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Provigil Tapering

This entry was posted in Antidepressant on by .
Medically Reviewed Fact Checked

Last Updated on August 3, 2022 by Carol Gillette

Alternative to Meds Editorial Team
Medically Reviewed by Dr Samuel Lee MD

Provigil tapering, titration, and weaning may be needed after moderate to long-term use. As with most pharmaceutical drugs, Provigil is typically prescribed without consideration of life factors, lab testing, or any in-depth discussion of effective natural Provigil alternatives.

There are a host of medical and psychosocial reasons why a person might suffer from a lack of energy. Poor diet, overconsumption of caffeine, weak adrenals, mitochondrial fatigue, lack of vitamin D, and unsatisfying lifestyle, are examples of some possible contributing factors. A brief visit to an outpatient clinic could not possibly address the deeper inquiry that may have been needed.

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Provigil Tapering

getting off provigilDespite the drug being marketed for some 23 years at present, there is limited clinical literature available on Provigil tapering. Certainly, there is a lack of exhaustive reports on phenomena associated with Provigil tapering or withdrawal. The FDA drug label for Provigil reports that after a single 9-week drug trial, no withdrawal symptoms were reported during the 14-day post-trial monitoring period after the drug was discontinued.2 However, a study in 2015 published in the Journal of Pharmacology and Pharmacotherapeutics reported the case of a 44-yr-old male who had become dependent on modafinil, the generic version of Provigil. His dependence on the stimulant was reportedly characterized by worsened lethargy, tremors, anxiety, and erratic sleep hours when he skipped the medication. To stay awake on his 12-hour work shift, his dependence eventually led him to take modafinil hourly. The withdrawal was difficult and required multiple other prescription drugs to mitigate the withdrawal symptoms. Provigil tapering was accomplished over a one-month period of time, reducing the dosage by 100mg every few days, along with bupropion and clonazepam to counter the extreme depression and amotivation (lethargy) the patient was experiencing.5

Alternative to Meds takes a different approach before, during, and after Provigil tapering by strategically addressing root causes for the original symptoms that had led to drug use in the first place. More information on methods used to repair and restore health is given below and by visiting Provigil alternatives on our website.

Why is Provigil Prescribed?

Provigil is the brand name for the generic medication modafinil. Provigil is a CNS stimulant, sometimes referred to as a CED (cognitive enhancing drug) that was FDA approved for the treatment of narcolepsy, “shift-work disorder,” and sleep apnea.2,4 According to the FDA drug label, Provigil produces euphoric and psychoactive effects similar to those of Ritalin or other stimulant drugs in humans. According to a study by Penalosa et al on US modafinil prescribing trends, there was a 15-fold increase in off-label prescriptions from 2002 to 2009. In fact, about 90% of Provigil (modafinil) prescriptions were reportedly for off-label treatment of conditions according to the study authors. These included depression, muscular sclerosis, Parkinson’s, CFS, and ADHD. Multiple US states have sued the drugmaker for promoting the prescription drug for off-label uses, but the practice continues.3

There have been hundreds of trials on rats, mice, cats, and monkeys, but only one trial was found on humans, as mentioned above, from the FDA drug label. It seems more research is needed about modafinil and the human CNS before any reliable conclusions can be drawn about safety and drug effects, especially since the mechanics of how the drug works are not known.9

Provigil Tapering Guidelines and Schedule

The safest method of tapering Provigil is in an inpatient setting, but at least under the care of a prescribing physician who has familiarity with what to expect and who can manage the withdrawal with confidence. Holistic practitioners will lean more toward addressing root causes with holistic protocols, rather than simply dampening the withdrawals with other medications.

The managing physician may need to cut the pills, which for Provigil means cutting the lowest dosage (100mg white oval tablets) in half, or smaller, as needed. Provigil has a half-life of 10-15 hours.2 The withdrawal from Provigil will occur quite soon after a tapering step. Provigil is considered easier to taper off than most SSRI antidepressants due to the neurochemicals involved. As noted above, fatigue and depression are features of Provigil withdrawal. There could also be mood alterations, as well as changes in perception and thoughts, typically characteristic of withdrawal from other stimulant drugs. There may also be possible changes to glutamate levels in the body, according to a rat study published in Neuroreport, in 1997.7 Too much or too little glutamate in the brain can have significant health consequences, such as cellular death by excitotoxicity, and should be monitored.8,10

