Talk:Modafinil

Rewrite

I have just done a major rewrite on this article, hopefully giving a more logical grouping of the information, as well as cleaning up the indications, adding counterindications and warnings, pharmacokinetic data, etc.

Some of this is from memory, though I added the PI sheet etc to the external links, and tried to verify the most important bits that I changed.

If there is anything you feel is not borne out by the sources, slap a {{fact}} tag on it, and drop me a message on my talk page, and I will source or remove it within a week at most (probably within a day or so). Please do not just revert the edit without discussing it first, despite the scope of the changes. Zuiram 02:38, 30 October 2006 (UTC)

Archive?

Are there any objections to moving a substantial part of the content on the talk page to an archive page? The page is getting crowded, and much of it is stale. Zuiram 02:44, 30 October 2006 (UTC)

Absorption and Tmax

I have added a few minor details, broadening the scope of the article. I would be interested if anyone knows the time for modafinil to take effect after ingestion. Richard Farmbrough.

Pretty much the standard 35-45min as with most ingested drugs. From the PDR monograph: "Absorption of PROVIGIL tablets is rapid, with peak plasma concentrations occurring at 2-4 hours. The bioavailability of PROVIGIL tablets is approximately equal to that of an aqueous suspension. The absolute oral bioavailability was not determined due to the aqueous insolubility (<1 mg/mL) of modafinil, which precluded intravenous administration. Food has no effect on overall PROVIGIL bioavailability; however, its absorption (t max ) may be delayed by approximately one hour if taken with food." (copyrighted, fair use, don't include in article) --Bk0 20:22, 21 Dec 2004 (UTC)

• • I have been using modafinil for about 2 months every week day and find it takes about 1 hour to take effect and probably 3 hours for peak effect. However this is a very subjective and hard to determine number.. i find its effect isnt so much waking you up and preventing you from wanting to sleep. You will usually wake up more as the day goes on regardless of taking this drug so its difficult to define. --danielg 16:20, 24 March 2006 (UTC)

Peak effect and peak concentration is not always the same thing. Zuiram 00:24, 30 October 2006 (UTC)

On a full stomach 100mg of modafinil can easily take 4 hours to have an adequate effect (perceived)... I'll stop yawning when it kicks in, generally 3~4 hours after dosing. Take by mouth every morning before meal (po qam ac) for faster results.

Military Use

Many sites refer to military use, some hard and fast documentation would be nice. Rich Farmbrough 13:46, 18 Aug 2004 (UTC)

This study is done by this canadian defence (defense) research firm. 63.201.228.94 05:10, 4 August 2005 (UTC)

---

"Dosage varies from once 100 mg/day to twice 200 mg per day (the second about 4 hours after waking), and is more effective on naive users."

This seems more qualitive than objective. What exactly is meant by "naive users?" Do you mean patients? How does one define their level of naivete in this case? What exactly does a "naive" person indicate in this instance? Is there any source for this claim? MSTCrow 14:44, Nov 23, 2004 (UTC)

Naive with respect to stimulants, I.E. newly diagnosed. The data is from a published paper listed at www.modafinal.com IIRC. Rich Farmbrough 19:18, 21 Dec 2004 (UTC)

Yes, "naive" when used in medical papers means a patient not yet exposed to whatever the paper is talking about. In this case it means people who have never before used modafinil. --Bk0 20:12, 21 Dec 2004 (UTC)

Some papers and anecdotes indicate that the sensitivity can be sustained by coadministering an alpha-2 antagonist, such as reboxetine. Otherwise, its utility as an augmentor in antidepressant therapy is reduced to nil in a matter of weeks. Zuiram 00:24, 30 October 2006 (UTC)

NPOV?

