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Modafinil is viewed as a promising pharmaceutical alternative to stimulant drugs in the treatment of attention-deficit hyperactivity disorder (ADHD).
While amphetamine (Adderall) and methylphenidate (Ritalin) have been the norm in addressing attention deficit disorders, more and more individuals are raising concerns about the high risk of side effects associated with these drugs.
Modafinil has proven effective at raising concentration, attention span and executive function and is now being prescribed off-label for ADHD cases in the USA. Sold under the name Provigil, this drug is a wakefulness promoter that is primarily used for alleviating fatigue due to sleep disorders.
Due to the mechanism of action differing to that of traditional stimulants, Modafinil is less likely to cause addiction, withdrawal, or put added strain on the heart.
Alertness
Mental Acuity
Focus- Stimulates wakefulness in the brain
- Promotes mental acuity & processing
- Enhances focus, motivation & energy
How Modafinil Works in the Body
Related Topics
- What is Modafinil? (Provigil)
- How Does Provigil Work?
- Effects and Benefits
- User Reviews
- Typical Experiences
- Recommended Dosages
- How to Take
- Provigil Uses
- Use for ADHD
- Effects on Weight Loss
- Negative Side Effects
- Abuse Warnings & Dangers
- Comparison to Adrafinil
- Comparison to Armodafinil
- Comparison to Adderall
- Where to Buy
- Generic Modafinil Brands
- Is Modafinil Legal?
- How to Get Modafinil
- Review of Online Sources
There has been a large amount of research into the ways Modafinil interacts with a variety of neurotransmitters and systems within the brain. However, the precise mechanisms of action for this drug are still not fully understood.
In various research studies, Modafinil has been seen to have an effect on multiple neurotransmitters, their receptors, and their signaling pathways, including Histamine, Dopamine, Epinephrine, Norepinephrine, and Orexin (Hypocretin).
What is clear is the fact that this drug elevates Histamine levels, which is one of the main reason why researchers think this is ‘wakefulness promoting agent’ rather than a stimulant in the classic sense.
Histamine is one of the natural hormones in the body that regulates the sleep/wake cycle and keeps you alert and aroused during the day. Conversely, Adderall and other amphetamines keep you awake by increasing the release of Norepinephrine in the brain which can lead to unfortunate stimulant side effects
Modafinil also seems to inhibit the actions of Dopamine transporters which leads to an increase in extracellular and synaptic concentrations of Dopamine at your neurons. This generates greater Dopamine activity in the brain even though Dopamine production and release are not themselves affected.
In other words, after the effects of Modafinil have worn off, your Dopamine levels will still be normal which means you will not experience the typical crash or “down” associated with stimulants.
Dopamine is one of the neurotransmitters involved in motivation, impulse control, goal-directed behaviors and focus. Recent experiments have found a link between low Dopamine levels and ADHD, so this could be one of the key reasons why Modafinil offers so many benefits for people with this disorder.
Another theory about the mechanisms of action for Modafinil involves the brain peptide known as Orexin. These peptides are found in the hypothalamus but are distributed out to many other parts of the brain including several areas that are known to regulate wakefulness. The activation of these neurons increase both Dopamine and Norepinephrine along with exciting additional neurons which lead to increased histamine levels.
Animal studies have shown that Modafinil does increase Histamine release in the brain and also that animals with defective Orexin receptors exhibit signs and symptoms related to narcolepsy. Modafinil does seem to activate these neurons.
Why Use Modafinil?
If you have read any of the recent articles on Modafinil in the media, you may get the sense that this drug is seen as a real-life version of NZT 48 (the fictional drug portrayed in the movie ‘Limitless’). It has been called “Wall Street’s drug of choice” and is revered for providing intense concentration for hours upon hours at a time.
Modafinil is a wakefulness promoting agent, also known as a eugeroic. This medication has been approved by the US FDA for the treatment of specific disorders like narcolepsy, shift-work sleep disorder, and excessive daytime sleepiness associated with obstructive sleep apnea/hypopnea.
It is described as a non-stimulant energy pill designed to help you stay awake and/or be better able to focus and function in cases of sleep deprivation.
This drug was originally developed in France by Lafon Laboratories. The initial attempts in the development of this drug in the late 1970’s were basically a series of benzhydryl sulfinyl compounds which included adrafinil and was offered as an experimental treatment for narcolepsy around 1986.
Modafinil itself is the primary metabolite of the original drug (Adrafinil). The difference being that Modafinil lacks the polar -OH group on its terminal amide which Adrafinil has. It does seem to have very similar activity to its parent and many who cannot get a Modafinil prescription will instead turn to Adrafinil which is unregulated and happens to be much cheaper.
