*An off-label use of a medication is a use that is not FDA-approved. Prescribers can decide to use a medication off-label because, in their professional judgment, they believe it may offer a benefit to someone.
*An off-label use of a medication is a use that is not FDA-approved. Prescribers can decide to use a medication off-label because, in their professional judgment, they believe it may offer a benefit to someone.
Modafinil and Adderall are both medications used to treat narcolepsy and ADHD symptoms, but they differ in their mechanisms and effects. Adderall is a stimulant primarily used to treat attention deficit hyperactivity disorder (ADHD), leading to heightened energy, concentration, and potential side effects like addiction and tolerance.1,2 Modafinil promotes wakefulness with less impact on the central nervous system, potentially increasing focus and alertness for some.
If you’re considering Modafinil or Adderall, or want to discuss your current prescription with a provider, you will be limited in your options. Circle Medical is an online psychiatry platform that can and will prescribe stimulant medications, which are controlled substances. This platform can connect you with a provider quickly and offer assessments and prescription consultation.
Boxed Warning: Amphetamine, dextroamphetamine mixed salts (Adderall) - Risk of medication misuse or abuse
Adderall has a black box warning. These are the most serious types of warnings from the Food and Drug Administration (FDA). Amphetamines, an active ingredient in Adderall, have a risk of misuse (abuse) which can lead to dependence on the medication, serious heart conditions, and even sudden death.
Adderall is a controlled substance, which means that it’s more likely to be misused or cause dependence. There are federal and state laws that limit the amount of medication that can be prescribed or dispensed within a certain period of time.
Modafinil is a controlled substance, which means that it’s more likely to be misused or cause dependence. There are federal and state laws that limit the amount of medication that can be prescribed or dispensed within a certain period of time.
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What Is Modafinil (Provigil)?
Modafinil, known by the brand name Provigil, is FDA-approved to treat excessive sleepiness in adult patients suffering from narcolepsy, obstructive sleep apnea (OSA), or shift work disorder (SWD). Some prescribers treat ADHD with modafinil, which is considered an off-label use. An off-label use of a medication is a use that is not FDA-approved. Prescribers can decide to use a medication off-label because, in their professional judgment, they believe it may benefit someone.
Modafinil’s exact mechanism for promoting wakefulness is uncertain. It performs similarly to stimulants with its wake-promoting effects and is thought to work with dopamine, but modafinil is not classified as a stimulant. Modafinil is classified as a Schedule IV controlled substance, which means it has the potential for abuse and dependence. Modafinil is not approved for use in children.
What Is Adderall?
Adderall is an FDA-approved medication for treating attention-deficit hyperactivity disorder (ADHD) and narcolepsy. It contains a combination of various forms of amphetamine. Adderall is not approved for use in elderly patients or children under 3 years old. Adderall works as a central nervous system stimulant and is thought to increase the levels of certain substances in the brain, such as dopamine and norepinephrine. These substances play a role in regulating attention, focus, and behavior.
In patients with ADHD, the drug helps improve attention span, reduce impulsivity, and decrease hyperactivity. In narcolepsy, it helps to control excessive daytime sleepiness and sudden sleep attacks. Adderall is classified as a Schedule II controlled substance due to its potential for abuse and dependence, and it should be used with caution to avoid misuse.1
Key Differences Between Modafinil & Adderall
Modafinil is a schedule IV medication FDA-approved to treat excessive sleepiness in adult patients suffering from narcolepsy, obstructive sleep apnea (OSA), or shift work disorder (SWD). Modafinil is sometimes used as an “off-label” treatment for ADHD.2 Adderall is a schedule II medication FDA-approved to treat ADHD and narcolepsy. Due to their potential for abuse and dependence, modafinil and Adderall should be prescribed with caution to avoid misuse. 1
While both drugs may be used as medications for ADHD, they are not interchangeable. Some key differences to be aware of include:1,2
- Adderall is used to focus, attention span, and other high-level cognitive functions. Modafinil only promotes wakefulness and helps delay the start of mental and physical fatigue.
- Adderall is approved for use in children as young as 3 years old. Modafinil is not approved for use in children due to the risk of severe skin reactions.
- Adderall has a higher risk for abuse and dependence, as well as sudden cardiac events, including a rare risk of death.