Hmm -- I was reading through this:

The manufacturer claims that modafinil allows people who suffer from unusual fatigue to remain awake without side effects or impairment of job performance. However it does not live up to this in all cases, occasionally producing rashes and intestinal problems. The usual prescription is for a single dose to be taken shortly after waking; its effects last for most of the day without preventing normal sleep at night, though in narcolepsy twice-daily administration is required. Under no-sleep conditions, a dose is taken at 8 hour intervals.

and it seemed to me that it was inappropriate for a "Indications" section. Side-effects have been their own separate section in every other Wikipedia entry I have read; why should this one be any different? It seems like it was written by someone who had a bad experience with the drug. I'm not seasoned enough to rewrite it myself, but can someone take a look at this?24.34.92.252 07:22, 10 November 2005 (UTC)

i tend to agree with you - this article is clearly written by someone very biased against modafinil (or possibly certain prescriptions in general?). the emphasis is on the negative side-effects and possible flaws with the medication rather than the various uses, treatment durations, and other necessary general information. very disappointing. i will try and take a moment to make some edits when i have more time.

long term effects & relation to other amphetamines?

(many topics in one actually)

Are any specifics known about the long term usage of this drug? For instance, would a fighter pilot on a typical hightened dispatch (let's say, for argument's sake, 2 weeks) be subjected to alternate between Zolpidem and Modafinil (or Dexedrine) ?

- What are the effects on the judgement capabilities of the subjects (short term and long term) after 24 or 48 hours of sleep deprivation?

- How does this compare or differ from general Amphetamines or Dexedrine with regard to:

- libido effects

- recreational

- perhaps dosage and half time ?

Martixer

I'm not aware of any literature or studies regarding the topics you mention, so any information would be anecodotal and original research. However, modafinil is not an amphetamine and the effects are quite different from, eg, dextroamphetamine. Modafinil is not particularly euphoric or recreational, so the abuse potential is low. Also, regarding your first example, sedatives such as Zolpidem shouldn't be necessary to achieve sleep; unlike typical sympathomimetic stimulants, insomnia is not a common side effect of modafinil use. --Bk0 (Talk) 15:21, 11 January 2006 (UTC)

The effects on judgement capabilities after sleep deprivation are better than with amphetamines for all durations of time. The same goes for sleep deprivation without drugs. Cognitive performance is also better. The exception is, of course, when sleep deprivation has gone on for so long that tolerance to the drug prohibits further dose increases.

My experiences with the effects you mentioned are limited to dexedrine, but I can offer some educated guesses based on the material I've read. Libido should be largely unaffected, though there is a potential for slightly elevated libido and a slightly shorter orgasm-refractory period in men. Recreational use value of modafinil is essentially zero; you should not experience any actual euphoria. If you don't have anything specific you need to do, it's unlikely to give you anything. Frequency of dosing (based on halflife etc) should be comparable to dexedrine (d-amphetamine), while desoxyn (d-methamphetamine) will last longer.

Zuiram 05:40, 3 November 2006 (UTC)

Urine smell of sulphur?

Can someone who has actually tken modafinil comment on whether it causes a rotten egg smell in your urine? Thanks. --James S. 04:54, 16 January 2006 (UTC)

It's not a rotten egg smell, but there's certainly an odor. It's very distinct. It smells like the drug tastes.

Eh, can't say I have - otherwise I wouldn't go into any public toilets...

Yes, when combined with certain other drugs. have you been combining this with amphetamines or benzodiazepines? - D. Morelos

-- Yes, it smells like sulfur. Its a by product of its breakdown. Anyone who takes it must notice it.. its only extremely strong when taken in high doses.. about 1gram if you are using it to stay up all night. Its never not there though. On par with coffee urine I would estimate. – danielg

I haven't noticed any odors at 400mg/day. --moof 10:16, 5 July 2006 (UTC)

Who on earth uses 1 gram a day? No offense here, but 600mg a day should keep a dead person awake for 24 hours. :P Zuiram 00:24, 30 October 2006 (UTC)

Patrick: 200 mg all 8 hours is enough to keep a narcoleptic cow awake for at least 40 hours. This is the proper dosage! The evidence suggests that a overdosis of modafinil is dramatically enhancing the elimination of active modafinil through the P450-Enzyme System in the liver, hence modafinil wears off within some days! Modafinil most effective dosage is at 200 mg all 8 hours is IMHO. I am on modafinil since months with-out any side effects.