Provigil Tapering Guidelines Include:
  • provigil tapering guidelinesYour physician may suggest a moderate dose reduction rather than abrupt discontinuation.
  • Have the smallest dose of pills prescribed to you. In this case, it is 100mg Provigil white oval tablets
  • You and your doctor can cut the 100mg pills, fractionally as in taking 3 of 4 quarters for a 25% reduction, or in half for a 50% reduction, or in half again for smaller dosing.
  • Your doctor can adjust each reduction as needed to accommodate personal sensitivity.
  • Withdrawal symptoms commonly emerge around the drug’s half-life. Provigil’s elimination half-life is 10-15 hours depending on individual variability.2 You may feel symptoms related to withdrawal the next day, and the duration of these will vary. Keeping a notebook may help to keep track.
  • Personal tolerance and life demands will determine how fast or slow the taper should proceed.
  • After a reduction, it is best to allow time to settle before making further adjustments.
  • Keep in close touch with your prescribing physician so that changes can be made according to your personal experience, tolerance, and reactions.

Sometimes a prolonged or protracted withdrawal may occur, and if it does we recommend inpatient care such as the programs delivered at the Alternative to Meds Center. Common problems such as nutritional deficiencies, interactions with other medications, toxicity, or additional challenges may need special monitoring and attention to completely resolve.

Provigil Tapering at Alternative to Meds Center

provigil discontinuation syndromeProvigil tapering and withdrawal may be complicated by various factors, including multiple medications, as well as underlying contributing conditions.

These factors can create a perfect storm for someone who has become dependent on medication and is trying to get off Provigil without relapsing symptoms or other difficulties.

At Alternative to Meds, tapering is only part of the solution. Symptoms that in the past led to a prescription can be addressed in a logical, step-by-step fashion, and resolved using holistic and alternative therapies. It is not uncommon for physicians to be unfamiliar with tapering Provigil, as there isn’t much information or training given on the subject in med school. Where Provigil tapering appears to be more complex than can be handled in an outpatient setting, our program has over 15 years of experience and the therapies that are needed for a successful taper.

Provigil Prescribed With Other Medications

It is not unusual for patients to have ended up taking quite a number of medications concurrently. A not uncommon scenario for some people suffering extreme daytime sleepiness is that tiredness may be a side effect of other drugs they were prescribed, such as mood stabilizers, or similar. Provigil may have been prescribed to counteract drug-induced sleepiness, apathy, lethargy, etc. That approach may be useful in some cases, at least temporarily, yet doing so can only be regarded as a very limited approach to the problem. A prescribing doctor’s time may be short, but certainly, a series of such quick fixes may ultimately escalate the complexity of the patient’s problems.

Problems can be complex. Simplifying can mean looking for root causes, which aren’t always going to be obvious. That is why testing is a reliable tool, as it can lead the way to a bonafide solution. We believe that modern medicine should focus, vigorously explore, investigate, and isolate the root causes of unwanted symptoms. Masking a symptom does not help a person beyond temporary relief. That is sometimes necessary. However, a careful investigation could help to guide and PREVENT future problems rather than be trapped into a sort of continual damage-control operation.

Is Provigil Overprescribed?

Avenues to correct unwanted symptoms may have been overlooked altogether in the rush to find relief. Quite apart from seeking help with Provigil tapering, a person who is looking to find and resolve underlying causes for their excess tiredness, lethargy, or lack of interest in life may benefit significantly from what Alternative to Meds Center has to offer.

A healthy body is designed to be able to convert food into energy and to distribute energy when needed throughout the body. The body is a marvelous machine! Discovering what is blocking that natural sequence of events may be many times more helpful, with much less potential damage in the long run than simply masking the symptoms. Whether a person does that with Provigil or 10 cups of coffee a day, or other artificial wake-up devices or habits, chasing symptoms is not the best way to get the relief that will be long-lasting.

Sleep-disturbed shift-workers have had their particular trouble bestowed with their own DSM label, known as Shift-Worker Disorder, or SWD for short.2 A diagnostic label may save a minute in the doctor’s office, but the bottom line is that daytime sleepiness isn’t caused by a deficiency of Provigil. It is likely more from a deficiency in sleep, perhaps a dis-ordered lifestyle, incorrect diet, a toxic workplace environment (including bad air), medication overload, or other factors. Until you investigate, these may never be discovered.

In some parts of the world, Provigil (and similar stay-awake pills) are available over the counter, without a prescription, and are used by shift workers to prevent falling asleep on the job. Some students have been convinced that these types of medications are able to help improve their grades at school by preventing tiredness during class. Airline pilots may be another group that might try to prevent sleepiness in order to function well on the job. These are common reasons to take a drug such as Provigil, but these reasons are all trying to prevent something that a drug cannot “cure,” but only temporarily mask or alleviate. Should symptoms become chronic, then a person is on a road leading nowhere but drug dependence. Modafinil is now considered a drug of concern for abuse and overdose, according to a 2019 paper by Reinert and Dunn, published in the Expert Review of Clinical Pharmacology. Reinert and Dunn advise that more health workers need to be made aware of the toxicity profile of modafinil for resuscitative or other emergency treatment.11

Is Getting Off Provigil Like Quitting Opioids?

