If you work the night shift and struggle to stay awake, or if you have daytime sleepiness from sleep apnea or other sleep disorders, you may have wondered if a medication can help you feel more alert.
For excessive daytime sleepiness, Provigil and Nuvigil are first-line treatments. Provigil (the generic is modafinil) and Nuvigil are non-stimulant medications—but what does that mean? How do they work? And is one better than the other?
How do Provigil and Nuvigil help keep you awake if they aren’t stimulants?
- Most likely, Provigil (modafinil) and Nuvigil enhance dopamine signaling (meaning they make your body more sensitive to dopamine, a neurotransmitter than can promote wakefulness). However, the exact way that they work is unknown.
- These medications do not appear to change the amount of dopamine or norepinephrine released—which is the way stimulants like Adderall work. Instead, Provigil and Nuvigil may have a stimulant effect by suppressing how well another type of neurotransmitter (GABA) works.
- Both Provigil and Nuvigil do enhance alertness.
- Provigil is available as the generic modafinil. This means it will generally be cheaper than Nuvigil and more often preferred by insurance companies.
- Modafinil is used in patients with daytime sleepiness as a result of sleep apnea at doses of 200 or 400 mg a day.
- Modafinil improves productivity, activity and alertness compared to a sugar pill/placebo.
- You can start with 100 mg dose and titrate up to increase your dose. If you have persistent sleepiness you can consider dividing doses, with 200 mg once in the morning and then again in mid-afternoon.
What you need to know about Nuvigil:
- Nuvigil is the R-enantiomer of racemic modafinil—this sounds complicated, but it just means that it has a slightly different chemical structure than Provigil and modafinil.
- It appears to be similarly effective, according to randomized trials, but Nuvigil and Provigil / modafinil have never been directly compared.
- Because of the longer half-life and the once-a-day dosing, Nuvigil is a good first-line choice, starting at a dose of 150 mg.
- Nuvigil has also been studied for fatigue related to menopause, and doses up to 150 mg a day were shown to improve quality of life.
- Nuvigil can also be titrated up to 250 mg once daily as needed.
What are the side effects?
- Both modafinil and Nuvigil should be used cautiously in people with a history of arrhythmias or heart disease.
- Chest pain, high blood pressure, and palpitations are much less common with these drugs than with stimulants like amphetamines.
- Neither modafinil nor Nuvigil causes high blood pressure.
- The most common side effect of both is headache, occurring 15 to 20 percent of the time.
- Other less common side effects are nausea, dry mouth, anorexia, and diarrhea.
Are they different from a stimulant like Adderall?
- Yes. Amphetamines like Adderall, Ritalin and Vyvanse promote the release of catecholamines (primarily dopamine and norepinephrine). Provigil and Nuvigil don’t do that.
- Unlike the stimulants used for ADHD, addiction has not been reported with the use of Provigil or Nuvigil.
Cost and savings tips:
- They are expensive. Even the generic Provigil (modafinil) will cost you.
- If you are taking 100 mg modafinil, try splitting a 200 mg tablet as they are generally the same price.
- Nuvigil is taken once a day and Provigil (modafinil) often twice a day. Think of this when paying per pill.
- The newer formulation of Nuvigil 250 mg is equivalent to two tablets of modafinil 200 mg. Again, taking half as many pills per month can offer significant savings here, even though Nuvigil is still brand-only.
Your cost will vary depending on your dosage, and whether you’re able to split the higher strength of Provigil (modafinil). However, when comparing equivalent doses—a 30-day supply of modafinil 200 mg (60 tablets) to a 30-day supply of Nuvigil 250 mg (30 tablets)—generic modafinil is actually more expensive than Nuvigil.
Both are still very expensive if you aren’t insured or if your insurance won’t cover them, but Nuvigil offers savings anywhere from $200 up to almost $1000 per month.
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*Prices as of September 9, 2015.
Keep in mind:
Provigil (modafinil) and Nuvigil are schedule IV controlled substances, with a low potential for abuse relative to the amphetamines like Adderall or Ritalin which are schedule II—but they still require a triplicate prescription and may have other restrictions when it comes to filling at the pharmacy.