Modafinil

About Modafinil

Modafinil promotes wakefulness, although exactly how it works is not known. Its label covers adults whose excessive sleepiness comes from narcolepsy, obstructive sleep apnea or shift work disorder; it is not approved for children. In sleep apnea it treats the sleepiness, not the blocked airway, so continuous positive airway pressure (CPAP) or other treatment of the obstruction carries on. The usual dose is 200 mg once a day, in the morning, or about an hour before the start of the shift for shift work disorder; doses up to 400 mg a day have been tolerated without consistent added benefit. Severe liver impairment halves the dose, and older adults may be given less.

There is no boxed warning. The main warning is serious rash, including Stevens-Johnson syndrome, which nearly always began within one to five weeks of starting: modafinil is stopped at the first sign of rash unless the rash is clearly unrelated, and studies in children recorded rash severe enough to stop treatment. Swelling of the face or throat, trouble breathing, or fever and rash with other organs affected also mean stopping it and calling at once. Anxiety, mania, delusions, hallucinations, aggression and suicidal thoughts have been reported. It is not recommended for people with a history of left ventricular hypertrophy, or who had mitral valve prolapse syndrome with earlier stimulant use, and heart rate and blood pressure may be watched more closely. Headache, nausea, nervousness, a runny nose, diarrhea, back pain, anxiety, trouble sleeping, dizziness and indigestion are the common side effects, and anyone allergic to modafinil or armodafinil must not take it.

Wakefulness may not return fully to normal, so the prescriber reassesses sleepiness and may advise against driving. As a Schedule IV drug, a prescription can carry up to five refills within six months of the date written, and refill information can be transferred between pharmacies only once unless they share a real-time online database. It reduces the effectiveness of hormonal contraceptives during treatment and for one month after the last dose, so another or an added method is needed. Intrauterine growth restriction and miscarriage have been reported with modafinil and armodafinil, though it is not known whether the drug caused them, and a pregnancy registry collects outcomes.

Taking Modafinil

How to take it

Once a day, with or without food: in the morning for narcolepsy or sleep apnea, or about an hour before the work shift for shift work disorder. Take it at the same time each day, since a late dose can make it hard to sleep, and keep using CPAP if it is prescribed.

If you miss a dose

MedlinePlus says to skip the missed dose and take the next one at the usual time. Do not take a double dose to make up for it.

Storage

At room temperature, away from excess heat and moisture (not in the bathroom), somewhere children and others cannot reach. Take unused tablets to a take-back program rather than flushing them.

Interactions to know about

It makes hormonal contraceptives less reliable and can lower cyclosporine levels; it can raise levels of omeprazole, phenytoin and diazepam, and warfarin may need more frequent clotting tests (INR). MAO inhibitors are combined with it only with caution. Avoid alcohol, and do not drive until you know how it affects you.

This summarizes the official prescribing information. Your prescriber’s and pharmacist’s instructions, and the leaflet that comes with your medicine, take priority.

Why the cash price for Modafinil differs from pharmacy to pharmacy

Generic modafinil has many makers, so quotes for the same tablet differ mainly by each pharmacy’s markup and dispensing fee, and on a month’s supply of one tablet a day the fee can be a large part of the quote. A prescription that names Provigil and blocks substitution is quoted at a brand price.

Controlled-substance rules add friction: a pharmacy that rarely fills modafinil may need to order it in, and because Schedule IV refill information can be transferred only once, it is worth choosing the pharmacy before the first fill.

Ways to pay less for Modafinil without insurance

• Ask for generic modafinil, and make sure the prescription allows substitution rather than naming Provigil only.
• If your dose is 200 mg, check that it is written as one 200 mg tablet rather than two 100 mg tablets.
• Compare more than one pharmacy, and ask whether modafinil is on a flat-price generic list.
• Once your dose is settled, ask the prescriber whether a ninety-day supply is appropriate.
• Upload the prescription to Script Unlock so licensed pharmacies can quote their cash price. You pay the pharmacy directly.

Questions to ask your pharmacist about Modafinil

1. 1.Should I take it in the morning or before my shift, and what if my shift times change?
2. 2.Does it affect my hormonal birth control, and for how long after I stop?
3. 3.Which rash, swelling or mood changes mean I should stop it and get help?
4. 4.Does it interact with my omeprazole, warfarin, cyclosporine or seizure medicine?

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