Modafinil (Provigil): Uses, Side Effects, Dosage, & More

What Is Modafinil (Provigil)?

Modafinil, sold under the brand name Provigil, is categorized as a wakefulness-promoting agent. By influencing brain chemicals, this medication helps increase alertness. Modafinil is FDA-approved to treat conditions defined by excessive sleepiness, such as narcolepsy, sleep apnea, and shift work disorder.¹ Modafinil is also classified as a Schedule IV controlled substance due to its risk for misuse and dependence. While still requiring caution, this risk level is relatively low on the scale of controlled substances.¹

How Does Modafinil Work?

Modafinil works by affecting brain chemicals to increase wakefulness and alertness. This helps alleviate symptoms related to certain sleep disorders and mental health conditions. Essentially, it gives your brain a boost to stay more awake and focused, making it easier to manage conditions that cause excessive sleepiness.

What Is Modafinil Used to Treat?

Modafinil is FDA-approved to treat specific sleep disorders, including narcolepsy, obstructive sleep apnea (OSA), and shift work disorder (SWD). FDA approval means the drug has undergone thorough evaluations for safety and effectiveness in treating certain health conditions.

Additionally, modafinil is sometimes used off-label, such as for cognitive enhancement or ADHD.² Off-label use refers to prescribing a medication for purposes not specifically approved by the FDA. While there is emerging information about using modafinil for ADHD, this use is considered off-label and involves prescribing the medication based on a healthcare professional’s judgment of potential benefits.

Common Side Effects of Modafinil

Several common side effects of modafinil tablets affect the digestive system, cause pain, or induce feelings of anxiety. While these symptoms are generally mild and may not require medical attention, individuals experiencing severe or persistent side effects should consult their healthcare provider

Common side effects of modafinil include:¹

• Headache
• Back pain
• Nausea
• Feeling nervous
• Stuffy nose
• Diarrhea
• Feeling anxious
• Trouble sleeping
• Dizziness
• Upset stomach

*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

Modafinil tablets have the potential to cause serious side effects requiring immediate medical attention. These include the development of a severe rash or allergic reaction and psychiatric issues. If any of these serious side effects occur, stop taking modafinil tablets and contact a doctor or seek emergency medical care.

Serious side effects of modafinil include:¹

• Serious rash or serious allergic reaction
• Psychiatric symptoms: depression, anxiety, hallucinations, mania, suicidal thoughts, aggressive behavior, and other psychiatric problems
• Cardiac symptoms: chest pain, abnormal heartbeat, and trouble breathing
• Unexplained wounds or ulcers on fingers or toes
• Mouth sores or peeling skin
• Swelling of the face, eyes, lips, tongue, or throat
• Trouble swallowing or breathing
• Fever, shortness of breath, swelling, or rapid weight gain, especially with physical exertion
• Dark urine, jaundice (yellowing of the skin or eyes)
• Persistent nausea or vomiting, severe stomach pain

*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.

Modafinil Warnings & Precautions

When taking modafinil, heed warnings and precautions for potential serious effects. Discontinue promptly at the first sign of a rash, angioedema, or multi-organ hypersensitivity reactions. Regularly assess for persistent sleepiness and use caution in patients with a history of psychiatric issues. Immediate medical attention is crucial for any concerning symptoms.

You may need to avoid or take precautions with modafinil if you:¹

• Have a history of medication-induced rash, including Stevens-Johnson syndrome: This condition involves the development of a severe rash that may require hospitalization. If you observe any rash, especially serious, discontinue modafinil and seek medical assistance.
• Have allergic reactions: If signs of an allergic reaction, such as swelling or difficulty breathing, occur, stop modafinil immediately and consult your healthcare provider.
• Have a history of angioedema and anaphylaxis reactions: Angioedema involves swelling, while anaphylaxis is a severe allergic reaction. If suspected, stop modafinil and seek immediate medical attention.
• Have a history of multi-organ hypersensitivity reactions: This condition may involve symptoms affecting various organs and could be life-threatening. If suspected, discontinue modafinil and seek prompt medical advice.
• Experience persistent sleepiness: If you continue to feel excessively sleepy, discuss this with your doctor and be cautious with activities requiring alertness.
• Have a history of psychiatric symptoms: If you’ve had psychiatric issues and experience symptoms like anxiety or depression, stop taking modafinil and consult your healthcare provider.
• Are concerned about effects on the ability to drive and use machinery: Exercise caution with activities like driving or using machinery until you know how modafinil affects you.
• Have known cardiovascular events: If you have a history of heart problems and experience new symptoms like chest pain, consider discontinuing modafinil and seek medical evaluation.
• Have a history of stimulant misuse or dependence: Modafinil is a Schedule IV controlled substance due it its low but still present risk for misuse and dependence. Modafinil may not be suitable for patients with a history of stimulant misuse or dependence.

There may be additional warnings or precautions with this medication. Talk with your healthcare provider about all the potential risks before you start taking this medication.

Modafinil Dosages for FDA-Approved Treatment

Modafinil dosages vary based on factors like age and the condition being treated. For FDA-approved uses, the recommended dose for narcolepsy or obstructive sleep apnea is 200 mg once daily, while for shift work disorder, it’s 200 mg before the shift. Patients with severe liver impairment and older adults may require a reduced dose. Modafinil tablets are available in 100 mg and 200 mg strengths, offering flexibility.

