Anyone taking Provigil?

Johnny_D · Jan 14, 2007

I read an article recently in Philadelphia Magazine that touted the benefits of Provigil. The article stated that the drug allows you to focus your mind without the side effects of typical stimulants. Also, it stated that the drug is not addictive. It went on to say that the US Air Force gives it to their pilots so they can maintain concentration on long flights.

This sounds like a great thing for med students. Anyone out there have any experience with it? Does it help with the late night studying? The drug is prescription, so you have to see a doctor first. Any feedback would be great.

BellyDancingDoc · Jan 14, 2007

Hey,

I got a sympathetic Doc to give me a prescription when Provigil was first approved for shift work. My experience went something like this:

The doc scripted me a bottle of 100 mg tablets. He told me to start by taking 1 100 mg tablet and to wait an hour. If I still didn't feel any change, I should take a second 100 mg tablet.

Well, I went home, took the first tablet and felt nothing. An hour later, as per Doc's orders, I popped the second.

Oh sweet lord.

My mind was buzzing so fast, and my thoughts were racing so quickly that I could not keep track of them. It was like I had suddenly gone insane ("manic" is probably the best way to describe it). Even worse, my whole body felt like it was vibrating. My hands, legs, arms, torso, everything seemed to be shaking. I was so wound up that I couldn't possibly study, or converse with anyone without sounding insane, or be in any way productive, and I certainly could not sleep. I wound up spending that whole night wide awake on the couch, shaking, and waiting for the drugs to clear my system.

Oh yeah... and on top of all of that I had some significant "GI issues."

So the moral of the story is... no, I'm not taking Provigil. Would I ever try is again? Maybe a 100 or 150 mg dose if I were desperate enough (I would never, ever try 200 mg again. Ever.). So while I'm sure that it doesn't have this effect on everyone, I would advise taking it with great caution...

Tired · Jan 14, 2007

Johnny_D said:
I read an article recently in Philadelphia Magazine that touted the benefits of Provigil. The article stated that the drug allows you to focus your mind without the side effects of typical stimulants. Also, it stated that the drug is not addictive. It went on to say that the US Air Force gives it to their pilots so they can maintain concentration on long flights.

This sounds like a great thing for med students. Anyone out there have any experience with it? Does it help with the late night studying? The drug is prescription, so you have to see a doctor first. Any feedback would be great.

Something tells me this is going to be another one of those threads where I end up completely losing it . . . I promise to try not to.

For what it's worth: Provigil (henceforth to be referred to by the correct name 'modafinil'), is indicated for use in disorders characterized by excessive sleepiness, including Narcolepsy, sleep apnea, etc. There is no FDA-indication for normal people who just want to 'concentrate' better.

The military has used amphetamines and other stimulants for many years, primarily for people whose work requires them to be awake and alert for many hours. The typical example is a bomber pilot who has to fly for 24+ hours. Their research has essentially shown that stimulants will restore the fatigued mind to alertness, but have shown no increase in concentration in people who are already rested. In other words, it'll get you back to normal, but won't make you super-human.

That being said, my issue with using modafinil or any other stimulant is this. Prescription medications should not be used for performance-enhancement. It turns doctors into drug dealers. Granted you might find isolated examples where it might be appropriate, but as a general priniciple, it is a bad idea.

BellyDancingDoc · Jan 14, 2007

Tired said:
Something tells me this is going to be another one of those threads where I end up completely losing it . . . I promise to try not to.

For what it's worth: Provigil (henceforth to be referred to by the correct name 'modafinil'), is indicated for use in disorders characterized by excessive sleepiness, including Narcolepsy, sleep apnea, etc. There is no FDA-indication for normal people who just want to 'concentrate' better.

Tired,

This is not quite true. Modafinil is approved for the (patently absurdly named) condition that they are calling "Shift Work Sleep Disorder." :laugh:

Basically, in order to have SWSD, all you have to do is (1) have irregular sleeping patterns caused by your work requirements and (2) feel crappy because of those irregular sleeping patterns.

http://www.provigil.com/patient/disorders/shiftwork.aspx

Sound like your average student? You betcha- this is how I was able to convince the Doc to give me a script.

So, while we can all get a good chuckle out of the SWSD "diagnosis," the fact is that modafinil is FDA approved for this kind of thing.