- Modafinil has drug interactions with birth control, as well as warfarin. Adderall I suggest adding ‘it interacts with medications that are used to treat depression, but not with these two common drugs.
- Both drugs are harmful to pregnancies, and Adderall is known to harm nursing babies. It is unknown whether or not Modafinil is excreted in breast milk.
The table below summarizes the key differences between Adderall vs Provigil (Modafinil):1,2,5,6
| Key Components | Provigil (brand name) | Adderall |
|---|---|---|
| What is the generic name? | Modafinil | Amphetamine salts |
| What forms does it come in? | 100mg and 200mg tablets | Immediate release: 5mg, 7.5mg, 10mg, 12.5mg, 15mg, 20mg, 30mg Extended release: 5mg, 10mg, 15mg, 20mg, 25mg, 30mg |
| What are the typical dosages? | 200mg daily in the morning (or before shift) | Most patients: begin at 5mg daily in the morning, titrating up to a maximum of 40-60mg daily |
| Who is FDA approved to take it? | Adults with narcolepsy, excessive sleepiness due to OSA, or SWD Elderly patients at half dosage | Children over 3 and adults with ADHD |
| Black Box Warnings | None | Abuse/dependence Sudden serious cardiac events, including death |
| Drug Interactions | Birth Control Warfarin Cyclosporine MAOIs (e.g. phenelzine) CYP2D6 (e.g. amitriptyline) CYP3A4 (e.g. diltiazem) CYP2C19 (e.g. citalopram) | SSRIs (e.g. sertraline) TCAs (e.g. nortriptyline) SNRIs (e.g. duloxetine) MAOIs (e.g. isocarboxazid) Dopamine blockers (e.g. haloperidol) Urinary alkalinizing agents (e.g. potassium citrate) CYP2D6 (e.g. risperidone) |
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What Are Modafinil & Adderall Used to Treat?
Modafinil and Adderall have multiple FDA-approved and off-label uses. Both can be used to treat narcolepsy and ADHD. Modafinil also has several off-label uses that Adderall does not. An off-label use of a medication is a use that has not been studied in clinical trials and so is not FDA-approved. Prescribers can decide to use a medication off-label because, in their professional judgment, they believe it may benefit the patient. Off-label usage is widely accepted as a safe medical practice.
The table below compares the medical and mental health conditions modafinil and Adderall are used to treat:1,2,3,4,5,6
| Condition | Modafinil | Adderall |
|---|---|---|
| ADHD | Off-label | FDA approved |
| Narcolepsy | FDA approved | FDA approved |
| Shift-work disorder | FDA approved | Not used |
| Obstructive sleep apnea-related fatigue | FDA approved | Not used |
| Other chronic condition-related fatigue | Off-label | Not used |
| Unipolar/bipolar acute depressive episode | Off-label | Not used |
Which Is More Effective: Modafinil or Adderall?
The effectiveness of Adderall and modafinil depends on the medical condition they are used to treat. Adderall is more effective for the treatment of ADHD and narcolepsy. Modafinil is more effective for excessive sleepiness associated with narcolepsy, obstructive sleep apnea, and shift work sleep disorder. While modafinil is sometimes used off-label for ADHD, its effectiveness in these areas may vary.1,2
Considering only stimulant properties, Adderall is the more powerful drug. With this comes the risk of more serious side effects. The choice between Adderall and modafinil should be made in consultation with a healthcare professional, considering individual medical needs and response to treatment.5,6
Modafinil & Adderall Dosages for FDA-Approved Treatment
The dosages of Adderall and modafinil can vary significantly for different individuals based on factors such as age, weight, medical condition being treated, and individual response to the medication. For Adderall, the dosage for ADHD can range from 2.5mg daily to 40mg daily. For narcolepsy, doses can range from 2.5 mg to 60 mg per day. The “right” dose is determined through weekly assessment by your provider. Modafinil dosages usually begin at 200mg daily for all conditions. Doses of 100 mg daily are reserved for elderly patients or those with liver conditions. Doses up to 400 mg daily have been studied but do not seem to be more effective. 1,2
Healthcare providers always individualize dosing based on each patient’s unique characteristics and adjust as needed to achieve the best balance between effectiveness and tolerability. Regular follow-ups and close monitoring are essential to ensure safe and effective use of these medications.1,2
Modafinil Forms & Strengths
Modafinil is only available in immediate-release tablet formulations with a dose of 100mg or 200mg. Once administered, modafinil will reach maximum effect in about 2-4 hours. After 2-4 days of dosing, the levels of modafinil are maintained at steady levels. It takes over 3 days for modafinil to become completely removed from the body. Modafinil is dosed in the mornings so it won’t prevent you from sleeping at night.2,6