The scant early research on Provigil maintained although the drug created euphoric effects similar to opioid drugs, Provigil was not thought to be dopaminergic in action. More recent research, however, has shown a different picture.2 Researchers have suggested that Provigil does interact to some degree, in rat studies, with dopamine receptors as well as serotonin receptors, GABA receptors, benzodiazepine receptors, norepinephrine, histamine, melatonin, and adrenal receptors. These are all subject to interactions with Provigil, though more needs to be understood about how exactly this interaction occurs.9

In contrast, opioid drugs have a well-documented and intense interaction with dopamine receptors. Opioids result in a flooding effect of dopamine into the CNS, which is how it is thought that opioid drugs artificially create a euphoric mood. Consequently, the withdrawals from opioid drugs are predictably harsh, with enough intensity to act as powerful drivers of addiction just to avoid experiencing the withdrawal symptoms.

However, unlike the predictably horrible cold-turkey cessation of heroin, stopping Provigil even if not done abruptly, may cause quite a range of unpredictable results. For some, getting off Provigil may cause minimal Provigil withdrawal symptoms. However, for others, trying to quit Provigil could bring on quite alarming adverse reactions. These might be due to the many interactions with other medications one is taking, or from any number of contributing factors. However, a person trying to quit Provigil may see a return of the original symptoms, such as lethargy or sleepiness, because it had never been actually resolved, only masked from view while medicated. This is why we address the underlying factors in conjunction with the Provigil titration

Safe and Gentle Provigil Weaning Includes Getting to the Root Cause

provigil weaningRegardless of the reason a person found him/herself using, or perhaps over-using Provigil, there may come a point where Provigil weaning becomes desirable. Who wants to have to keep taking a pill just to stay awake? Or, just to stay interested in life? Alternative to Meds Center provides help for a person who is trying to quit Provigil. But as importantly, or even more so, is the focus on discovering and treating/correcting the underlying causes of narcolepsy or daytime sleepiness or depressed mood, lack of interest in one’s career, or disinterest in life in general. Resolving the root causes reduces or eliminates the need to rely on drugs.

It is important to note that in some rare cases, stopping Provigil can initiate severe withdrawal symptoms known as multi-organ hypersensitivity, which can be life-threatening as it affects multiple vital organs.1 Especially where multiple drugs are involved, and the person has been suffering from MDD and has been medicating their symptoms for many years, inpatient care is the safest due to the interactions that modafinil can cause with antidepressants or other drugs.2

There can be a scenario requiring stopping the drug immediately. In the case of Steven’s Johnson syndrome, or other life-threatening reactions associated with modafinil, abrupt drug cessation is the correct emergency action that can save a person’s life.2

Research suggests that the longer a person has been taking Provigil, the more intense and long-lasting the withdrawals are likely to be.5 Just as the CNS and the entire body adapt to the presence of any drug, it takes time to readjust. There is no “one size fits all” approach when it comes to how to get off Provigil. That is why programs at Alternative to Meds are designed for each individual client based on their unique profile and health history.

Alternative to Meds Center Provigil Tapering Support Services

provigil tapering sedona arizonaProvigil tapering at Alternative to Meds Center would include a combination of many of the features listed on our services page. Specifically, for this drug, you typically want to support the natural stimulatory aspects of the nervous system and clean up the energy physiology. Amino acid support in the way of dopamine and norepinephrine precursors, for example, is likely fundamental. Nutrients can play a huge role, such as vitamin B6, tyrosine, and phenylalanine, and any others that lab testing might have found to be lacking.

Focusing on good sleep cycles and circadian rhythm can be supported by boosting melatonin synthesis. Also, a note on mitochondria and recovery. The mitochondria of each cell are what produce energy, and according to research published in the Integrative Medicine Journal, author Pizzorno states they are fundamental to life and health.12 Glutathione is vital to mitochondrial function and is often deficient in the human body. There are many things that can impair Kreb’s cycle of energy metabolism. For one example, we can look to the various poisons that are part of food in the form of pesticides, which often include heavy metals as components. The Alternative to Meds Center focuses on lessening the body’s burden of such toxic interferences that affect energy metabolism. More information on this topic can be viewed on the neurotoxin removal page. And, one of the better and very direct treatments that we have in our arsenal for energy-boosting is an IV protocol called NAD+. This IV literally feeds the mitochondria exactly what it needs to synthesize energy (ATP), and is a true boon for correcting lethargy stemming from physiological sluggishness.