Tired · Jan 14, 2007

BellyDancingDoc said:
Tired,

This is not quite true. Modafinil is approved for the (patently absurdly named) condition that they are calling "Shift Work Sleep Disorder." Basically, in order to have SWSD, all you have to do is (1) have irregular sleeping patterns caused by your work requirements and (2) feel crappy because of those irregular sleeping patterns.

http://www.provigil.com/patient/disorders/shiftwork.aspx

Sound like your average student? You betcha- this is how I was able to convince the Doc to give me a script.

So, while we can all get a good chuckle out of the SWSD "diagnosis," the fact is that modafinil is FDA approved for this kind of thing.

Ah, I see it now. I was looking at the pharm textbooks when I typed my reply.

Still disturbs me though. Reliance on pharmaceuticals to perform your basic work duties is a bad habit to get into. In college my dorm friends used to snort Aderall to study for tests, and a couple used speed (not crystal meth, there is a difference remember). Did it help? Yeah, probably. But I doubt such a technique is a sustainable solution to the problem of being tired. How many years can you take modafinil before your brain downregulates the receptors, and you need more and more and more . . .

OHMAN0125 · Jan 14, 2007

Tired said:
Ah, I see it now. I was looking at the pharm textbooks when I typed my reply.

Still disturbs me though. Reliance on pharmaceuticals to perform your basic work duties is a bad habit to get into. In college my dorm friends used to snort Aderall to study for tests, and a couple used speed (not crystal meth, there is a difference remember). Did it help? Yeah, probably. But I doubt such a technique is a sustainable solution to the problem of being tired. How many years can you take modafinil before your brain downregulates the receptors, and you need more and more and more . . .

I hear that some residents routinely take Provigil when they have to do call. I mean it is for shift work. In my opinion, there's a big difference between provigil and adderall.

Tired · Jan 14, 2007

OHMAN0125 said:
In my opinion, there's a big difference between provigil and adderall.

In what way?

OncoCaP · Jan 14, 2007

Here is a common combination used by certain individuals who graduated beyond the cup of coffee or energy drinks and are typically in the upper income bracket (or heading that way): Provigil 200mg qd to wake up and Ambien 10mg hs to sleep. It's been on the "fast mover shelf" since at least 4 or 5 years ago (maybe a lot longer). Welcome to your life on drugs. In my personal opinon, I see it as a bad thing; I don't like the fact that significant number of people feel like they need to take performance enhancing drugs to do their job. It's a sad commentary on our life and its demands.

808_Drum · Jan 14, 2007

Tired said:
In what way?

Adderall is an amphetamine, and amphetamines have a high potential for abuse. Provigil is NOT an amphetamine. It "promotes wakefulness" but is not the same type of stimulant as an amphetamine. It is not used for ADHD. While it could be abused by the same type of person who would abuse amphetamines, it is not habit-forming, and one does not generally develop a tolerance to provigil.

It can be very helpful for people who have their circadian rhythm interrupted by working night shift but needing to function on a "normal" daytime schedule on their days off (residents, for example).

humuhumu · Jan 14, 2007

OncoCaP said:
Here is a common combination used by certain individuals who graduated beyond the cup of coffee or energy drinks and are typically in the upper income bracket (or heading that way): Provigil 200mg qd to wake up and Ambien 10mg hs to sleep. It's been on the "fast mover shelf" since at least 4 or 5 years ago (maybe a lot longer). Welcome to your life on drugs. In my personal opinon, I see it as a bad thing; I don't like the fact that significant number of people feel like they need to take performance enhancing drugs to do their job. It's a sad commentary on our life and its demands.

Agreed. But can you blame residents for trying a drug that appears to be safe, effective, and (now) FDA-approved for "shift work sleep disorder"? Is there anything natural or healthy about working 80-hour weeks with frequent overnight call? I'm surprised modafinil hasn't spread like wildfire among residency programs (or maybe it has, I don't know)...

BellyDancingDoc · Jan 15, 2007

humuhumu said:
Agreed. But can you blame residents for trying a drug that appears to be safe, effective, and (now) FDA-approved for "shift work sleep disorder"? Is there anything natural or healthy about working 80-hour weeks with frequent overnight call? I'm surprised modafinil hasn't spread like wildfire among residency programs (or maybe it has, I don't know)...

Based on my personal experience (see post #2 of this thread), I suspect that part of the reason it hasn't "spread like wildfire" is that it apparently does not always work the way they say it should. Believe me, there is no possible way I could have performed during call in that tripped out state...

