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Provigil (Modafinil) Side Effects, Withdrawal and FAQs

Provigil (modafinil) is a CNS stimulant with similar effects to cocaine and amphetamines.
Marketed for shift workers, astronauts and military personnel to stay awake, and to treat narcolepsy disorder, modafinil is a Class IV controlled substance in the US, and its use is banned in Olympic sports.

Provigil, the brand name for the generic modafinil, has a troubled history concerning certain severe side effects and withdrawal symptoms associated with the drug, and questions that arose when various efforts began to promote the drug for non FDA-approved usages, such as treating ADHD in children (which use was ultimately denied FDA-approval), or as a “smart drug”, and other uses.

Individuals may want to thoroughly research the drug either before starting to take it, or to address safety concerns especially in the case where adverse symptoms may have led to considering quitting the drug. The most frequently asked questions section below may provide a good starting point for such research. More information is freely available on request.

What is Provigil (Modafinil) Used For?

The FDA-approved uses for Provigil (modafinil) are to treat the following conditions:

  • NARCOLEPSY: excessive sleepiness, especially that occurs spontaneously or unexpectedly during normal waking hours
  • SWD: shift work sleep disorder
  • SLEEP APNEA: a sleep disorder involving intermittent airway stoppage and frequent snoring episodes, associated with oxygen deprivation and certain heart conditions

The drug is also used “off-label” for wakefulness, for instance; students needing to stay up all night in preparation for exams, or at the workplace if an energy boost is desired that is long lasting, even through the next day.  More information on this topic is below.

NOTE: ALL PEDIATRIC USE OF PROVIGIL IS BANNED BY THE FDA. IN EUROPE PRESCRIBING THE DRUG TO ANYONE UNDER THE AGE OF 18 IS RESTRICTED.

Provigil (Modafinil) Alternative Names and Slang

Stimulant drugs are popularized on the street, and have also become increasingly common in workplace settings, in schools, and in military use to keep soldiers awake during long-duration missions. Slang terminology refers to these types of drugs as go-pills, uppers or speed.

Modafinil is the generic name and is sold and prescribed under numerous trade names, including Provigil, Modiodal, Movigal, Alertex, Intensit, Vigil, Wakelert, Modiwake, and many others in various countries.

Perhaps in an attempt to continue to promote non-FDA approved use, Provigil is also referred to in certain literature as a “cognitive enhancer” or a “smart drug”. Provigil has been added to a group of stimulants called nootropic drugs. Ritalin is one example of this drug class, which is promoted “off-label” as a cognitive enhancement drug.

The drug may sound like a good idea but does come with risks. Due to the possibility of life-threatening side effects, adverse reactions need to be carefully watched for.

The drug has never been FDA approved for prescribing to children.

Provigil (Modafinil) Side Effects

Some side effects of Provigil are severe and can be life-threatening requiring immediate medical intervention regardless off age. The drug can produce a wide range of reactions, including these:

  • Suicidal thoughts, thoughts of self-harm, suicide attempt
  • Stevens – Johnson syndrome: a potentially life-threatening condition caused by medication that first causes flu-like symptom, followed by raised welts which blister, painfully burst and form dark crusts. The face, mouth, eyes, throat, and the entire body can be affected. The condition needs immediate emergency care either in a burn unit, or hospital with ICU.
  • Mood changes that occur abruptly or without observable cause
  • Depression
  • Anxiety
  • Agitation
  • irritability
  • Shortness of breath
  • Confusion
  • Insomnia
  • Decreased appetite
  • Uncharacteristic aggression, energy, talkativeness
  • Swelling in the legs, face, eyes, throat, tongue or other areas
  • Allergic reactions such as hives, itching skin, redness
  • Hallucinations
  • Drug-induced psychosis: this can be confused with other forms of psychosis and be inadvertently treated with antipsychotics.
  • Fever
  • Dizziness
  • Dark colored urine
  • Unusual bruising or bleeding
  • Congested or stuffy nose
  • Headache
  • Insomnia
  • Tachycardia: racing heartbeat, pounding heartbeat
  • Heart palpitations (irregular heartbeat)
  • Respiratory depression, difficulty breathing
  • Chest pain
  • Emotional blunting, inability to feel pleasure or other usual emotional response
  • Increased liver enzymes
  • Tingling or numbness in the hands or feet

 

Provigil (Modafinil) Withdrawal Symptoms

Some individuals have reported an absence of any significant withdrawal symptoms on stopping the drug.  Clinical trials on the topic are scarce; however, one study showed a correlation between discontinuation and the emergence of life-threatening symptoms.  (1)

These were reported to be:

  • Stevens-Johnson syndrome, a serious allergic reaction requiring immediate medical intervention in a burn unit or ICU
  • Multi-organ hypersensitivity ( a sometimes fatal condition of allergic reaction to various internal organs such as liver, kidneys, blood vessels, etc.)
  • TENS: Toxic Epidermal Necrolysis (a potentially fatal skin condition characterized by swelling and sepsis and/or death)
  • DRESS (drug induced rash with eosinophilia, meaning abnormally high white blood cell count) and other systemic symptoms requiring emergency medical treatment.

