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 prescribed (or otherwise obtained) for a wide range of “off-label” uses. An article published in the JAMA – Internal Medicine reported that across all years, 89% of patients had an off-label prescription for modafinil. The authors also showed a 10-fold increase in the number of prescriptions from approximately 50,000 in 2002 to over 500,000 in 2008. These are astounding figures. Modafinil was prescribed for depression, multiple sclerosis, Parkinson’s disease, chronic fatigue, ADHD, and other conditions. The 2013 research letter found about half of all modafinil prescriptions were accompanied by an antidepressant, and 15% were co-prescribed benzodiazepines.14
NOTE: Provigil is not approved for children aged 17 and under. That would make any prescription to this age group off-label. In children with narcolepsy, side effects of Provigil included Tourette’s Syndrome, hostile behavior, sudden loss of muscle tone, weakness, hallucinations while falling asleep, low white blood count, and painful menstruation.10
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. Provigil has addictive potential according to published studies.11
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.
CNS stimulants like Provigil are commonly referred to in certain literature as “cognitive enhancers” or “smart drugs.” Though the mechanics of action are different, Ritalin is another example of drugs that are promoted “off-label” as a cognitive-enhancement drug. In an interesting double-blind placebo-controlled study analyzing 2876 chess games, 4 groups of players were compared: those taking a placebo, those taking Ritalin, those taking Provigil, and those taking caffeine. Placebo chess players played faster than all other groups, needing less time for considering their next moves than either those taking Ritalin, caffeine or Provigil.15
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. More on side effects is below.
Provigil Side Effects
Some Provigil side effects are severe and can be life-threatening requiring immediate medical intervention regardless of age. According to the drug label, Provigil can produce a wide range of reactions, similar in nature to other CNS stimulant drugs.1,10
Side effects* of Provigil:
- Nausea, upset stomach
- Back pain
- Stuffy nose
*The Cognitive Vitality Advisory Board advises that no long-term studies have been done regarding modafinil side effects on patients with dementia or cognitive decline.5
Severe Provigil side effects1,10 include:
- Suicidal thoughts, thoughts of self-harm, suicide attempt
- Stevens-Johnson Syndrome: a potentially life-threatening condition caused by medication that first causes flu-like symptoms, followed by raised welts which blister, painfully burst, and form dark crusts. The face, mouth, eyes, throat, and 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 an observable cause
- Irritability, hostility
- Shortness of breath
- Decreased appetite
- Mania: uncharacteristic aggression, energy, talkativeness
- Swelling in the legs, face, eyes, throat, tongue, or other areas
- Severe rashes, allergic reactions such as hives, itching skin, redness
- Drug-induced psychosis: this can be confused with other forms of psychosis
- Dark-colored urine
- Unusual bruising or bleeding
- 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 Withdrawal Symptoms
Some individuals have reported an absence of any significant Provigil withdrawal symptoms on stopping Provigil. Clinical trials on the topic of withdrawal from Provigil are scarce.11 One sign of Provigil dependence is the emergence of withdrawal symptoms when stopping Provigil.
Severe Provigil Side Effects Requiring Withdrawal:
- Stevens-Johnson Syndrome*: a serious allergic reaction requiring immediate medical intervention in a burn unit or ICU
- Multi-Organ Hypersensitivity: a sometimes fatal condition/allergic reaction to various internal organs such as the 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): abnormally high white blood cell count and other systemic symptoms requiring emergency medical treatment.
*Important Notes on Provigil Withdrawal: The FDA recommends to immediately stop the drug if signs of a rash appear and seek medical attention at once. **According to the FDA, a study reported that discontinuation of Provigil 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.
Provigil withdrawal symptoms can include the following according to FDA-required labeling information and clinical reports:1,10,11
- Lethargy, sleepiness
- Low mood, anhedonia, dysphoria
- Rise in body temperature
Discontinuing/Quitting Provigil (modafinil)
Quitting 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 the risk to life can be mitigated, as in an ICU. More commonly, gradual tapering off Provigil is recommended. Medication tapering can be completed at Alternative to Meds Center once any and all life-threatening factors have been addressed if needed in a hospital setting.
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 and a developing Provigil addiction that is not addressed.
For many persons, it may not be so much the withdrawals from Provigil that need addressing, but the return of original symptoms, that could be resolved successfully with safer alternative treatments.