidal thoughts
• Aggressive behaviors

*All medications, including modafinil, can cause side effects which can be mild or serious. This is not a comprehensive list of all possible side effects. You should talk with your doctor about any questions you have and to understand the potential side effects and benefits of any medication.

Allergic Reactions to Modafinil

Although uncommon, allergic reactions to modafinil are possible. Individuals with hypersensitivity to the drug or similar drugs should exercise caution when taking this medication.  If an allergic reaction occurs, seek immediate medical attention, as these reactions can be life-threatening.

Allergic reactions to modafinil may include:^{1, 5}

• Hives
• Swelling of the face, mouth, or throat
• Difficulty swallowing
• Difficulty breathing
• Chest pain
• Rapid heart rate

If someone experiences an allergic reaction to modafinil, prompt medical attention is crucial. These symptoms can be life-threatening if not treated appropriately by a trained healthcare provider. After the allergic reaction has been treated, modafinil should be discontinued, and alternative options should be explored. A healthcare provider can discuss other treatment options for your specific condition.

Modafinil Warnings & Precautions

Before starting modafinil, individuals should be aware of the important warnings and precautions associated with its use. Some individuals may be at risk of severe reactions when taking this medication. This is often based on an individual’s medical history, and the risks should be thoroughly discussed with a healthcare provider.

Precautions for taking modafinil:²

• Serious rashes: Serious rashes, such as Stevens-Johnson Syndrome, have occurred with modafinil use. These rashes can be life-threatening; therefore, you should contact your healthcare provider if a rash develops.
• Anaphylaxis: Severe allergic reactions can occur when taking Modafinil and require immediate medical attention. Symptoms may include difficulty breathing and swelling of the face, mouth, or throat.
• Multi-organ hypersensitivity reactions: Although very rare and not fully understood, Modafinil may cause severe reactions in multiple organs in the body, including the heart, liver, and blood.
• Psychiatric symptoms: Modafinil can cause adverse psychiatric symptoms such as mania, delusions, hallucinations, and aggression. This risk may be higher in those with a history of mental health disorders.
• Driving and using machinery: Any drug impacting the brain can alter judgment, thinking, or motor skills. Individuals should be cautioned to avoid driving or operating machinery until they are confident the medication will not affect their ability to do so.
• Heart problems: Modafinil can cause heart problems, including chest pain, rapid heart rate, and irregular heartbeat. It should be used cautiously in individuals with a history of heart problems.
• Taking modafinil during pregnancy or breastfeeding: The effects of modafinil on a fetus or breastfed infant are not fully known. Modafinil should only be used if the potential benefit justifies the potential risk.

Interactions With Modafinil

Modafinil has the potential to interact with various medications, substances, and herbs. It is important to be transparent with your healthcare provider about all substances taken to ensure your safety. Modafinil can cause some medications to remain in the body longer, increasing the risk of side effects. Other medications may be less effective when taken with modafinil.

8 substances you should avoid while taking modafinil include:^{2, 3}

• Hormonal contraceptives: Ethinyl estradiol and other hormonal contraceptives may be less effective when taking modafinil.
• Triazolam: Modafinil may decrease the effect of triazolam, a medication used to treat insomnia.
• Seizure medications: Modafinil can increase the blood levels of some seizure medications, such as diazepam and phenytoin.
• Antidepressants: Modafinil may increase the blood levels of some antidepressants, including tricyclic antidepressants and selective serotonin reuptake inhibitors (SSRIs).
• Warfarin: Individuals on warfarin should have their prothrombin times and INR closely monitored when taking modafinil.
• Carbamazepine: Carbamazepine can decrease the effect of modafinil and may require dose adjustments.
• Fluvoxamine: Fluvoxamine may increase the effect of modafinil, increasing the risk of side effects.
• Fluoxetine: Fluoxetine may increase the effect of modafinil, increasing the risk of side effects.

This is not a comprehensive list of all possible interactions with modafinil. You should talk with your doctor about any questions you have and understand the potential interactions and benefits of any medication.

Can You Become Addicted to Modafinil?

Modafinil can cause effects similar to other central nervous system (CNS) stimulants, including euphoria and alterations in mood. Because of this, it does have the risk of abuse. However, this risk appears to be lower when compared to CNS stimulants, such as Ritalin and Adderall. Modafinil does not seem to have a risk for dependence as it does not cause withdrawal symptoms.

Modafinil is a controlled substance, and patients will be closely followed when taking this medication. This may include limiting how much can be prescribed at one time and having more frequent follow-up visits with a healthcare provider.

Alternative Treatments for ADHD

There are many alternative treatment options for the treatment of ADHD. Stimulant medications, such as Ritalin and Adderall, are often the first-line treatments for ADHD. There are, however, non-stimulant options available, as well.

Other options for the management of ADHD include therapy and lifestyle changes. Therapies, such as CBT for ADHD, can help individuals develop practical strategies to manage symptoms, improve organization skills, and enhance problem-solving abilities. Online group therapy or support groups provide another option for individuals to share experiences, gain insight, and receive encouragement.

Lifestyle changes can play a crucial role in managing ADHD symptoms. Establishing consistent routines, incorporating regular exercise, and optimizing sleep can contribute to the overall well-being of an individual, leading to improved attention and focus.

Questions to Ask Your Healthcare Provider About Modafinil

If you are experiencing symptoms of ADHD, you should first start by discussing your options with your healthcare provider. You can ask if modafinil might be a good option for you based on the symptoms you are experiencing. Discussing with a healthcare provider, such as your doctor, therapist, or psychiatrist, will allow you to explore all the treatment options for your symptoms. If you need a healthcare provider or are looking to change prescribers, you may want to consider online psychiatry services, a convenient and accessible option you can do from home.

Questions to ask your care team about modafinil include:

• How long will it take for me to adjust to taking modafinil?
• Am I at risk for more serious symptoms if I am already taking medication treatments for other mental health disorders?
• Am I at an increased risk of side effects, given my medical history?
• What is the best dosage to ensure fewer side effects?
• When should I reach out to you if I am experiencing side effects?
• Is there anything I should tell my therapist about this new medication?
• How will modafinil impact my daily activities, such as work, exercise, and sleep?
• Are there any potential long-term effects that I should be aware of when taking modafinil?
• How often should I schedule follow-up appointments?