What is modafinil and how does it work?
In 1998 the FDA approved a “wakefulness promoting” drug, modafinil, under the brand name Provigil.
The chemical components of modafinil are known. However, the mechanics of how modafinil works are unknown.3 Though its effects are somewhat similar to stimulant drugs such as cocaine and amphetamines, the physiological pathways affected are dissimilar.
According to the label, modafinil mainly influences 3 neurotransmitters, namely dopamine, norepinephrine, and histamine. Modafinil also acts weakly on some other receptors, including serotonin, GABA, melatonin, adenosine, and possibly others. These and other potential interactions are not completely mapped or understood, even decades after modafinil’s FDA approval.4
Why is modafinil prescribed?
Modafinil was initially approved to treat 2 conditions, sleep apnea and narcolepsy. In 2022 or earlier, approval to treat SWD (shift work disorder) was added.4,9
With sleep apnea, a person can be chronically tired from the airway collapsing during sleep, resulting in sleep loss and daytime sleepiness. There are oral devices that have been designed to keep the airways open. Surgical interventions and weight loss are sometimes recommended as alternatives to drug therapy.10
In the case of narcolepsy, and shift work disorder, a person’s sleep/wake cycle has become dysregulated and the person may fall asleep unexpectedly during normal waking activities. In these cases, modafinil has been used as a “work-around” to avoid the negative consequences of falling asleep at random times while working, or even while driving or operating machinery.
Off-label Uses of Modafinil
There is a difference between approved and non-approved uses, collectively termed “off-label” prescribing. It’s not illegal to prescribe a drug off-label, but off-label uses have not been tested in clinical trials. These uses are also subject to modafinil withdrawals if the drug is discontinued, most markedly if the drug has been taken for a long time, or at high dosages.
Modafinil can cause intensified emotions and adrenal overstimulation. A doctor may elect to prescribe modafinil along with antidepressants to patients who suffer from what is called “treatment-resistive depression.” That means a person has tried several antidepressants without a successful outcome.11
A doctor treating a patient with schizophrenia may prescribe modafinil to counter-act weight gain, or the lethargy and flatness associated with most antipsychotic medications. In theory, that sounds well and good, however, modafinil can significantly neutralize the potency of other medications. This can precipitate a sudden or gradual relapse of symptoms, and overstimulate the CNS, all of which can be disastrous.7
In off-label use, stopping the drug can result in modafinil withdrawal symptoms, especially if stopped abruptly.
So-called Smart Drugs and Modafinil Withdrawal
Drug-makers of Modafinil (and about 100 other drugs currently in the pre-approval stage) are exploring modafinil as a drug that enhances cognitive ability in healthy people. Let us hope that greed doesn’t cause a whole new chapter to be added to the book of drug industry fiascos. 
The lack of research on the long-term effects of “smart drugs” is concerning, as is the ease of buying pharmaceuticals online without medical or quality oversight.1,2,13,14,18
Theories about “smart drugs” became popularized in the 1970s, when a wave of “cognitive enhancers” (nootropics) began to be introduced. Interestingly, the rise in this off-label marketing of “cognitive enhancers” including the ADHD stimulants, modafinil, and others, parallels the collapsing educational standards in the US. Contrary to the “smart drug” branding, these drugs do not actually make people smarter. There can be a perception or belief of increased sharpness, focus, clarity of thought, etc., however, clinical testing shows this to be more imagined than real.6
Modafinil became promoted as a drug that could allow a busy executive or computer programmer to perform at top speed for long hours, despite lack of sleep, or proper meals. Sort of like a “coffee fix” but on steroids. Students existing on a diet of empty calories, using modafinil for late night studying, especially before exams, could encounter a variety of negative consequences. If using the drug became habitual, one of those consequences would be experiencing modafinil withdrawal symptoms when the drug is stopped.
Modafinil Side Effects
Modafinil can increase alertness and focus in a sleep-deprived individual, but can also cause unwanted side effects that range from mild to dangerous and life-threatening for some.1
Modafinil side effects can include:
Headaches- Anxiety, nervousness
- Increased heartrate, tachycardia
- Dizziness or lightheadedness
- Insomnia
- Nausea
- Decreased appetite
- Diarrhea
- Runny nose
- Can reduce effectiveness of birth control pills
Life-threatening and rare side effects of Modafinil can include:
- Psychosis, mania
- Stevens-Johnson syndrome
- Seek immediate medical care for rashes, blisters, large areas of peeling skin
These rare and life-threatening modafinil side effects usually emerge within a few weeks of taking the drug.
Modafinil Alternatives (Drug-free)
Sleep is essential to overall good health. There are drug-free interventions for sleep-deprivation that may offer more healthy choices. Drug-free psychiatry uses plant-based nutraceuticals for treating specific ailments and symptoms that not only perform better than pharmaceuticals, but do not burden the person with harmful drug side effects.15-17
Depending on what modafinil is being prescribed to treat, drug-free alternatives can be explored to avoid the potential side effects of modafinil. These alternatives can be useful to ease modafinil withdrawal as well.
Consider the following drug-free alternatives to wakefulness-promoting drugs like modafinil:
Repair a dysfunctional thyroid- Overhaul the diet to eliminate sugars, high carb, refined, or processed foods
- Eliminate endocrine disruptors, chemicals and preservatives in foods
- Adequate protein, omega-3s, fresh fruits and vegetables
- Improve sleep hygiene, drug-free interventions for sleep apnea
- Daily exercise
- Cleanse neurotoxins from the body
- CBT and other personalized counseling
- Exposure to sunlight and fresh air
- Physical therapies to enhance energy, relaxation, mental clarity, physical well-being
- Herbal and vitamin/mineral supplements & nutraceuticals such as ginkgo biloba, SAMe, amino acids and many others
- Nebulized glutathione treatments
- IV therapy
Modafinil Withdrawal at Alternative to Meds Center
Alternative to Meds Center uses all of the above-mentioned drug-free therapies and additional personalized strategies to assist during and after modafinil withdrawal to eliminate symptoms and simultaneously promote improved health. Herbal remedies are selected carefully, and monitored so that dosage can be modified as needed.
Lab testing is used to isolate sources of imbalance or disruption in the system, so that these can be addressed in healthy ways. Managing modafinil withdrawal can be greatly eased using a wide range of physical support therapies, nutritional supplements, and orthomolecular-based diet choices.
ATMC is insurance-friendly, and we can help with the process of applying your benefits to your inpatient services at the center. Our aim is your successful outcome as well as improving your overall health during your stay and well after you leave. Call us today for more information on modafinil withdrawal services at Alternative to Meds Center.
Modafinil withdrawal symptoms are more likely to emerge after long term use. Dependence is a common difficulty that rears its head when you stop a drug abruptly. Especially in cases of high dosages, or long-term use, modafinil withdrawal symptoms are likely to be more intense compared to a gradual taper over a longer period of time.1
