Nuvigil vs. Provigil: Which Is Best for Narcolepsy?
Key takeaways:
Nuvigil (armodafinil) and Provigil (modafinil) are first-choice medication options for narcolepsy. They’re both considered effective, but Nuvigil may last longer in the body.
Nuvigil and Provigil are different from traditional stimulants like Adderall (dextroamphetamine/amphetamine salts). They work in different ways and are less likely to cause dependence or misuse. Still, Nuvigil and Provigil are controlled substances that do have a higher likelihood to be misused than non-controlled substances.
The most common side effect of Nuvigil and Provigil is headache. Nausea, nervousness, and dry mouth are also possible. More serious side effects include misuse, severe rashes and allergic reactions, and mood changes.
Table of contents
Excessive daytime sleepiness is one of the most common symptoms of narcolepsy. This is a medical condition that affects your brain’s ability to stay awake during the day. Although there’s no cure, both medications and lifestyle changes may help.
Nuvigil (armodafinil) and Provigil (Nuvigil) are two medications that are considered first-choice medications for narcolepsy. The two share a lot of similarities, but have a few key differences. So which one is right for you?
What is Nuvigil?
Nuvigil is a medication that’s FDA approved to treat daytime sleepiness due to the following conditions:
It’s available as an oral tablet in the following doses:
50 mg
150 mg
200 mg
250 mg
Nuvigil is a controlled substance. This means it has a higher likelihood than non-controlled medications to cause dependence and addiction. So taking Nuvigil only as prescribed is important.
What is Provigil?
Provigil is approved for the exact same conditions as Nuvigil. It comes as a 100 mg and 200 mg tablet. And like Provigil, it’s also a controlled substance.
How do Nuvigil and Provigil work for narcolepsy?
We don’t know exactly how Nuvigil and Provigil work to promote wakefulness. We do, however, know that they affect many chemicals in the brain, making them more available for the brain to use. This includes chemicals such as dopamine, norepinephrine, and glutamate. They may also reduce the levels of another chemical called gamma-aminobutyric acid (GABA). It’s likely that these effects combined promote wakefulness.
Are Nuvigil and Provigil different from stimulants like Adderall?
Yes. While Nuvigil and Provigil may be considered stimulant medications, there are many differences between these medications and traditional stimulant medications. Traditional stimulant medications available by prescription include Adderall (dextroamphetamine/ amphetamine salts) and Ritalin (methylphenidate). These medications treat attention-deficit hyperactivity disorder (ADHD) and narcolepsy.
Some differences between Nuvigil and Provigil and traditional stimulants include:
Nuvigil and Provigil are structurally unrelated to traditional stimulants.
Like Nuvigil and Provigil, traditional stimulants affect dopamine and norepinephrine. But they do so in a different way. And they aren’t known to affect other chemicals in the way that Nuvigil and Provigil do.
Nuvigil and Provigil are less likely to be misused than traditional stimulants.
Nuvigil and Provigil have a lower risk of side effects, including a lower chance of negative effects on the heart.
How are Nuvigil and Provigil dosed for narcolepsy?
Nuvigil and Provigil are both taken once a day in the morning. They can be taken with or without food. But keep in mind that food may affect how quickly they start working in the body. Still, if taking either medication with food (like your breakfast) helps you remember to take it, go ahead and take them with food.
The usual Nuvigil dosage for narcolepsy is 150 mg to 250 mg once every morning. The usual Provigil dosage for narcolepsy is 200 mg once every morning. For Provigil, doses up to 400 mg per day may be used, but evidence doesn’t show that 400 mg works any better than 200 mg.
How effective are Nuvigil and Provigil for treating narcolepsy?
Nuvigil and Provigil have different chemical structures. Provigil is made of two compounds that are mirror images of each other (called an R-isomer and S-isomer). Nuvigil is made of only the R-isomer.
The difference in structure between Nuvigil and Provigil affects how long each medication lasts in the body. Nuvigil is known to last longer in the body. In fact, some research shows a lower dose of Nuvigil (150 mg) is comparable to a higher dose of Provigil (200 mg) for people with shift work sleep disorder.
Though Nuvigil may last longer in the body, both Nuvigil and Provigil are considered effective at treating narcolepsy. There’s not much research comparing the two medications directly for narcolepsy though. One study of over 100 male participants compared Nuvigil and Provigil, but the comparison was done in healthy adults who were sleep-deprived for the purpose of the study. Nuvigil improved wakefulness and attention span for a longer amount of time than Provigil.