Doses will be smaller for those with severe liver disease. There is a longer-acting version of modafinil, with the brand name Nuvigil, which is not discussed in this article. Your provider will take into account your age as well as your liver health to determine which dose to place you on. A pharmacist will be helpful in consulting for drug interactions that may affect individual drug levels.2,6
Modafinil is available in the following forms and strengths:2
- 100mg oral tablet
- 200mg oral tablet
Adderall Forms & Strengths
Adderall is available in various strengths, from 2.5mg to 30mg, as both an immediate-release (IR) tablet and an extended-release (XR) capsule. For ADHD, the recommended starting dose for children aged 3 to 5 years is 2.5 mg daily, which can be increased weekly by 2.5 mg until an optimal response is achieved. For children aged 6 and older, the starting dose is 5 mg once or twice daily, with weekly increases of 5 mg. The maximum daily dose is typically 40 mg. For the treatment of narcolepsy, the usual dose ranges from 5 mg to 60 mg per day, depending on an individual’s response. Dosages may be adjusted by your provider based on tolerability and effectiveness, with careful monitoring to ensure appropriate use and minimize side effects.
Adderall IR achieves peak effect in about 3 hours. is never dosed past 2 or 3 pm to avoid issues with sleeping. The XR formulation is always dosed in the mornings and will achieve peak effect in about 7 hours.
Normally, it takes about 1.5-2.5 days for the medication to be completely removed from the body. Children clear the drug faster. When choosing a starting dose, prescribers will consider the patient’s age as well as symptom severity. The XR formulation is generally associated with fewer side effects due to the steadier release of the drug. A pharmacist will be helpful in consulting for drug interactions that may affect individual drug levels.1,5
Adderall is available in the following strengths:
- For immediate release tablets: 5mg, 7.5mg, 10mg, 12.5mg, 15mg, 20mg, 30mg
- For extended-release capsules: 5mg, 10mg, 15mg, 20mg, 25mg, 30mg
Both modafinil and Adderall, like all medications, must be taken as prescribed. It is important to take each drug as early in the day as possible to avoid issues with sleeping. Adderall can be taken after breakfast, as the drug may decrease appetite. In contrast, food has little effect on modafinil.1,2
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Side Effects of Modafinil & Adderall
For modafinil, common adverse reactions include headache, nausea, and nervousness. Less common side effects include diarrhea, back pain, anxiety, insomnia, dizziness, and heartburn. Often, the higher the dose, the more severe the side effects. Rare but serious effects that require medical attention may include changes in blood counts, swelling of the limbs, and agitation.
Adderall’s common adverse reactions include headache, dry mouth, elevated blood pressure, and decreased appetite. Less frequent reactions include mood swings. In those with preexisting heart conditions, Adderall may cause sudden heart attacks. Adderall may cause tics or worsen tics in those with Tourette’s syndrome. A severe decrease in appetite from use may lead to reduced growth in children.
This is not a comprehensive list of possible mild or serious side effects. It’s important to note that both drugs have the potential for serious adverse reactions, and a healthcare professional should closely monitor their use. Patients should report any concerning side effects promptly to their healthcare provider or pharmacist and should not discontinue or adjust the dosages without medical guidance. Following the prescribed dosing regimen is essential for optimizing benefits and minimizing risks associated with these medications.1,2,5,6
The table below compares the most common side effects of modafinil and Adderall:*1,2,5,6,7
| Side Effects | Modafinil | Adderall |
|---|---|---|
| Headache | Yes | Yes |
| Nausea | Yes | Yes |
| Anxiety/Nervousness | Yes | Yes |
| Tremors | No | Yes |
| Increased blood pressure | No | Yes |
| Weight loss/appetite suppression | Yes | Yes |
| Dry mouth | Yes | Yes |
| Side Effects | Modafinil | Adderall |
|---|---|---|
| Sudden heart attack | No | Yes |
| Abuse/dependence | No | Yes |
| Seizure onset/worsening | No | Yes |
| Raynaud’s Disease | No | Yes |
| Serious allergies/ Stevens-Johnson syndrome | Yes | Yes |
| Muscle damage/rhabdomyolysis | No | Yes |
All medications, including modafinil and Adderall, have a risk of side effects, including serious side effects. This is not a complete list of side effects. You should talk with your healthcare professional about the benefits and risks of any medication before starting treatment.