Modafinil has been prescribed in France since 1994 and in the US since 1998, under the brand name of Provigil. It is also approved for use in the UK, since receiving approval in 2002. It has not yet been approved as a prescription for ADHD in these countries.
- Increases energy, wakefulness and motivation
- Boosts mental performance and focus
- Supports memory and cognition
Prescribed Modafinil Uses
Modafinil has been approved as a prescription drug by the FDA to treat narcolepsy, shift-work sleep disorder, and obstructive sleep apnea/hypopnea syndrome (OSAHS).
Narcolepsy is a wakefulness sleep disorder that causes excessive daytime sleepiness and may cause the patient to randomly and instantly fall asleep during the day. In multiple double-blind placebo-controlled clinical trials Modafinil has been seen to promote wakefulness and significantly decrease daytime sleepiness compared to placebo.
One study concluded that the use of Modafinil along with another narcolepsy drug, sodium oxybate, may be even more effective than either medication alone, and more research needs to be done in this area.
Shift-work sleep disorder is circadian rhythm sleep disorder that occurs when people experience excessive daytime sleepiness and possibly insomnia at sleep times due to a non-normal sleep schedule caused by working late/overnight or very long work shifts. One study saw that attention span lapses and general wakefulness was improved in patients who took a 200 mg dose of Modafinil before their work shift compared to placebo patients.
Sleep apnea/hypopnea syndrome is a medical condition that involves the muscles of the mouth relaxing and the tongue either partially or fully blocking the airway while sleeping. Hypopnea refers to the shallow, labored breathing that occurs with partial obstruction, while apnea refers to the lack of breathing experienced with total obstruction.
Most people with this condition have poor quality of sleep due to many episodes of poor or no breathing, which can cause choking and the person to wake up multiple times per night. Modafinil has been approved as an adjunct treatment for sleep apnea to improve wakefulness and decrease daytime sleepiness caused by poor sleep quality.
Using Modafinil For ADHD
Anecdotal reports and reviews of Modafinil often state that this drug dramatically improves focus and attention span.
Users state that they are much more motivated to follow through with tasks when taking Modafinil and that they do not experience as much mental strain when working or reading for extended periods of time. It is known to boost mental performance, judgment and analysis skills as well as memory capacity which is why many view it as an overall cognitive enhancer.
These are all areas which can benefit individuals suffering from ADHD and so it was natural that researchers would look into the merits of such a therapeutic application. There has been an explosion of studies within the past decade demonstrating the efficacy of Modafinil for improving attention processing and executive function.
In one double-blind, randomized, placebo-controlled crossover study, a 200 mg dose of Modafinil was found to improve cognition and and response inhibition in adults with attention-deficit hyperactivity disorder compared to placebo, producing similar patterns of cognitive enhancement seen in healthy patients.
Improvements were seen on tests of short-term memory, visual memory, spatial planning, and stop-signal motor inhibition. In several measures with improved accuracy, a decrease in latency to respond was seen, suggesting the Modafinil allowed for longer reflection on answers and an inhibition of impulsive responses. Improvements were also seen in sustained attention in the ADHD patients, an improvement not seen in the healthy group.
Another study compared Modafinil and dextroamphetamine, a commonly prescribed ADHD medication, to a placebo. Patients took one of the three treatments for a two week period, the were rotated to another treatment, completing all three treatments during the trial. Scores on the DSM-IV ADHD Checklist were significantly improved with both active drugs compared to the placebo. The researchers concluded that Modafinil may be a viable alternative to conventional stimulant medication currently prescribed for ADHD.
One compelling study published in the December 2005 edition of the journal Pediatrics found that Modafinil significantly alleviated core ADHD symptoms in children and resulted in less inattention and hyperactive impulsiveness. 48% of the trial group were rated as “very improved” at the end of the 9 week study.
While Modafinil does in fact share many similarities with current ADHD treatment drugs like Adderall and Ritalin, it has a much lower risk side effects than those other drugs. Unfortunately, when the pharmaceutical company Cephalon applied to have ADHD added to the approved conditions that Modafinil could be used to treat, the FDA chose not to approve it.
The FDA actually made its decision on the basis of a sole adverse event report in which a child developed a skin rash. The rash was diagnosed by his doctor as Stevens-Johnson syndrome and even though it was not conclusively linked to the usage of Modafinil the FDA still decided to ban it as a treatment for ADHD in children.
This decision received a lot of criticism due to the fact that this was only one instance in a trial of over 1,000 individuals. Further embarrassment resulted for the FDA when the doctor who made the initial diagnosis later retracted his diagnosis.
Despite this decision, physicians in the US can still prescribe Modafinil for ADHD as an off-label medication.