What are the known side effects of Nuvigil and Provigil?
The most common side effect of Nuvigil and Provigil is headache. Other side effects and their frequency in clinical studies are discussed below. Certain side effects may be more likely at higher doses, including headache, nausea, and dry mouth.
| Side effect | Nuvigil | Provigil |
|---|---|---|
| Headache | 17% | 34% |
| Nausea | 7% | 11% |
| Dizziness | 5% | 5% |
| Nervousness | 1% | 7% |
| Anxiety | 4% | 5% |
| Dry mouth | 4% | 4% |
| Trouble sleeping | 5% | 5% |
| Not eating | 1% | 4% |
What are the serious side effects of Nuvigil and Provigil?
These medications may have serious side effects, though these are more rare. Below we’ll discuss some examples of the more serious side effects.
Dependence and misuse
Since these medications are controlled substances, it’s possible to become dependent on them, leading to misuse or overdose. Symptoms of overdose include shortness of breath, restlessness, and hallucinations. Overdoses can be fatal. If you think you’ve taken too much of these medications, seek emergency care. And if you or someone you know struggles with substance use, help is available. Call SAMHSA’s National Helpline at 1-800-662-4357 to learn about resources in your area.
Serious skin reactions
Severe skin rashes like Stevens-Johnson syndrome and toxic epidermal necrolysis can occur with Nuvigil and Provigil. If you spot any signs of a rash, stop your medication and contact your healthcare provider immediately. Though the rash may be harmless, it’s important to be evaluated right away in case it’s something more severe.
Allergic reactions
Swelling of the face and lips and trouble breathing may be signs of a serious allergic reaction to Nuvigil or Provigil. Drug Reaction with Eosinophilia and System Symptoms (DRESS) syndrome can also occur. This is a life-threatening medication allergy that often shows up as a high fever and rash. It usually involves problems with your organs. Seek emergency care if you experience any signs of a severe allergic reaction.
Mood changes
Mood changes, including depression, irritability, and suicidal thoughts, may occur. If you have a history of depression or other psychiatric conditions, like bipolar disorder, let your healthcare provider know before starting Nuvigil and Provigil. If you or someone you know is having thoughts of suicide, you’re not alone, and help is available. Call the National Suicide Prevention Lifeline at 988, or text HOME to 741-741 to reach the Crisis Text Line.
Worsening motor skills
Nuvigil or Provigill may alter your judgment and motor skills. Avoid driving a car or doing any potentially hazardous activities until you know how these medications affect you.
Heart problems
Though rare, these medications may cause heart problems in certain people. If you have a history of certain heart conditions, these medications may not be the best option for you. So make sure your healthcare provider knows your full medical history before starting Nuvigil or Provigil.
What interactions do Nuvigil and Provigil have?
Nuvigil and Provigil may have several drug interactions. For example, they can lower levels of certain medications in the body. This includes cyclosporine (Sandimmune) and some benzodiazepines. You may need a higher dose of these medications if you take them with Nuvigil or Provigil.
Nuvigil and Provigil can make some birth control products, including oral birth control pills with ethinyl estradiol, less effective. You should use backup contraception (like a condom) while taking Nuvigil or Provigil, and for one month after you stop them.
Nuvigil and Provigil can also increase levels of certain medications in the body. This includes phenytoin (Dilantin, Phenytek), omeprazole (Prilosec), and propranolol (Inderal LA). In this case, you may need a higher dose of these medications.
This isn’t a complete list of possible Nuvigil and Provigil interactions. Before starting one of these medications, give your pharmacist a list of all the medications and supplements you take. They can help you check for possible interactions.
The bottom line
Nuvigil and Provigill treat narcolepsy and other medical conditions. Both medications are considered first-choice options for narcolepsy. But Nuvigil may last longer in the body than Provigil.
Both medications are taken once a day in the morning, with or without food. They have similar side effects, with headache being the most common. And since they’re controlled substances, they have the ability to cause dependence or misuse. Other serious side effects include serious skin or allergic reactions and mood changes.
Before starting these medications, make sure your healthcare provider and pharmacist know your medical history and all the medications you take. They can help you evaluate whether Nuvigil vs. Provigil is right for you.
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