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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 25 of 31. This is the beginning of the thread.
Posted by Michael D on February 15, 2002, at 16:36:21
"Modafinil (Modiodal and Provigil), this is the very latest analogue of Adrafinil, and likewise is a unique non-sleep-affecting stimulant, specially designed to treat narcolepsy, hypersomnia and catoplexy.
It is considerably more potent than Adrafinil, but is designed to be less likely to be the cause of any liver enzyme problems with long term use. Doses are one or two tablets (100mg each) as required. Avoid use in the evening."
Does anyone have experience with Modafinil (Provigil or Modiodal)? Has it been approved in the US?
Michael Dewolf
Posted by Michael D on February 15, 2002, at 17:04:36
In reply to Modafinil vs. Adrafinil, posted by Michael D on February 15, 2002, at 16:36:21
Has it been approved in the US?
Yes. (just found out)
Michael D
Posted by manowar on February 15, 2002, at 18:17:29
In reply to Modafinil vs. Adrafinil, posted by Michael D on February 15, 2002, at 16:36:21
Hi,
Provigil (Modafinil’s trade name) is available in the US. It's not a controlled drug either like other psychostimulants. For me it's a miracle drug. I have experience with both Modafinil and its sister drug Adrafinil. They both are very effective. Go to the bottom of the page and do a search for Modafinil or Adrafinil and you'll find lots of threads you can read.*For anyone that might be interested, I found out today why Adrafinil will never come to the US. Guess why-- no money in it. I talked to a pharmacist and he told me that when a new drug is developed the company has patent rights for fifteen years. However, the time count starts when the drug first goes to market, whether it be in the US or Europe. Evidently, Adrafinil has been around for a long time in Europe. There would be no reason for Lafon Labatories to jump through hoops and spend tons of money to get the drug FDA approved, because other companies would immediately develop generics.
Damn, the price of capitalism. But I still love it. Beats the hell out of socialism.
Tim
Posted by IsoM on February 15, 2002, at 18:49:50
In reply to Adrafinil will never see our shores:(, posted by manowar on February 15, 2002, at 18:17:29
Tim, I share your pessimism but I can tell when I feel good & meds are working. Despite my stated pessimism, I'm optimistic it will be manufactured for North American use. Cephalon, a large international pharmaceutical company that specialises in medication related to neurological disorders & problems, bought Lafon Labs the end of last year. Lafon approached them supposedly to further international markets for the medications they came up with.
Who knows? Whatever, if it does come out in NA, they'll find a way to get their money's worth out of it.
Posted by manowar on February 15, 2002, at 20:54:10
In reply to Adrafinil will never see our shores: Maybe? » manowar, posted by IsoM on February 15, 2002, at 18:49:50
Hi IsoM,
I'm not being pessimistic; I'm being realistic. There's no money in Adrafinil, because its patent has run out, and that's why it'll never hit our shores. Cephalon produces Provigil. Why would they market Provigil that cost $5 a pill, and try to bring to market Adrafinil, which is a drug that can cause potential problems in people, just so as soon as it hits the US market- a copycat drug will be produced. There's no reason for it. There's no money in it. Cephalon has a corner on the market with the unique Provigil. That's why they charge the outrageous cost of $5 a 200 mg pill.
But frankly, for me it's well worth it, and I would pay the high sum for making my life much more livable. You really can't put a price on that.
Actually, since my insurance company won't cover the drug, I've opted to get the cheaper Adrafinil from IAS, which cost me about $2 a day for four 300 mg tabs which is comparable to two 200 mg tabs of Provigil which would cost me $10 a day. It's a no brainier: I'll take the Adrafinil.
Tim
> Tim, I share your pessimism but I can tell when I feel good & meds are working. Despite my stated pessimism, I'm optimistic it will be manufactured for North American use. Cephalon, a large international pharmaceutical company that specialises in medication related to neurological disorders & problems, bought Lafon Labs the end of last year. Lafon approached them supposedly to further international markets for the medications they came up with.
>
> Who knows? Whatever, if it does come out in NA, they'll find a way to get their money's worth out of it.