IMPORTANT NOTE ON PROVIGAL (MODAFINIL) WITHDRAWALS: The FDA recommends to immediately stop the drug if signs of a rash appear and seek medical attention at once. The study also reported that discontinuation did not prevent a rash from becoming life-threatening, nor did it prevent life-long disfigurement or becoming disabled as a result. (1)

Where emergence of a rash or other severe or life-threatening adverse effects require withdrawal, such as Stevens – Johnson syndrome, hallucinations, psychotic episodes, etc., the process would be best managed for safety reasons, in an inpatient setting, where adequate monitoring and treatment are readily available.

Discontinuation symptoms can appear within some hours, days or even weeks after the drug is stopped, and include the following according to FDA-required labeling information:

  • Lethargy
  • Emotional blunting, inability to feel pleasure
  • Anxiety
  • Insomnia
  • Angioedema (swelling beneath the skin or the mucous membranes)
  • Anaphylaxis (swelling of the throat, face, tongue, eyes, lips, larynx, difficulty breathing, hoarseness, difficulty swallowing)
  • Agitation and rage episodes
  • Psychosis, hallucinations, agitation, mania

Discontinuing/Quitting Provigil (Modafinil)

Coming off a prescription drug like Provigil sometimes needs to be done without delay when taking the drug has induced a life-threatening reaction; however, this must only be done in a medical setting where risk to life can be mitigated, as in an ICU.

The drug is reportedly easily found and purchased online, where safety information is not adequately provided. This is important to note, where young people can become vulnerable targets, especially if they feel under pressure to perform well in school and are lacking guidance and direction towards better solutions.

In some situations, a person may intend to keep their use of Provigil undisclosed; thereby resulting in possible tragic health consequences as proper treatment may not be able to be administered appropriately because the immediate causative agent remains unknown.

Provigil (Modafinil) FAQs

Several questions regarding Provigil can be hard to find definitive answers for, but such information is nonetheless vital to ensure personal safety and health.

In the below section, we have attempted to provide information on some of these questions as much as possible concerning some of the legal issues, mechanism of action, and other frequently asked questions.

An individual may want to better understand and resolve such questions before engaging in taking Provigil or other brand name and generic equivalents.

Is Modafinil Legal?

Different countries have different legal positions on the purchase and distribution of modafinil, some of which are described briefly here:

US have classed Modafinil as a Schedule IV controlled substance that only a DEA registered importer can bring into the country without a prescription. A US resident is limited to bringing in a maximum of 50 pills from a foreign country in person only, for personal use.

NOTE: Schedule IV drugs are considered low risk for abuse and addiction, yet many find this drug highly addictive and it is often abused.  

UK laws regulate the drug as only available by prescription and only to persons age 18 or older.

China laws ban the drug from any medical or prescription use, making the drug illegal to possess.

Japan laws classify the drug as a Schedule 1 (illegal, no medical use) psychotropic drug, which is illegal to import. Comparable Schedule 1 drugs are heroin, LSD, etc.

Russia has regulated modafinil as a Schedule II substance, meaning it has high potential for abuse and addiction, similar to cocaine or morphine. Possession of just a few pills can result in a lengthy prison sentence.

Australia regulates modafinil as legal with prescription only for human or animal medical use.

Canada lists modafinil as an uncontrolled schedule F substance, meaning that the drug will be seized by border/custom officers on attempting to import the drug.

Scandinavian countries also list the drug as prescription only.

Mexico laws consider modafinil as an uncontrolled substance, meaning it can be dispensed and purchased without a prescription. Within the borders of Mexico the drug is legal, but crossing borders with it would be subject to the laws of the country of entry.

Before traveling to any country or crossing borders with a prescription drug, it is highly advisable to check with customs laws before travel.

Is Modafinil A Stimulant?

Yes, although the drug is not classified as a stimulant per se. Modafinil is used to help people suffering from narcolepsy to stay awake during normal waking hours. It is also used to stimulate and prevent drowsiness for shift workers, and to stimulate alertness of soldiers or others who need to stay alert and awake for long periods of time.

Modafinil and other prescribed stimulant drugs, like the stimulant drug Ritalin, have been included in a relatively new class of drugs called “nootropics”. Nootropic drugs are promoted as cognitive enhancers, whose popularity has been seen to expand with executives, college students, and others who may want to improve mental sharpness, while reducing the need for sleep.

Ritalin, modafinil and other drugs in this class all act as stimulants, which can make the user feel brighter, euphoric and reduce the need for sleep. However, there is a growing body of evidence showing that over time, a sleep-deprived, artificially boosted level of energy can result in significant injury and degradation to mental and physical health. This drug is recommended to be taken only for specific sleep disorders for health and safety reasons. (2)

Is Modafinil a Narcotic?

Yes, and no. A narcotic, by definition, is an illegal drug which affects mood or behavior, and is sold for non-medical purposes.

Since modafinil does affect mood and behavior, and is sold for non-medical purposes as well as medical purposes, and is sometimes sold legally and sometimes illegally, the context and geography relating to the user and the purpose of use would be the deciding factors.