Contact Alternative to Meds Center

We invite you to contact us to find out more about the way Provigil tapering can be part of an overall health-restorative action in an inpatient setting. Also, how we handle sorting out multiple drug dependencies that may also be part of the picture. And, just as important, exactly how to effectively address the root causes of the symptoms that preceded starting the drug in the first place. Alternative to Meds Center can provide the required level of attentive care that is required during Provigil tapering.

1. Kate N, Grover S, Ghormode D. Dependence on supratherapeutic doses of modafinil: a case report. Prim Care Companion CNS Disord. 2012;14(5):PCC.11l01333. doi: 10.4088/PCC.11l01333. Epub 2012 Oct 18. PMID: 23469316; PMCID: PMC3583757. [cited 2022 July 5]

2. FDA Provigil label information 2010 Oct [cited 2022 July 5]

3. Peñaloza RA, Sarkar U, Claman DM, Omachi TA. Trends in On-label and Off-label Modafinil Use in a Nationally Representative Sample. JAMA Intern Med. 2013;173(8):704–706. doi:10.1001/jamainternmed.2013.2807 [cited 2022 July 5]

4. Kumar R. Approved and investigational uses of modafinil : an evidence-based review. Drugs. 2008;68(13):1803-39. doi: 10.2165/00003495-200868130-00003. PMID: 18729534.[cited 2022 July 5]

5. Krishnan R, Chary KV. A rare case modafinil dependence. J Pharmacol Pharmacother. 2015;6(1):49-50. doi:10.4103/0976-500X.149149 [cited 2022 July 5]

6. McClellan KJ, Spencer CM. Modafinil : A Review of its Pharmacology and Clinical Efficacy in the Management of Narcolepsy. CNS Drugs. 1998 Apr;9(4):311-24. doi: 10.2165/00023210-199809040-00006. PMID: 27521015. [cited 2022 July 5]

7. Ferraro L, Antonelli T, O’Connor WT, Tanganelli S, Rambert F, Fuxe K. The antinarcoleptic drug modafinil increases glutamate release in thalamic areas and hippocampus. Neuroreport. 1997 Sep 8;8(13):2883-7. doi: 10.1097/00001756-199709080-00016. PMID: 9376524. [cited 2022 July 5]

8. Zhou Y, Danbolt NC. Glutamate as a neurotransmitter in the healthy brainJ Neural Transm (Vienna). 2014;121(8):799-817. doi:10.1007/s00702-014-1180-8 [cited 2022 July 5]

9. Gerrard P, Malcolm R. Mechanisms of modafinil: A review of current researchNeuropsychiatr Dis Treat. 2007;3(3):349-364. [cited 2022 July 5]

10. Lewerenz J, Maher P. Chronic Glutamate Toxicity in Neurodegenerative Diseases-What is the Evidence?Front Neurosci. 2015;9:469. Published 2015 Dec 16. doi:10.3389/fnins.2015.00469 [cited 2022 July 5]

11. Reinert JP, Dunn RL. Management of overdoses of loperamide, gabapentin, and modafinil: a literature review. Expert Rev Clin Pharmacol. 2019 Sep;12(9):901-908. doi: 10.1080/17512433.2019.1657830. Epub 2019 Aug 31. PMID: 31422705. [cited 2022 July 5]

12. Pizzorno J. Mitochondria-Fundamental to Life and HealthIntegr Med (Encinitas). 2014;13(2):8-15.[cited 2022 July 5]

Originally Published Nov 2, 2019 by Diane Ridaeus

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

Dr. Samuel Lee

Dr. Samuel Lee is a board-certified psychiatrist, specializing in a spiritually-based mental health discipline and integrative approaches. He graduated with an MD at Loma Linda University School of Medicine and did a residency in psychiatry at Cedars-Sinai Medical Center and University of Washington School of Medicine in Seattle. He has also been an inpatient adult psychiatrist at Kaweah Delta Mental Health Hospital and the primary attending geriatric psychiatrist at the Auerbach Inpatient Psychiatric Jewish Home Hospital. In addition, he served as the general adult outpatient psychiatrist at Kaiser Permanente.  He is board-certified in psychiatry and neurology and has a B.A. Magna Cum Laude in Religion from Pacific Union College. His specialty is in natural healing techniques that promote the body’s innate ability to heal itself.

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