Posted by Michael D on February 15, 2002, at 22:40:57
In reply to Re: Adrafinil will never see our shores: Never:(, posted by manowar on February 15, 2002, at 20:54:10
>
> Actually, since my insurance company won't cover the drug, I've opted to get the cheaper Adrafinil from IAS, which cost me about $2 a day for four 300 mg tabs which is comparable to two 200 mg tabs of Provigil which would cost me $10 a day.Isn't Adrafinil toxic to the liver?
I'm trying to understand if it's *always* toxic.
Michael D
Posted by IsoM on February 15, 2002, at 23:31:00
In reply to Re: Adrafinil will never see our shores: Never:(, posted by Michael D on February 15, 2002, at 22:40:57
Michael, all drugs when they're metabolised & not excreted unchanged, are metabolised by the liver. Some drugs can be harder on the liver than others. Acetaminophen (Tylenol) is one the worse drug for the liver (its chief metabolite is very poisonous). It isn't that adrafinil or modafinil is toxic to the liver, but the liver is the major processing plant of the body where all chemicals other than nutrients undergo changes before being excreted from the body. (The explanation is a little simplistic but just trying to give you an idea).
Different drugs use different enzymatic pathways in the liver for metabolism. I'm NOT advocating anything on this site but this link will give you a quick rundown on *how* the liver works, if you're interested in educating yourself about these matters:
http://www.garynull.com/Documents/Continuum/LiverOfTheMatter.htmAnyway, in a healthy individual, the liver can handle adrafinil & modafinil, but due to differences in our genetic make-up, in our health, diet, other meds, & enviroment, people's ability to metabolise different medications vary. Hence, the need for regular liver enzyme level checks.
Posted by IsoM on February 15, 2002, at 23:35:41
In reply to Re: Adrafinil will never see our shores: Never:(, posted by manowar on February 15, 2002, at 20:54:10
Ah, Tim, I know, I know. ...I'm a realist too but still hoping. Very silly of me though. That's probably what kept me going through all my life.
I sure hope they don't end up stopping adrafinil production in France down the road. There'd probably be too much of an outcry in Europe, if they did. Wonder if Provigil garners enough attention here in NA if any other companies will get going to come up with some other *afinils?
Posted by 3 Beer Effect on February 16, 2002, at 3:17:16
In reply to Modafinil vs. Adrafinil, posted by Michael D on February 15, 2002, at 16:36:21
I have been prescribed & take Provigil 200 mg/day + Klonopin 1 mg breakast, 1 mg lunch, 2 mg bedtime + Lamictal 50 mg (titrating up 25 mg a week to an effective dose) for Social Phobia, Depression, & Bipolar II/ADD. Luckily, my insurance company (Cigna) covered the Provigil.
Provigil has been well recieved by most people on this site, but for me the results so far have been relatively dissapointing. It seems to have effects on me similar to a slightly stronger version of sustained release caffeine that lasts 8-10 hours but without caffeine nervousness, anxiety, & insomnia. It does get you out of bed in the morning, but seems to be noticeably weaker for brain stimulation than the other ADD psychostimulants (but, on a positive note, has less side effects).
Once you take the prohibitively high cost into account, Provigil seems to be an overrated drug that some doctors are excited about because unlike the other ADD psychostimulants (Sch II), it poses a low abuse potential (Sch IV). (One amusing study I read was that drug addict monkeys preferred & self administered l-ephedrine (Over the counter Bronkaid asthma tablets) over Provigil!!!
I think on my next Psychiatrist visit I will ask about switching to Dexedrine Spansules which are like Provigil in that they have a long duration (10 hours?), smooth action, & once-a-day morning dosing. I am guessing that they cause less nervousness & anxiety because of their smooth, long, controlled release. [I tried Dexedrine 5 mg bid immediate release before & at that low dose Dexedrine increases talkativeness & self-confidence while reducing timidity. So I am thinking that when combined with high-dose Klonopin, Dexedrine Spansules may prove the ideal social phobia combination]. Has anyone out there tried the Dexedrine Spansules?
In my opinion Provigil pales in comparison to the amphetamines- Dexedrine, Dexedrine Spansules, Dextrostat, Adderall, & the psychostimulants Ritalin & Focalin) which I think are far superior & much cheaper psychostimulants/general stimulants.
