Wake Up! Provigil and Nuvigil, Relief from Fatigue

Dr. Sharon Orrange
Dr. Orrange is an Associate Professor of Clinical Medicine in the Division of Geriatric, Hospitalist and General Internal Medicine at the Keck School of Medicine of USC.
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Folks with fatigue from obstructive sleep apnea or neurologic illnesses like multiple sclerosis see improvement in fatigue with Provigil and Nuvigil, but at a cost. Fatigue is a common complaint and a remedy may be worth paying money for.

Modafinil (Provigil) acts on the central nervous system, although the mechanism for its effect is unknown. It is used as therapy for the treatment of excessive daytime sleepiness that persists in patients with obstructive sleep apnea (OSA) who have fatigue despite therapy (wearing the CPAP mask).

Provigil works for patients with persistent daytime sleepiness despite adequate conventional therapy. Taking 200 mg of Provigil a day improves daytime sleepiness, productivity, activity, intimacy, and vigilance compared with placebo. Well, that might be worth forking out the dough.

Nuvigil is the “newer” version of Provigil and is similarly effective though the two have not been compared head to head. Nuvigil is even more expensive than Provigil yet there is no evidence it’s any better.

Provigil taken once in the morning promotes wakefulness into the early evening without disrupting nighttime sleep. That’s a good thing. Patients with persistent afternoon sleepiness may benefit from divided dosing with 200 mg in the morning and 200 mg in the early to mid-afternoon.

While modafinil (Provigil) should be used cautiously in people with a history of arrhythmias or heart disease it’s important to note that adverse cardiovascular effects are less common with modafinil than other stimulants. Modafinil is well tolerated and side effects are uncommon, but include headache, nausea, dry mouth, and diarrhea. The good news on modafinil is that addiction has not been reported.

So I have to ask: Modafinil for fatigue, worth the price?

Dr O.

Modafinil 200mg runs about $300 – $600 for 30 tablets, but it is covered as a Tier 1 generic by many insurance plans, meaning you’ll pay only your lowest copay. In contrast, 30 tablets of Provigil 200mg can cost more than $1200, and because there is a generic available, it’s less likely to be covered by insurance plans. If it is covered, it will most commonly be under Tier 3, or your highest copay. Nuvigil is also quite expensive, at around $500 for 30 tablets of either the 150mg or 250mg strength, and it is also likely to be covered under a higher insurance copay level (Tier 2 or 3).

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