Modafinil Forms & Strengths

Modafinil is available in tablet form with strengths of 100 mg and 200 mg. These tablets are not categorized as extended-release, delayed-release, or sustained-release. Instead, they are designed for immediate effect. The choice between forms and strengths depends on various factors, such as the patient’s specific condition, age, and overall health. Dosages may vary based on the severity of the condition being treated, ensuring a personalized and effective treatment approach for each patient.

Modafinil is available in the following forms and strengths:¹

• 100 milligram (mg) oral tablet
• 200 mg oral tablet

How Should I Take Modafinil?

For narcolepsy or obstructive sleep apnea, the typical dosage is 200 mg orally once a day in the morning. For shift work disorder, it may be prescribed at a dose of 200 mg approximately 1 hour before your work shift. It’s essential to adhere to the recommended dosage, as doses beyond 400 mg/day haven’t consistently shown additional benefits.

In cases of severe hepatic (liver) impairment, the dosage should be reduced, and for geriatric patients, lower doses may be considered. Always take modafinil as directed, and consult your healthcare provider for personalized guidance.

What Happens If I Miss a Dose of Modafinil?

If you miss a dose of modafinil, take it as soon as you remember. However, if it’s close to your next scheduled dose, skip the missed one and continue with your regular dosing schedule. Do not double up to make up for a missed dose. Modafinil is most likely to be effective when taken consistently and according to your prescribed dosing routine.

If you have missed a dose and aren’t sure if you should take it, contact your pharmacist or healthcare professional.

Can You Overdose on Modafinil?

Yes, overdosing on modafinil is possible. In clinical trials, very high doses, up to 8 times the recommended amount, caused symptoms like restlessness, confusion, and digestive issues. In fatal overdose cases, symptoms included sleep problems, confusion, and changes in the heart. Accidental overdoses, even in children, were generally not severe. Symptoms of an overdose may include restlessness, confusion, digestive problems, and cardiac side effects. If someone takes too much modafinil, there’s no specific antidote. Seek immediate medical help if there are concerns about an overdose.

What Should You Do If You Take Too Much Modafinil?

If you take too much modafinil, seek immediate medical attention by calling 911 or going to the nearest emergency room. Be prepared with the amount of modafinil ingested, the time of ingestion, and any symptoms experienced.

Do not wait for symptoms to worsen before seeking help. Emergency medical professionals can assess the situation, provide necessary interventions, and monitor your condition.

What to Avoid When Taking Modafinil

When taking modafinil, be cautious of potential interactions with medications. Modafinil may affect how other medications work, stay in your body, and get broken down by your body. Taking modafinil in these circumstances requires a dosage adjustment to prevent harmful outcomes. Consult your healthcare provider to ensure safe and effective medication use.

5 substances you should avoid while taking modafinil include:

• Contraceptives: Modafinil may reduce their effectiveness; alternative contraception is recommended. Contraceptives are hormonal birth control methods, and modafinil can impact their efficacy, increasing the risk of unintended pregnancies.
• Cyclosporine: Modafinil can lower blood levels, requiring monitoring and potential dosage adjustments. Cyclosporine is an immunosuppressive medication often used in transplant patients, and modafinil may interfere with its blood concentrations, affecting its therapeutic effects.
• Warfarin: Warfarin is a blood thinner, and modafinil interaction may influence its anticoagulant effects, requiring closer monitoring to prevent bleeding complications.
• Monamine oxidase inhibitors (MAOIs): Caution is advised when using modafinil with MAOIs, a type of antidepressant. Combining them with modafinil may lead to adverse effects due to potential interactions.
• Phenytoin, diazepam, propranolol, omeprazole, clomipramine: Modafinil may impact the enzymes needed to break these medications down. This may prolong the time needed for your body to get these medications out of your system, possibly requiring you to get dosage adjustments.

How to Get a Prescription for Modafinil

Obtaining a prescription for modafinil requires consultation with a healthcare professional as it is prescription-only. Healthcare providers such as psychiatrists or sleep specialists are authorized to prescribe modafinil after a thorough assessment.

During the assessment, your provider will inquire about your medical history, sleep patterns, and overall health. If modafinil is deemed a suitable treatment option, a prescription will be provided. To find a psychiatrist, patients can start by asking their primary care physician for recommendations, consulting their insurance provider, or using online directories to find qualified mental health professionals in their area.

Questions to Ask Your Healthcare Provider About Modafinil

You may have questions about modafinil and the potential risks and benefits of taking it. Key questions may include understanding the expected effects, possible side effects, and how modafinil aligns with your overall treatment plan. If you’re looking for a new prescriber, online psychiatry services may be a valuable option to consider.

Questions to ask your care team about modafinil include:

• How safe is modafinil?
• 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 other medications?
• What is the best dosage to ensure fewer side effects?
• Can modafinil be taken with my current medications?
• Are there specific lifestyle changes or precautions I should take while on modafinil?
• What are the potential interactions between modafinil and my existing health conditions?
• How often should I follow up with my healthcare provider while on modafinil?
• Are there any specific symptoms that should prompt an immediate call to my healthcare provider?
• Will modafinil affect my sleep patterns, and how should I manage this?
• What alternative treatments or strategies can complement modafinil for my specific condition?
• Can I engage in activities like driving or operating machinery while taking modafinil?