3 Beers.
Posted by dennison on February 16, 2002, at 13:23:22
In reply to Modafinil vs. Adrafinil, posted by Michael D on February 15, 2002, at 16:36:21
> "Modafinil (Modiodal and Provigil), this is the very latest analogue of Adrafinil, and likewise is a unique non-sleep-affecting stimulant, specially designed to treat narcolepsy, hypersomnia and catoplexy.
>
> It is considerably more potent than Adrafinil, but is designed to be less likely to be the cause of any liver enzyme problems with long term use. Doses are one or two tablets (100mg each) as required. Avoid use in the evening."
>
> Does anyone have experience with Modafinil (Provigil or Modiodal)? Has it been approved in the US?
>
> Michael DewolfHi I took provigil for three months,200mg aday!!! Wow what A disappointment, from very first dose I noticed hmmm darn can't think straight-this is not good is it-nope course not!!!! I was bound and determined though to make it - no matter how much I sufferred as long as the eventual outcome was good. For 3 months I panicked,sufferred did absolutely nothing. How could I, I was in a mental cloud and plus my shoulder joint and neck were so painful couldn't even raise my arms, hmmm this is supposed to be helpful--I don't think so !!! Finally I said this shall stop, I went off provigil head cleared-up muscles worked ok-- hmm !! Well so much for the provigil bandwagon. Since I have seen several people "IRL" in real life go through the same syndrome-- strange how marketing studies don't reflect what occurs out in the "real" world, I had very very good expectations for provigil unfortunately didn't pan-out!!! :(:( Bummer too bad. Some people might do well on provigil just as some people do well on all sorts different meds,my opinion is that provigil will have limited success simply has very little utility and the side-effects were byfar worse that I've personally ever experienced and I've been round block few times. Geez I'd much better have liked to come on and give provigil rave review, hate to be so negative but this provigil is a real piece of work:(:( .
Posted by Michael D on February 16, 2002, at 13:37:10
In reply to Re: Modafinil vs. Adrafinil, posted by dennison on February 16, 2002, at 13:23:22
Thank you all for your replies.
From what I heard I think I'm going to lean away from Modafinil.
Michael Dewolf
Posted by Mr. Scott on February 16, 2002, at 14:38:30
In reply to Unhappy with Provigil, posted by 3 Beer Effect on February 16, 2002, at 3:17:16
Posted by 3 Beer Effect on February 16, 2002, at 15:45:07
In reply to Re: Modafinil vs. Adrafinil, posted by Michael D on February 16, 2002, at 13:37:10
I wouldn't be scared away from Provigil. Go ahead & give it a one month trial. I just prefer a stronger (psycho)stimulant. Provigil is fairly subtle compared to the other prescription stimulants. I'm not exactly sure of the reason you are taking a stimulant, but Provigil definitely works as a general stimulant with less side effects than all the other stimulants including caffeine. (It should not 'cloud your head' but make thinking slightly clearer like caffeine- Dennison's fogginess may have been from a drug interaction). I take it at 8 am on an empty stomach, & I wake up by 8:30 am. It, with Klonopin at night, has finally stablilized my sleeping patterns (Before, with no medications, I couldn't fall asleep until 6:30 am & i'd wake up at 3:30 p.m.).
The problem for me is that is seems to work as a general stimulant but does not seem to be a very effective psychostimulant especially compared to Ritalin or Focalin (the 2 stimulants that cause the most brain/higher thought stimulation of all the stimulants) or even Dexedrine.
I do get up and clean my room, rearrange furniture, go shopping, & do any other tasks that need to be done, but it doesn't help me study (but that might be a procrastination problem of my own). My room is absolutely spotless, while before it was a disgusting mess. Additionally, I rewired my home theatre system for optimal sound etc.--- In other words I've gotten more done in the 2 weeks on Provigil than I had in the previous 3 months when on no stimulant at all & was depressed. (It is showing signs of pooping out at mid-afternoon, but at 2 weeks that seems too early to tell- might be my imagination.)
The problem with Provigil is that it is too expensive, & is not covered by many insurance companies. There are better, much cheaper (generic available) alternatives such as Dexedrine, Dexedrine Spansule, Ritalin, & Focalin (the new improved d-isomer of Ritalin- less side effects). Avoid Ritalin SR (sustained release)- inconsistent & lousy.