DRJJ1 · Jan 15, 2007

BellyDancingDoc said:
Hey,

I got a sympathetic Doc to give me a prescription when Provigil was first approved for shift work. My experience went something like this:

The doc scripted me a bottle of 100 mg tablets. He told me to start by taking 1 100 mg tablet and to wait an hour. If I still didn't feel any change, I should take a second 100 mg tablet.

Well, I went home, took the first tablet and felt nothing. An hour later, as per Doc's orders, I popped the second.

Oh sweet lord.

My mind was buzzing so fast, and my thoughts were racing so quickly that I could not keep track of them. It was like I had suddenly gone insane ("manic" is probably the best way to describe it). Even worse, my whole body felt like it was vibrating. My hands, legs, arms, torso, everything seemed to be shaking. I was so wound up that I couldn't possibly study, or converse with anyone without sounding insane, or be in any way productive, and I certainly could not sleep. I wound up spending that whole night wide awake on the couch, shaking, and waiting for the drugs to clear my system.

Oh yeah... and on top of all of that I had some significant "GI issues."

So the moral of the story is... no, I'm not taking Provigil. Would I ever try is again? Maybe a 100 or 150 mg dose if I were desperate enough (I would never, ever try 200 mg again. Ever.). So while I'm sure that it doesn't have this effect on everyone, I would advise taking it with great caution...

NOTHING LIKE PROMOTING DRUG ABUSE

BellyDancingDoc · Jan 15, 2007

DRJJ1 said:
NOTHING LIKE PROMOTING DRUG ABUSE

Hey now, that's uncalled for!!!

I got that prescription in a perfectly legal manner, and used it as recommended by my doctor and the pharmaceutical company. I was living a "shift work" lifestyle, and therefore qualified for SWSD, as questionable as that "disorder" might be. I'll thank you to NEVER EVER to besmirch my name (OK my handle) with that kind of accuation.

Also, my experience on Provigil was actually quite miserable, so I would hardly characterize the above post as "promotion."

OncoCaP · Jan 15, 2007

BellyDancingDoc said:
Based on my personal experience (see post #2 of this thread), I suspect that part of the reason it hasn't "spread like wildfire" is that it apparently does not always work the way they say it should. Believe me, there is no possible way I could have performed during call in that tripped out state...

http://www.rxlist.com/cgi/generic2/modafinil_ad.htm
The most commonly observed adverse events (≥5%) associated with the use of PROVIGIL... were headache, nausea, nervousness, rhinitis, diarrhea, back pain, anxiety, insomnia, dizziness, and dyspepsia. The adverse event profile was similar across these studies.

In the placebo-controlled clinical trials, 74 of the 934 patients (8%) who received PROVIGIL discontinued due to an adverse experience compared to 3% of patients that received placebo. The most frequent reasons for discontinuation that occurred at a higher rate for PROVIGIL than placebo patients were headache (2%), nausea, anxiety, dizziness, insomnia, chest pain and nervousness (each <1%).

Also, here are patient experiences, from good to bad:

http://www.askapatient.com/viewrating.asp?drug=20717&name=PROVIGIL

OHMAN0125 · Jan 15, 2007

808_Drum said:
Adderall is an amphetamine, and amphetamines have a high potential for abuse. Provigil is NOT an amphetamine. It "promotes wakefulness" but is not the same type of stimulant as an amphetamine. It is not used for ADHD. While it could be abused by the same type of person who would abuse amphetamines, it is not habit-forming, and one does not generally develop a tolerance to provigil.

It can be very helpful for people who have their circadian rhythm interrupted by working night shift but needing to function on a "normal" daytime schedule on their days off (residents, for example).

Mmmmm.........pharm... :laugh:

anon-y-mouse · Jan 15, 2007

Johnny_D said:
I read an article recently in Philadelphia Magazine that touted the benefits of Provigil. The article stated that the drug allows you to focus your mind without the side effects of typical stimulants. Also, it stated that the drug is not addictive. It went on to say that the US Air Force gives it to their pilots so they can maintain concentration on long flights.

This sounds like a great thing for med students. Anyone out there have any experience with it? Does it help with the late night studying? The drug is prescription, so you have to see a doctor first. Any feedback would be great.

