- #20401 November 5, 2006 at 8:57 pm
Good afternoon. I am dropping by this forum to offer some insights about Provigil (modafinil). I can assure you that I am not associated with Cephalon, and that will be obvious from my comments about the drug. However, I have done quite a bit of research into the various studies on the drug.
• When Provigil stops working for you, try taking 1-3 days off from the drug.
• Alternatively, try lowering your dosage to 75% of what you found originally effective.
• Taking more Provigil doesn’t usually solve the problem in the long term.
• Don’t take more than 600 mg/day. If you’re taking more than 400 mg/day, monitor your blood pressure.
1. Modafinil in General
2. Some Precautions
3. Theory: Why Modafinil Stops Working
1. MODAFINIL IN GENERAL
My top priority here is accessibility, not completeness and precision. If you would like to know the longer version of the story, I recommend doing your own research.
Adrafinil, a.k.a. Olmifon, was discovered in the 1970s. Adrafinil is uncontrolled. You don’t need a prescription for it. It’s also unpatented. You can get it for cheap.
Adrafinil breaks down into Modafinil (and some other stuff). That other stuff causes side effects in some people: stomach aches and skin irritation. If you use it for several months, you should have your liver enzymes checked; it may alter how you metabolize other drugs. Any change in liver enzymes disappears after you stop taking it, though.
Modafinil breaks down into l-modafinil and d-modafinil (and some other stuff). Both l-modafinil and d-modafinil have stimulant effects. They both reach their peak levels after 1.5 to 2.5 hours (in most people). L-modafinil lasts much longer than D-modafinil; it has a 12-ish hour half-life. D-modafinil’s half-life is 3-ish hours.
L-modafinil, a.k.a. R-modafinil, a.k.a. Armodafinil, a.k.a. Nuvigil® is going to hit the market early 2007, supposedly. When isolated, Cephalon claims that l-modafinil takes a little longer to peak (5-6 hours). This “smoothes out” the day.
400 mg adrafinil ~= 200 mg modafinil ~= 100 mg armodafinil.
Adrafinil is super cheap because it’s unpatented and doesn’t require a prescription in the US.
Modafinil is super expensive (~$8.50/200mg) until 2011 when it will become slightly cheaper (as the result of some complicated lawsuit settlements with generic manufacturers) until 2014 when it becomes completely generic.
Armodafinil will likely be super expensive as well.
NOTE: Modafinil is available from overseas manufactures as Modalert, Modatec, and several other brands for about $1.50 (US patents don’t apply in India). Be careful because (a) it is technically illegal to import these, but a 90-day personal supply is usually forgiven by customs, and (b) these products are legitimate, but some overseas pharmacies sell counterfeit versions. Do a lot of research. I can’t help you here, for legal reasons.
2. SOME PRECAUTIONS
As I’m sure most of you know, the FDA-approved dosage is 200 mg for narcolepsy. Cephalon’s (publicly) recommended dose is a maximum of 400 mg. Whatever.
Take extreme caution in exceeding 600 mg per day. Cephalon’s Phase 1 trials tested out 600 mg/day and 800 mg/day and found that 800 mg/day was unsafe due to blood pressure and heart rate changes.
If you insist on taking 600 mg/day or more, check your blood pressure and heart rate often. You can get an automatic blood pressure and pulse monitor from Omron for $55 from Amazon.
If your blood pressure is 140/90 to 180/120 (either number within that range), see a doctor about getting medicine for high blood pressure. Or reduce your dosage. If your blood pressure is between 180/120 and 220/140, seek immediate attention. If your blood pressure is over 220/140, go to the emergency room.
3. THEORY: WHY MODAFINIL STOPS WORKING
First of all, Cephalon will never admit that this happens. In fact, they’ve funded several studies to prove that people don’t develop a tolerance to modafinil. But read some anecdotes online; something is wrong.
Most people find modafinil effective on the first day (given 200 mg/day). Very effective. After that, it’s iffy. For many, it stops working by the third day. For others, it stops working after 3 weeks. For others still, it stops working after 6 months. For the lucky few, it works for over 2 years.
I have two theories as to why that might be.
THEORY A: Modafinil becomes ineffective when you have too much of it in you.
Modafinil has a long half-life. 24 hours after you take the first dose, you still have some amount of the drug left in you. When you take it every day, the modafinil levels keep on building up.
After 4-7 days, you reach a “steady state” level. This level is around 30% higher than a single dose, depending on individual factors. Thus, taking 400 mg for a week is like taking 520 mg for the first time.
If this is true, then raising the dose is the wrong solution. But that’s what people seem to be doing. 200 mg stops working for them after a week, so they go to 400, then 600, then get frustrated and quit.