For extremely anxious or irritated individuals who need a more subtle medication, drug abusers, or those whose jobs are boring and/or don't involve much thinking (Provigil increases vigilance), Provigil may be a better choice than those above.
I am going ask to switch to Dexedrine spansules at my next psychiatrist visit (regular Dexedrine is stronger & more effective but I have social phobia & the spansules will cause less anxiety, & like Provigil you only have to take it once a day in the morning (which is nice).
BUT, assuming that I don't get any poopout on Provigil in the next two weeks, I'll probably return to Provigil later in life when I am used to a monotonous job routine & don't need strong psychostimulants to help me study. (Dexedrine increases your heart rate somewhat, so is probably not good for old people).
3 Beers.
> Thank you all for your replies.
>
> From what I heard I think I'm going to lean away from Modafinil.
>
> Michael Dewolf
Posted by Bob on February 16, 2002, at 15:47:20
In reply to Modafinil vs. Adrafinil, posted by Michael D on February 15, 2002, at 16:36:21
Does Modafanil have any effect on sexual function - good or bad?
Bob
Posted by spike4848 on February 16, 2002, at 17:52:04
In reply to Unhappy with Provigil, posted by 3 Beer Effect on February 16, 2002, at 3:17:16
Sorry about the language, but 100mg of provigil gave me palpations and panic attacks. Maybe I need to increase my klonopin .... but I hate to jackup one drug just to tolerate another.
Spike
PS I miss my "screw lexa" post! LOL
Posted by Ritch on February 16, 2002, at 21:56:30
In reply to Screw Provigil!, posted by spike4848 on February 16, 2002, at 17:52:04
> Sorry about the language, but 100mg of provigil gave me palpations and panic attacks. Maybe I need to increase my klonopin .... but I hate to jackup one drug just to tolerate another.
>
> Spike
>
> PS I miss my "screw lexa" post! LOL
Spike, so Provigil aint' no better than Ritalin or Adderall, etc.????Mitch
Posted by IsoM on February 16, 2002, at 22:45:47
In reply to Re: Screw Provigil! » spike4848, posted by Ritch on February 16, 2002, at 21:56:30
> > "...so Provigil aint' no better than Ritalin or Adderall, etc.????
Mitch"Mitch, it appears that it isn't better than the other stims for many people & for some, is much worse. But like most meds, for some people (me) it's way better than traditional stims. Probably has a lot to do with individual symptoms & metabolism.
Posted by Rick on February 18, 2002, at 22:07:30
In reply to Modafinil vs. Adrafinil, posted by Michael D on February 15, 2002, at 16:36:21
Michael -
Suggestion: Be careful about basing your conclusions about Provigil on one thread. For that matter, be careful basing your conclusions *soley* on what you see on this great board, period. There are just so many variables that can make a BIG difference in your response vs. others'...individual body chemistry; your specific mental disorder, subtype and manifestations; comorbid disorders if any; very importantly: what else you're taking (or NOT taking) at the same time (including OTC products); dosage; dosing schedule, more.
Provigil has added some wonderful dimensions to the good work Klonopin was alreay doing for my Social Phobia, whereas other stimulating meds (even just stimulating AD's like Wellbutrin and selegiline) added back lots of anxiety and worked against Klonopin's benefits. OTOH, if I were taking Provigil alone, my guess is it would be pretty damn ineffective for my SP, maybe even detrimental. Likewise, I know from experience that 100 mg goes a long way for me (some people get by with even 50 mg or 75 mg). I do spike it to 200 mg on ocasional days, but when I keep that up for too long, I start to get kind of wired and Provigil's benefits decline.
The good thing abut trying Provigil -- and even here YMMV -- is that you should know pretty quickly whether it's helping, hurting, or having no effect. If it's not helping after a week or two including dosage adjustment in the appropriate direction, you can dump it almost cold turkey. (Do check with your doctor of course in case you have a disorder where a sudden shift in medication can be dangerous. In any event, there are no physical withdrawal symptoms.)
Cautions: 1) Provigil can have an initial mild-euphoria effect for some poeple, and when this quickly dissipates they mistakenly assume poop-out. 2) That said, since it can self-metabolize, Provigil sometimes CAN poop out temporarily. This usually resolves quickly; if not, increase the dose a little for a few days. 3) While this seems like an uncommon side effect, Provigil can raise blood pressure in some people, so be sure to check a few times to see if this applies to you.