I know someone in my class who routinely uses this. He calls it a "nap" pill and 100mg usually resets his circadian clock as he needs it. It's also a cognitive stimulant apparently. The only major problems he said he had was sometimes he'd get a headache.

humuhumu · Jan 15, 2007

OncoCaP said:
Also, here are patient experiences, from good to bad:

http://www.askapatient.com/viewrating.asp?drug=20717&name=PROVIGIL

Very interesting link. Clearly not a "wonder drug" for everyone. And expensive too.

stargirl50 · Jan 15, 2007

if your work/sleep schedule even resembles anything like "shift work disorder" as a first or second year medical student, you've got other problems.

sleepy_dwarf · Jan 16, 2007

I have a off label script for Modafinil for depression related hypersomnia. I originally started on 200mg in the morning, but found that I was becoming sleepy again in the early afternoon, and eventually switched to 100 upon waking, and 100 at noon. Despite the earlier post, I found the effect rather subtle and do not feel stimulated at all. I have noticed that I have a cognitive improvement, with the main improvement in short term memory recall. My only side effect has been some pretty noticeable dry mouth, especially when I take 200mg in the morning and consume any additional caffeine. Dry mouth is minimal when I split the dose and avoid caffeine.

Shift work sleep disorder is not simply a decrease in performance associated with shift work. The ability to resist the effects of sleep deprivation varies across people. Some people (damn them) are able to perform well despite significant sleep deprivation. For other people, even a small decrease in sleep quality will have a profound effect in performance. That means that a portion of the population that does undertake shift work will perform below the arbitrary expectation of themselves and society of how they should perform when sleep deprived. These individuals are at greatly increased risk for harming themselves and others on the job, and on the commute home afterwards.

anon-y-mouse · Jan 16, 2007

sleepy_dwarf said:
I have a off label script for Modafinil for depression related hypersomnia. I originally started on 200mg in the morning, but found that I was becoming sleepy again in the early afternoon, and eventually switched to 100 upon waking, and 100 at noon. Despite the earlier post, I found the effect rather subtle and do not feel stimulated at all. I have noticed that I have a cognitive improvement, with the main improvement in short term memory recall. My only side effect has been some pretty noticeable dry mouth, especially when I take 200mg in the morning and consume any additional caffeine. Dry mouth is minimal when I split the dose and avoid caffeine.

Shift work sleep disorder is not simply a decrease in performance associated with shift work. The ability to resist the effects of sleep deprivation varies across people. Some people (damn them) are able to perform well despite significant sleep deprivation. For other people, even a small decrease in sleep quality will have a profound effect in performance. That means that a portion of the population that does undertake shift work will perform below the arbitrary expectation of themselves and society of how they should perform when sleep deprived. These individuals are at greatly increased risk for harming themselves and others on the job, and on the commute home afterwards.

Are you on any other concurrent medications - especially for the depression? How's the modafinil use affecting the depression? Other stimulants (amphetamines mainly) tend to have the effect of making existing depression much more acute.

drmistga · Jan 17, 2007

Oh man did I not like provigil, I tried it 3 years ago or so when it was becoming more exposed and marketed. I always loved adderall for studying and whoever said it does not increase concentration when you are rested is not speaking from experience because I 100 percent knew I was super human. But anyway I got provigil during first year and remember trying it initially. I do not remember the dose to be honest but the first time I definetly did not feel anything like the high of amphets and no increased concentration however I could not fall asleep. My eyes were just alert and not heavy, kind of like if you drink caffeine really late at night or something.

The problem with this is my brain was still tired and I could not study anymore but yet I could not sleep either-was the worst of both worlds. I upped my dose the next couple days and my god-my heart was pounding out of my chest a million miles an hour. I could barely walk, nevermind study and made me feel like crap. So that was it for that.

It basically keeps you from sleeping but has no helpful increase in brain/focus endurance or enhancement. Kind of sucks IMO

Tired · Jan 17, 2007

anon-y-mouse said:
Are you on any other concurrent medications - especially for the depression? How's the modafinil use affecting the depression? Other stimulants (amphetamines mainly) tend to have the effect of making existing depression much more acute.

Modafinil is commonly used to treat depression, especially in the terminally ill patient who requires a rapid onset of action (SSRI/SNRIs take 2-6wks for onset and full effect). The geriatricians and palliative care people rave about how well it works.

sleepy_dwarf · Jan 19, 2007

I'm on Wellbutrin SR for my depression/anxiety, which helped everything except my hypersomnia. Sleeping 10+ hours a day was putting a small kink in my medical school career, but I am performing markedly better now.

abecedarianMD · Jan 20, 2007

try sulbutiamine, a precursor to thiamine.

commonly used in india (i believe), this should work similar to provigil in that it keeps you alert and does not have any sides or dependence issues. it is kind of pricey, but it can do the proverbial "trick".

Anyone taking Provigil?

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