Warnings & Precautions for Modafinil & Adderall
It is important to understand the warnings and precautions for using Adderall. There is a risk of serious heart events, especially in children and adolescents and patients with preexisting structural heart problems. Adderall may cause modest increases in heart rate and blood pressure and may worsen symptoms of preexisting psychosis and bipolar illness, and new psychotic or manic symptoms can occur. Decreased growth may occur in children, and careful follow-up of weight and height is advised. Pregnant women and nursing mothers should use the drug cautiously, and pediatric use in children under 3 years of age is not recommended.1
People taking modafinil should be assessed regularly for persistent sleepiness. Caution should be exercised in patients with a history of psychosis, depression, or mania, and discontinuation of Modafinil may be considered if psychiatric symptoms develop.2
Adderall and modafinil may interact with various drugs. Both drugs require close monitoring in patients with underlying medical conditions such as high blood pressure, heart failure, or recent heart attacks.1,2
Risks to consider when taking modafinil and Adderall include:
- Interactions with alcohol: Both medications may decrease your tolerance to alcohol. Both alcohol and stimulants increase the risk of seizures.1,2
- Allergic reactions: Allergic reactions, including serious and fatal reactions such as anaphylaxis and Stevens-Johnson syndrome, have been rarely reported with both Adderall and modafinil. If you notice any unexplained rashes, swelling of the limbs or face, serious hives, or difficulty breathing, call 911 right away.1,2
- Sudden serious cardiac events: Sudden deaths, stroke, and heart attacks have been reported in adults taking stimulant drugs like Adderall at usual doses for ADHD. Patients with serious structural heart abnormalities, serious heart rhythm abnormalities, coronary artery disease, or other serious heart problems should generally not be treated with stimulant drugs.1
- Drug interactions: Patients taking birth control, warfarin, or cyclosporine may be better suited to a drug other than modafinil. Patients taking antidepressants or other mental health medications may be at increased risk for drug interactions. (See drug interactions.)2
Potential Drug Interactions With Modafinil & Adderall
Modafinil may change the effect of other important drugs you are taking. Your providers may make some adjustments for these drugs when used with modafinil. For patients taking some birth control, the effectiveness may be reduced when used with modafinil, so alternative or additional birth control methods are recommended. Adderall and modafinil may interact with other mental health medications, including MAO inhibitors and antidepressants.1,2
Disclaimer: Taking certain medications, herbs, or supplements alongside modafinil and Adderall can change how these medications work in your body or increase the risk for serious side effects. This article does not consider all the possible interactions. Please let your doctor, psychiatrists, and pharmacists know about all the products you currently use, such as prescription medication, nonprescription drugs, and herbal supplements. Do not start, stop, or change the dosage of any medicines without your doctor’s approval.