Other threads have many reports on response to Provigil -- ranging from very negative to very positive (count me gratefully and enthusiastically in the latter group, at least in tandem with Klonopin).
Incidentally, with regard to the comment that pdocs like prescribing Provigil because it is in a lower-control class than amphetamine based drugs: I had to spend weeks cajoling my pdoc to prescribe Provigil instead of the Ritalin that he wanted me to try. I'm glad I persisted in making a case for Provigil. That was a year and a half ago.
Rick
Posted by Rick on February 18, 2002, at 22:43:49
In reply to Re: Modafinil vs. Adrafinil » Michael D, posted by Bob on February 16, 2002, at 15:47:20
> Does Modafanil have any effect on sexual function - good or bad?
>
> BobMy experience on doses up to 200 mg Provigil: Slightly pro-sexual. Certainly no selegiline/deprenyl, though!
Rick
Posted by 3 Beer Effect on February 19, 2002, at 1:33:39
In reply to Re: Modafinil vs. Adrafinil » Michael D, posted by Rick on February 18, 2002, at 22:07:30
I read somewhere that if you have prior experience with the "hard" psychostimulants like Dexedrine, Adderall, Desoxyn, Ritalin, Concerta or Focalin then you will probably be dissapointed with Provigil because it is not nearly as powerful as the above drugs (although it lasts much longer).
But if you are so-called "naive" with stimulants, then Provigil 200 mg would probably be a great medication for you. It it also good because it is a once a day med so people at work won't see you taking a pill during your lunch break & think you are a
'druggie'.In the study I read the "naive" subjects did very well on Provigil 200 mg, while Dexedrine users who agreed to switch to Provigil often dropped out of the study & started taking Dexedrine again, were non-compliant, & in general had difficulty switching to Provigil.
As a case in point I used to be on a high dose of Ritalin (20 mg 2x per day). I also used to abuse Adderall (obtained from friends) the night before exams or before college parties to be more social. This morning I took 200 mg of Provigil on an empty stomach & could still not get out of bed, while a "naive" stimulant user probably would have been up, ready to take on the world, & be singing in the shower.
I then took another 100 mg of Provigil about 2 hours later (still with an empty stomach) & still lounged in bed. Finally, I had to resort to taking 50 mg of Primatene ephedrine hcl w/ 2 mg of Klonopin to offset the horrible ephedrine side effects, & for the rest of the day I was awake & incredibly productive.Interestingly, I noticed that with 2 mg of Klonopin I had no social anxiety with the 50 mg ephedrine hcl (the max dose of ephedrine which is probably the most anxiety/nervousness/side effect ridden stimulant out there- if I take ephedrine by itself I am a nervous wreck
).
Perhaps, any psychostimulant (EXCEPT Ritalin/Focalin/Concerta which tends to make people shy/introverted & focused on their work rather than other people) combined with the right dose of Klonopin will make social phobia go away.When I took Dexedrine 5 mg 2x per day WITH NO OTHER MEDICATIONS I had a major increase in self-confidence, self-esteem, immediate relief from major depression, & very little social anxiety & even some social disinhibition. Personally, I haven't experienced any of these social enhancing effects with Provigil, which is why I am hoping to switch back to Dexedrine in a few weeks. I am going to try the Dexedrine spansule b/c I think that because it has a subtle & long action it would work better for social phobia than regular Dexedrine, although (unfortunately) it would not work as well for ADD/psychostimulant purposes. But I have never heard of anyone who has tried the Dexedrine Spansules, so they might "suck" like Ritalin SR (a pretty worthless drug).
Anyways I am happy that I have found the right combination for me after months of SSRI/Effexor/Remeron agony-
1-- Lamictal (mood-stabilizer/anti-depressant); 2-- Non-Caffeine prescription Stimulant {Provigil or Dexedrine] (to get out of bed in the morning & to reduce timidity (from low dopamine) & cause social disinhibiton;
3-- Most importantly Klonopin (although Klonopin makes you kind of "dumb" & seems to affect short term memory).