It has been estimated that 90% of all Modafinil prescriptions written in the USA are for unapproved purposes. While Cephalon continues to caution against giving Provigil to children, it is still considered an effective therapy for adult ADHD.
Modafinil is Not Approved for ADHD
Despite studies which have shown it to alleviate symptoms of ADHD, the US has not officially approved Modafinil as a medication to treat this condition. This means that drug companies (like Cephalon who manufactures Provigil) are not allowed to advertise using Modafinil for ADHD.
Regulations have prevented pharmaceutical companies from communicating findings from studies showing Modafinil’s ability to increase focus and attentiveness.
Despite these restrictions, under FDA regulations doctors are still free to prescribe this medication for this purpose should they think it to be the most prudent course of treatment. As such, there are many in the US who do legally take Modafinil for ADHD and who have been seeing some remarkable results with much lower risk of side effect.
Some doctors will prescribe Modafinil as an alternative ADHD medication when conventional stimulant drugs such as Adderall or Ritalin have caused patients to have adverse effects. From user reports, some of the serious mood related side effects seen with traditional ADHD medications such as anxiety and depression are not seen when using Modafinil.
A recent estimate from a professional organization of psychiatrists found that as much as 90% of Modafinil prescriptions are for off-label conditions such as ADHD. While it is promising that some doctors see the benefits of using Modafinil for ADHD that multiple studies have shown, it would be better if this was an FDA approved on-label use for Modafinil. If this was the case, then more people may be able to be prescribed this medication for their condition.
Other Off-Label Uses Of Modafinil
There are a number of approved clinical uses for this drug according to the FDA. Some of the most well-known include treatment for narcolepsy, sleep apnea, and even shift-work sleep disorder (for those whose sleep cycles are disrupted due to working at odd hours).
In other countries outside the USA it is also prescribed for idiopathic hypersomnia. Modafinil has also been shown effective in the treatment of other mood disorders and cognitive impairments. These include helping with the symptoms of depression, bipolar disorder, Parkinson’s disease, schizophrenia, disease related fatigue, and withdrawal from opiate and cocaine dependence.
Side Effects Of Modafinil
While Modafinil is much safer than ADHD drugs like Adderall and Ritalin, there are some side effects associated with this drug. These may include things like drowsiness, back pain, headache, nausea, nervousness, stuffy nose, diarrhea, anxiety, dizziness, upset stomach, and sleep issues.
Most of these are usually mild, but there is also the potential for some more serious side effects, such as serious skin rash or allergic reactions, hives, mouth sores, blistering or peeling skin, swelling of the face/eyes/lips/tongue/legs/throat, trouble swallowing or breathing, fever, and shortness of breath.
If you are looking for an Adderall alternative medication to treat adult ADHD, consider talking to your doctor to find out if Modafinil is appropriate for you.
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Article last updated on: March 13th, 2018 by Nootriment
5 Comments
Hello,
I trid ritaline and since i have also anxiety, it causes me mood swings and i am anormamly gentel in the begining and after i am furious with a low mood. I think it has so much sidd effects on my moid and anxiety. Is modafinil better? Or adrafinil?
Please respond i m lost, help me:)
I would certainly give them a try. Try as many things as you can and see if one works. You probably wouldn’t have mood swings with modafinil/adrafinil.
There are a lot of interesting comments in the article, however, I haven’t been able to identify the source within the given sources that provides the following details…
“90% of Modafinil prescriptions are for off-label condition such as ADHD” (this doesnt state ADHD alone and may only make up a small fraction of cases)
and
” The rash was diagnosed by his doctor as Stevens-Johnson syndrome”
Can anyone find this info,thanks
Hi Jimmy,
The 90% figure was provided in a report by Cephalon and is cited at https://books.google.ca/books?id=v3D-CAAAQBAJ&pg=PA60&lpg=PA60&dq=90%25+of+Modafinil+prescriptions+are+for+off-label+condition&source=bl&ots=J0y9dHGfgs&sig=fs0YMM80sTumpd5-kcxqbIFcZro&hl=en&sa=X&ved=0CCsQ6AEwAmoVChMIh8HlkejGxwIVj3-SCh3dcgea#v=onepage&q=90%25%20of%20Modafinil%20prescriptions%20are%20for%20off-label%20condition&f=false
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3221356/ also provides data from a patient survey in which less than 1% reported they were taking it for an approved on-label usage. However, this survey didn’t specifically poll on ADHD/ADD.
VERY IMPORTANT:
If you are taking a form of birth control, please check with your doctor before using modafinil!!!!
It can reduce its efficacy, and the effect on unborn children has not been assessed.