If this theory is correct, then:
- (a) Raising your daily dose should not relieve your symptoms any more.
(b) After a 1-3 day “drug holiday” off modafinil (taking no modafinil at all), it should work as well as the first time when you take the same dose as the first time [200mg].
(c) Reducing the daily dose by 25% should relieve symptoms. For example, if 200 mg was effective on the first day, then taking 150 mg every day for a week should get back to that level. (150 * 130% = 200; plasma levels are dose-proportional)
THEORY B: Modafinil affects your sleep architecture.
This was briefly mentioned in a couple of studies that I’ve read, but I haven’t looked into this in depth.
The theory is that, when you take modafinil every day, your “trough levels” (the level in your body every morning before taking it) get high enough that it affects your sleep. If your sleep becomes less restful, this would make you more tired the next day.
If this theory is correct, then:
- (a) Raising your daily dose should not relieve your symptoms any more. (In fact, it might make them worse over the next few days.)
(b) A 1-3 day drug holiday, with plenty of rest, should make modafinil start working again when you resume.
(c) Reducing your daily dose might not help.
As an off-topic comment: Modafinil can stop working for anyone, not just people with sleep problems.
DISCLAIMER: I am not a doctor. This is not medical advice. I do not recommend using this information for the basis of any decision. Consult your doctor before making any medical decision.
If any of you decide to try this stuff (under supervision, of course…), reply and indicate how it goes.#128904 November 6, 2006 at 1:14 am
I’ve been on 200mg of modafinal for about three months. 100mg in the morning and 100mg at noon. It has worked very well thus far for me. Originally I started with 100mg in the morning, but would fall alseep in the afternoon, the extra 100mg at noon really helps though. I still feel bad whenever I can’t sleep the previous night, but I am far more alert and I don’t constantly nod off throughout the day anymore.
In my case modafinil greatly helps with the EDS, but isn’t the complete solution, since I am unable to sleep many nights.#128905 November 6, 2006 at 2:10 am
I’ve been on 200mg of modafinal for about three months… It has worked very well thus far for me.
That’s good to hear, Sahhah3. This topic concerns those who found Provigil effective before it stopped working. This could very well happen to you after a while. If it does, please come back and tell me about it– especially if you decide to try one of my recommendations from before.#128906 November 6, 2006 at 3:57 am
I was on 1000mg per day. It still wasn’t helping. So increasing it really did nothing but cause stress because I had to fight with my insurance company to agree to pay for it. Now I’m on Dextroamphetamine. That is not much better. I am home recuperating from major back surgery. So here is my schedule. Wake up 7:30am. I take 30mg of Dex. Then around 10:00 I fall back asleep until about 1:30 in the afternoon. I get up, shower and get dressed. I go for a walk. Then I fall asleep again around 7 or 8 pm for an hour or so. Not on purpose. Just pass out. Then I am awake until 4 or 5 a.m. It is horrible. It wasn’t any better on the Provigil. I was taking Ambein CR before my surgery but can’t take it now because of other medication I am taking for my back.#128907 November 6, 2006 at 5:27 am
I have been on Provigil since January of 2005 and I love it. It works well for me. I started out taking 200 mg in the AM. But it wasn’t quite good enough so we doubled it and that helped. It also isn’t the complete picture for me. I find when I am on a good med that helps with getting me restfull sleep at night (I have had very brief sucess with benzos and a short lived but wonderful time on the combo of topamax and flexeril. Still on both, just that the topamax no longer does all the great sleep stuff) and on the provigil I do pretty well, and I can get by on nine hours at night and stay awake during the day mostly. I suspect adding a short term stimulant like adderal on those extra sleepy days would help even more.
I was recently diagnosed with narcolepsy. Before that I could not afford a sleep study and we assumed I had some bad hypersomnias and/or possible idiopathic hypersomnia. With sleep apnea being a slight but seeminly unlikely possibility. Well I have narcolepsy. And I have sleep apnea. And I have some hypersomnias. I am also on CPAP now and it makes me more sleepy.
Anyway since the diagnosis I have been breaking up the provigil dose into taking it two times a day. Once when I first get up and then again before lunch and I will take a nap around lunch time. Taking it this way helps with the afternoon nodding off and sleepiness.
Since I started taking it I have always had breaks from it. Some of these were intentional- a day here or there where I decided I would be lazy and sleep and read in bed. Some of these were days when I had the stomach flu. Or there were times I couldn’t get provigil due to cost. I was a poor college student with no prescription insurance so I relied on the wonderful program from NORD for my meds. But I had a big break for a while when I sent my reapplication in a little late and then another form was lost or something… I also took a break the week before my sleep study.