Medications and substances that have harmful interactions with modafinil and Adderall include:1,2
| Complicating Interactions | Modafinil | Adderall |
|---|---|---|
| Tricyclic antidepressants | X | X |
| MAOIs/Serotonin-active drugs (St. John’s wort, buspirone, SSRIs, SNRIs, certain migraine and opioid drugs) | X | X |
| Warfarin | X | |
| Steroidal contraceptives | X | |
| Cyclosporine | X | |
| Alcohol | X | X |
| Acidity-altering gut or urinary agents (Vitamin C, sodium bicarbonate, potassium citrate, some diuretics) | X | |
| Other agents: ritonavir, quinidine | X | |
Costs & Insurance Coverage
Adderall is on the cheaper end of drugs that can be used to treat ADHD. IR generic tablets vary from ~$2 to $8 per tablet, with the brand name being more expensive. Modafinil’s price is ~$20-40 per tablet and is cheaper than its long-acting counterpart, Nuvigil. Copays will vary by insurance company, and since Adderall and modafinil may not be preferred drugs under all plans, cost-sharing may be steeper than other medications, especially for brand-name medications.8,9,10,11
The chart below compares cost information about modafinil and Adderall:8,9,10,11
| Cost Information | Modafinil | Adderall (generic) |
|---|---|---|
| Quantity | 30 | 30 |
| Dosage | 200mg | 20mg |
| Pharmacy | Community/Hospital/Mail Order | Community/Hospital/Mail Order |
| Cost per capsule/tablet | ~$20-40 | ~$2 |
| Total cost (cash price) | ~$900 | ~$60 |
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Which Is Right for You: Modafinil or Adderall?
The choice between modafinil and Adderall depends on individual needs and medical conditions. Modafinil is a suitable option for those with excessive sleepiness due to conditions like narcolepsy, sleep apnea, or shift work disorder. It offers wakefulness without causing hyperactivity or euphoria. Modafinil may not be suitable for those who take warfarin, oral contraceptives, or cyclosporine. Adderall is primarily prescribed for ADHD, as it helps improve focus and concentration. However, it can be habit-forming and carries a risk of side effects, especially in individuals with heart or psychiatric conditions.
Neither medication is a great choice for those with severe liver or kidney conditions. Ultimately, the decision should be made after consulting with a healthcare professional who can assess the specific medical history and needs of the individual. For all ADHD patients, cognitive behavioral therapy is a first-line treatment option, either alone or in combination with medication. You may consider online psychiatry services if seeing a doctor in person isn’t feasible.1,2,5,6
How to Get a Prescription for Modafinil & Adderall
Modafinil and Adderall are available by prescription only. You will need to see a licensed prescriber and receive a qualifying diagnosis to be prescribed. Healthcare providers that may prescribe these substances include MDs or DOs (including family practice or psychiatrists), and ARNPs or PAs in certain states. Prescribers will take into account your diagnosis, individual needs and preferences, other medications, and health conditions when deciding what prescription is right for you. When many medications are in play, a pharmacist should be consulted to verify any drug interactions.
Questions to Ask Your Health Team About Modafinil & Adderall
Coming to appointments prepared with questions and concerns empowers you to actively participate in your healthcare decisions. Your healthcare providers and pharmacists are there to support you.
Questions to ask your prescriber about modafinil and Adderall may include:
- Is it safe to take modafinil or Adderall with my other medications?
- Will modafinil or Adderall be covered by my insurance?
- Which one has the best results as a treatment for ADHD?
- Does my medical history increase my risk of side effects for either?
- How long can I expect side effects to last?
- How often should I see you for checkups while taking modafinil or Adderall?
- What should I do if I am unsure whether ADHD medications are right for me?
- Do any of my other medications interact with modafinil or Adderall?
- I drink alcohol (give amount and frequency). Is this a concern?
- Do you know if my insurance prefers Adderall/modafinil?
In My Experience
In my experience, modafinil and Adderall are rarely used as options for the same conditions. Modafinil is mainly used for narcolepsy. I have rarely seen modafinil used for ADHD because there are many other treatment options for ADHD. Adderall is mainly prescribed for ADHD, and I rarely see Adderall used for its off-label uses. It does take some time to get the “right” Adderall dose, so keeping open communication with your provider and pharmacist is an important step to finding the most effective dose for you. Cost can sometimes play a big part in which drug is prescribed, so I suggest reaching out to your pharmacist to find a more cost-effective option if either modafinil or Adderall is too costly for you. Both medications work very well in my patients for the conditions they are FDA approved for if patients are taking them as prescribed. I see more abuse of these medications than I would like to, which increases the risk of severe side effects.
Additional Resources
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Best Online Psychiatry Services
Online psychiatry, sometimes called telepsychiatry, platforms offer medication management by phone, video, or secure messaging for a variety of mental health conditions. In some cases, online psychiatry may be more affordable than seeing an in-person provider. Mental health treatment has expanded to include many online psychiatry and therapy services. With so many choices, it can feel overwhelming to find the one that is right for you.
