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Updated August 05, 2015.

Plenty of people abuse cognitive-enhancing or psychostimulant drugs in a nonprescription capacity in order to increase productivity, combat fatigue and help with intellectual challenges.  Although abuse of cognitive-enhancing drugs like amphetamine, methylphenidate and modafinil (Provigil) is typically associated with university students--an estimated 7 to 20 percent of U.S. college students have reported abusing the drugs--other more surprising groups of people abuse these drugs, too.


  For example, 8.9 percent of surgeons surveyed in Germany reported nonprescription use of cognitive-enhancing drugs.

Modafinil (Provigil) is supposed to be less addictive than other psychostimulants like amphetamine; however, we still don't understand exactly how this drug works or its long-term effects.  Moreover, modafinil can cause some serious adverse effects and should be taken only when prescribed by a physician.

 

What is modafinil?

 

Modafinil is sometimes called a "wakefulness-promoting agent."  Researchers believe that this drug works by increasing synaptic availability of neurotransmitters like monoamines, catecholamines, dopamine, serotonin, adenosine, histamine and noradrenaline.  Modafinil effects the hypothalamus, hippocampus, and amygdala which are parts of the brain.

Modafinil is a tablet taken by mouth usually once-a-day.  Most people who work during the day take the drug in the morning on either a full or empty stomach. However, shift workers who take the drug to promote wakefulness take the drug before their shifts begin.

 

 

What does modafinil treat?

 

Modafinil is used to treat problems with consciousness, arousal and wakefulness.  Some conditions treated with modafinil include the following:

• narcolepsy
• shift-work sleep disorder
• obstructive sleep apnea
• traumatic brain injury
• adjuvant treatment of depression
• ADHD
• palliative or end-of-life care

With respect to palliative or end-of-life care, many specialists choose to prescribe psychostimulants like modafinil because they improve mood faster than psychiatric medications.  Furthermore, dependance is of less concern during end-of-life care.

 

What are the adverse effects of Modafinil?

 

Moafinil's most common adverse effects include the following:

• vomiting
• nausea
• agitation
• anxiety

Other adverse effects include the following:

• insomnia
• diarrhea
• constipation
• sweating
• hoarseness
• difficulty breathing
• chest pain
• irregular heartbeat
• suicidal ideation (thoughts of suicide)
• hallucination
• rash
• blisters
• hives

Some of these adverse effects are scary and dangerous so be sure to contact your physician if you experience any of them.

Additionally, some of these adverse effects such as insomnia, restlessness, chest pain, nausea and confusion may result from overdose with modafinil.  If you suspect overdose, call emergency services or contact a physician immediately.

 

What are some contraindications for modafinil use?

 

Modafinil isn't for everyone, and before your physician prescribes you this medication, you should inform her of the following:

• allergy to modefanil or armodafinil (an enantiomer of modafinil);
• antidepressant medications including SSRIs, TCAs and benzodiazepines;
• antiseizure medications like phenytoin and carbemazapine;
• antifungal medications like itraconazole and ketoconazole;
• illicit drug abuse or dependence;
• vitamins, nutritional supplements and herbal supplements.

People who have angina or recently had a heart attack shouldn't be given modafinil.  Furthermore, it's unclear the effect that modafinil has on seizure threshold.  Thus, modafinil may be dangerous in people with epilepsy and other seizure disorders.

 

There are no long-term studies on the effects of modafinil on the brain.  A physician must carefully consider whether to prescribe modafinil and weigh the benefit of its stimulant properties with potential adverse effects.  Although modafinil is probably less addictive than other stimulants like amphetamines and methylphenidate, it still can likely lead to dependence. 

Every time a physician makes the decision to prescribe modafinil, this decision is patient specific. In other words, if you're prescribed modafinil or any other psychostimulant, this prescription is only for you.  You shouldn't share or sell modafinil--or any prescription drug for that matter.  Such diversion is harmful and illegal. 

<sub>Selected Sources

Liu D, Norman MA, Singh B, Lee K. Depression & Other Mental Health Issues. In: Williams BA, Chang A, Ahalt C, Chen H, Conant R, Landefeld C, Ritchie C, Yukawa M. eds. Current Diagnosis & Treatment: Geriatrics, Second Edition. New York, NY: McGraw-Hill; 2014. Accessed July 27, 2015.

Siu G. Pharmacotherapy. In: Maitin IB, Cruz E. eds. CURRENT Diagnosis & Treatment: Physical Medicine & Rehabilitation. New York, NY: McGraw-Hill; 2015.  Accessed July 27, 2015.

Article titled "Prevalence of cognitive enhancer use among New Zealand tertiary students" by S Ram and co-authors from Drug and Alcohol Review published in 2015.  Accessed on 7/27/2015.</sub>