I find it is still effective for me. Without it I have quite a hard time maintianing any sleep schedule at all- its all over the place. With it I do have some semblance of one and I gives me more control over staying awake and it decreases my EDS.#128908 November 6, 2006 at 7:00 am
I started on 100 mg of Provigil in 2003. Eventually worked up to 1000mg. I also have OSA. I use a dental device because I could not get use to the CPAP. I tried for over a year. The Dr. said I may have to go back on the Provigil. I don’t know how much higher they could go on the Dextroamphetamine. It’s a rough cycle. Meds to stay awake and meds to go to sleep. I have memory problems. I’m recuperating from back surgery so I am sleeping on and off a few hours here and there. I’m in a hospital bed and can only walk and do some gentle physical therapy. So laying in bed all day knocks me out. I was off the meds for about 6 weeks and it was bad. I only started them again so I don’t sleep 20 hours a day. I just switched doctors because the last one stopped listening to me. He told me that my sleep study said I was fine to drive. I told him that I am in a car two minutes and I want to close my eyes. His answer was “well the test say you are okay”. Sure the Multiple Wake test was fine because all you do is sit on the bed with the tv off while on 1000 mg of Provigil and 20 mg of Ritalin. Of course I stayed awake. Although I know I drifted off but it didn’t register. If they simulated driving then forget it. They would have yanked my license if I failed. Maybe he was helping me. He wanted me to start Xyrem but it scares me. His answer was “that is all I can do for you. There is nothing else”. My new dr. is reviewing all the paperwork so maybe he has a miracle for me.#128909 November 6, 2006 at 7:01 am
I was on 1000mg per day. It still wasn’t helping. So increasing it really did nothing but cause stress because I had to fight with my insurance company to agree to pay for it.
Please read the original post.
I am suggesting that less of Provigil is the solution, not more. Also, 1000 mg is unsafe and usually causes severely high blood pressure (if not many cognitive side effects).#128910 November 6, 2006 at 7:40 am
Honestly I could not concentrate enough to read the entire post. I was just talking about my problems. I will go back and read it when I have a clear head.#128911 November 6, 2006 at 2:02 pm
Hessie, I would be happy to talk to you about my experience with Xyrem if you are interested. I was very apprehensive in the beginning, but it has definitely made a difference in my life.#128912 November 7, 2006 at 4:12 am
Thanks. I’m not ready yet. It just seems so scary. I have OSA. Can you wake up if there is an emergency. Very scary. Thanks for the offer. If they suggest it again I’ll take you up on your offer.#128913 November 7, 2006 at 2:53 pm
It is illegal to purchase prescription drugs from pharmacies outside the US.
Additionally, I highly recommend consulting your doctor prior to making any changes in your drug regimen. This includes but is not limited to dosage, frequency of dosage, drug holidays, supplements, over the counter medications, etc. This is a patient message board and should not substitute for medical advice.#128914 November 7, 2006 at 6:03 pm
It is illegal to purchase prescription drugs from pharmacies outside the US.
Additionally, I highly recommend consulting your doctor prior to making any changes in your drug regimen. This includes but is not limited to dosage, frequency of dosage, drug holidays, supplements, over the counter medications, etc. This is a patient message board and should not substitute for medical advice.
Thank you for reiterating these points. I did note them in my original message.#128915 November 8, 2006 at 9:48 pm
I also have my own theory based on my experience. I will share it with you.
No Provigil is best because I found Provigil to be completely useless for my EDS. I’ve never taken more than the prescribed dosage of 200mg. In fact, I’ve mentioned to my sleep doctor that Provigil does nothing for the EDS, and therefore, I’d rather just not take any at all.
How can a drug that is so expensive be so useless?
Cindy#128916 November 8, 2006 at 10:19 pm
I agree. I was on 1000 mg which cost $1300.00 per month. I only paid $10.00 but had to fight the prescription company constantly to pay for it. But, the Dextroamphetamine is not much better. I’m on 30 mg. I’m sleeping all day and up all night. I went to bed at 4:30 a.m.. I woke up at 7:30 am because the cats were chasing each other. Then I fell asleep at 12:30 in the afternoon until 3:30. Now I’ll be tired around 8pm. and up until 4 am. again. It’s a vicious cycle. At least on the Provigil I went to bed earlier. Still on 1000 mg I was exhausted. I was working though. I’m still home recuperating from the back surgery. I can’t drive yet so that is not an issue.#128917 November 26, 2006 at 2:44 am
Now this is VERY interesting. My regular family dr told me that it’s VERY unusual to develop a tolerance to provigil. My neurologist recommended xyrem. So, I took Xyrem for about 7 months but the side effects were KILLING me, so I stopped. But now, I’m taking the provigil again, and not having any problems! Hmmmmmm. I guess we will see, huh?
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