The Library of Congress defines Provigil and modafinil not as narcotic drugs or even as “stimulants”, but as “wakefulness promoting agents”. (3)

However, some believe that such polished or academic definitions may have the questionable effect of promoting these drugs without the glaring stigma associated with narcotics and stimulants. This may mislead some into discounting the health liabilities associated with potential abuse of the drug.

Is Modafinil a Dopamine Agonist?

While Modafinil is not a strong dopamine agonist in the same way as cocaine is, Modafinil may act, at least in part, as a dopamine agonist, meaning it can act in a similar dopaminergic fashion. The drug has a rather complex and not entirely understood psychokinetic mechanism as regards dopaminergic and other types of CNS neurotransmitter/receptor action.

The drug induces or activates histamine and certain proteins and enzymes and may influence some neurotransmitters, similar to but weaker in action than cocaine. The dopamine transport mechanisms being blocked (causing accumulation in the nerve synapses) can result in euphoria and other effects. The exact dopaminergic action of Provigil or modafinil is thought likely better explained by some other not yet understood mechanism, as only a negligible dopamine agonist effect has been established, which action is observed to be significantly weaker than that seen in other stimulants.

These various chemical processes that the drug influences can combine, synergistically contributing to an elevated sense of energy and brightened mood and euphoria that is associated with this stimulant drug. More research is needed to further explore the exact psychokinetic action on the brain and highly complex central nervous system.

How Long Does Modafinil Stay in Your System?

The half-life of modafinil is roughly 15 hours, according to the patient instruction pamphlet that is given out with a prescription to the drug in the UK. (2)

The half-life of any medication, including Provigil or modafinil can be affected by individual genetics, which will affect the rate of metabolism, any kidney or liver efficacy issues, and certain other health factors.  The slower the rate of metabolism, the longer the half-life can become.

Does Modafinil Show Up on Drug Tests?

Here is some information on modafinil or other brand name versions and drug test results:

  • Modafinil breaks down into several types of metabolites. Some of these metabolites clear faster than others.
  • These inactive metabolites can test positive on plasma, serum or urine drug tests for up to 30 hours after ingesting Provigil.
  • Routine drug testing, for instance routine drug testing at a place of work, does not usually include testing for modafinil.
  • Special testing panels and other methods of testing for the presence of modafinil can be utilized such as liquid chromatography, gas-based tests, or other specialized testing methods.
  • False positives for methamphetamines or other stimulant drugs are not likely to show up on a modafinil drug test because their structure differs significantly. However, Ritalin, Adderall and Concerta all have similar structures to methamphetamines, and therefore that is why these can test as a false positive to amphetamines, because they are so similar. Because of the difference in structure, there cannot be a false positive for amphetamines on a modafinil test.
  • If you are an athlete, testing for doping agents is common and so a drug test would most likely be used that was specifically designed to detect this substance. (4)

Nuvigil vs. Provigil How Are they Different?

Nuvigil is the brand name for the generic drug armodafinil, a variation of modafinil. There are similarities between Nuvigil and Provigil, i.e. both are prescribed to promote wakefulness. However, there are also some differences:

  • They have slightly different chemical structures.
  • Nuvigal pills start at 50mg and increasing by 50mg up to 250mg maximum. Provigil pills come in only two strengths, either 100mg or 200mg.
  • Nuvigil tablets are round and white, Provigil tablets are elongated and white.
  • Beyond these slight differences, there is no great dissimilarity between the two drugs.

Treatment for Provigil (Modafinil) Abuse and Addiction?

If a person has found the adverse effects of Provigil have outweighed the benefits, we can help a person to safely recover. One strategically important part of recovery that is sometimes overlooked is the advantage of being able to discover and fully address the root causes of symptoms that led to taking prescription drugs in the first place.

For instance, if the causes of lack of energy or sleep disturbances were never exhaustively searched for, and fully addressed, these problems can likely return after stopping the prescription, leaving a person in roughly the same shape or perhaps worse off than before. The root causes can be discovered through lab testing and other diagnostic measures and can be resolved through non-drug means, including testing for and clearing toxic burden out of the body, rebalancing chemistry in the body through targeted nutrition and supplementation, learning de-stressing techniques, and many other actions.

Please contact us at the Alternative to Meds Center for more detailed information on how our program can help with possible lingering after effects of Provigil, and assist in regaining robust energy and good health that lasts much longer than the temporary effects of drugs that did not satisfy your health goals fully.


This content has been reviewed, and approved by a licensed physician.

Dr. John Motl, M.D.

Dr Motl is currently certified by the American Board of Psychiatry and Neurology in Psychiatry, and Board eligible in Neurology and licensed in the state of Arizona.  He holds a Bachelor’s of Science degree with a major in biology and minors in chemistry and philosophy. He graduated Creighton University School of Medicine with a Doctor of Medicine.  Dr. Motl has studied Medical Acupuncture at the Colorado School of Traditional Chinese Medicine and at U.C.L.A.

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