So I guess the moral of the story is, once you have takeb "hard" ADD stimulants you have a very hard time going back to "soft" stimulants like Provigil or Adrafinil----- Kind of like how people who take the pain killers for chronic pain Dilaudiud/Numporphan/Morphine/Percocet have a really hard time when there doctor refuses to give them those meds anymore & puts them on the weaker painkillers Vicodin or Codeine.
Posted by Bekka H. on February 19, 2002, at 7:08:29
In reply to Provigil vs. other psychostimulants, posted by 3 Beer Effect on February 19, 2002, at 1:33:39
Hello 3 Beer Effect. You're back!
I was wondering how much Lamictal you take and when do you take it (at night)? Did you have difficulty starting it? Did you get rashes, etc? Any other side effects?
By the way, I've taken Dex Spansules in the past, and it felt kind of "vague" because I was used to the intensity of the immediate release tabs. Maybe if I had tried the spansules first, it would have been better. Also, the Dexedrine people (i.e., the manufacturers) really need to upgrade their technology. They should make a Dex spansule similar to Concerta's release mechanism.
Posted by Mark H. on February 19, 2002, at 10:16:05
In reply to Modafinil vs. Adrafinil, posted by Michael D on February 15, 2002, at 16:36:21
My two cents:
Provigil: extremely expensive and effective, yet I didn't get anything accomplished for the four months I was on it, and I didn't care. If it had gone on much longer, I would have lost my job.
The other brand: not approved for use in the US. Why risk liver damage and import risks for something less effective than Provigil?
Mark H.
Posted by Rick on February 19, 2002, at 10:17:52
In reply to Provigil vs. other psychostimulants, posted by 3 Beer Effect on February 19, 2002, at 1:33:39
> So I guess the moral of the story is, once you have takeb "hard" ADD stimulants you have a very hard time going back to "soft" stimulants like Provigil or Adrafinil----- Kind of like how people who take the pain killers for chronic pain Dilaudiud/Numporphan/Morphine/Percocet have a really hard time when there doctor refuses to give them those meds anymore & puts them on the weaker painkillers Vicodin or Codeine.Or kind of like benzo users who are switched to BuSpar. But that could be because they're used to the quick sedative effects benzos provide, or because BuSpar is a placebo for most people and often prescribed for the wrong disorders (panic, social phobia)?
Rick
Posted by Rick on February 19, 2002, at 11:07:34
In reply to Re: Modafinil vs. Adrafinil, posted by Mark H. on February 19, 2002, at 10:16:05
> My two cents:
>
> Provigil: extremely expensive and effective, yet I didn't get anything accomplished for the four months I was on it, and I didn't care. If it had gone on much longer, I would have lost my job.Interesting. I finally got the performance-based promotion I wanted, plus several award for my work after starting Provigil. Helps mental alertness and concentration for me, but unfortunately not memory. Never ceases to amaze me how difrently people react to the same meds. E.g., some people find Celexa activating. (For me, it was, "Leave me alone, I want to sleep!")
Rick
Posted by IsoM on February 19, 2002, at 11:30:19
In reply to Re: Modafinil vs. Adrafinil » Mark H., posted by Rick on February 19, 2002, at 11:07:34
Ahh, yes... individual differences can be amazing! Modafinil doesn't activate one person but does another. Doesn't help memory of one but does of another. Makes one person jittery & wired, another calm & relaxed but still alert.
Mark H's point is exactly why nobody will really know how a certain med will affect them till they give it a "fair trial" period. I have had nothing but very GOOD results from adrafinil (so probably would with modafinil too). It's been a real God-send to me & I am now finishing looking for the perfect med combo to work for me as I've found it at last.
3 Beer Effect mentioned that he found a vast diff between hard stims & soft ones like modafinil/adrafinil. He theroised that anyone who's used the hard stims probably wouldn't get much from the soft ones. I don't doubt that may be true for many (like him) but definitely isn't for me.
The activating effects of adrafinil are honestly as strong for me as Dexedrine but way gentler, always even (no peaks & dips like I got from a dose kicking in then wearing off), but for me, more focused.
It reminds me of someone's description of a person with ADHD - "he leapt on his horse & rode off wildly in all directions". That's me with Dexedrine, that's even me without stims but only in bursts. With adrafinil, I ride off wildly in just one direction. Maybe someone without the hyper part of ADD, lethargic instead, might feel better with hard stims.
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