Petition

Just disambiguated the reference to the FDA petition, as coming from a private individual (as aposed to any of the drug companies mentioned)

Evidence based on the fact that the adressee in the petition response: http://www.fda.gov/ohrms/dockets/dockets/05p0265/05p-0265-let0001-vol1.pdf [is James S.] ... appears to be unrelated to drug companies. --Zootalures 23:26, 13 March 2006 (UTC)

Yes, that's me. There was an earlier petition from a competing drug company in application for generic production, but it was withdrawn when the particle size patent was asserted. In the U.S. form of government, people are peers of companies. Full petition text. --James S. 04:18, 14 March 2006 (UTC)

News

Well, the patent is about to expire, and suddenly the world press is full of articles: by date; Here is the latest at present; some peer-reviewed work; now known also as "Sparlon,"for skin rashes and child ADHD; apparently this has been an "off-label" treatment for years; comparison with coffee for wakefulness; financial news; FDA panel reversal on ADHD.

I predict they will close my petition, or keep it open, but not grant it. However, I predict that within a few weeks of April 1st (the patent expiration date), that the company which had the withdrawn generics application will challenge the particle size patent, asking for injunctive relief, thereby circumventing the generics application process. This drug is not usually excluded from insurers' formularies. --James S. 20:58, 24 March 2006 (UTC)

Vigicer or vigicer?

Where does the name "Vigicer" come from? It is not in MEDLINE or the U.S. Patent and Trademark Office's TESS, live or dead. However, there is no shortages of google hits for it from "without a prescription" pharmacies. Is Vigicer the black/grey-market name?

Should it be capitalized? --James S. 21:11, 24 March 2006 (UTC)

It is the marketed name of the drug, so it would be Vigicer. It's a proper noun. — tomohawk 15:53, 17 May 2006 (UTC)

Histamine

Just corrected some spelling and stuff and added some additional European names. A lot of info on this page is quite 'US-centric' (no offence meant!) such as patents, legality etc - added some UK stuff.

The section on histamine suggested that modafinil works on H3 only, could not find any evidence for this so changed to statement about promoting histamine release. Berry 09:49, 26 April 2006 (UTC)

Modafinil is a reliable medicine against narcolepsy, sleep-apnoe-sydrome and good by shift-working. But you cannot expect wonder of this. you will not "pull out trees" with it. So the effect is more modest in this.--Fackel 20:20, 30 May 2006 (UTC)

C-fos

"by greatly elevating c-fos expression"

Thought this was unnecessarily scientific and there is no real info anywhere about what this gene is or does. Am life sciences student and myself have never heard of it! If anyone wants to put it back in, then please write something like 'by greatly elevating the expression of c-fos, a -------." Berry 21:00, 22 June 2006 (UTC)

• • I'm relatively new to Wikipedia discussions and I could not find where this should go but...**

How exactly is the modafinil chemical displaced racemic? I see no chiral carbon...

I didn't know this either, but it seems to be the sulphur atom in the sulfoxide group and not a carbon that is chiral. Berry 12:03, 26 July 2006 (UTC)

modafinil

does modafinil help curb your appetite? and do you think it could be a replacement for adderall users?--kim--71.87.196.11 15:00, 24 July 2006 (UTC)

Any stimulant will tend to reduce appetite, but I don't think modafinil is as potent in this regard as typical stimulants. As to using it for any particular purpose, go talk with your doctor. In the future, if asking for hints on WP, try to at least include some information about what you intend to use it for. Zuiram 00:24, 30 October 2006 (UTC)

I know this is anecdotal, but here you are: when I went on it (due to narcolepsy), I lost 20 pounds in about six weeks. I also fasted completely accidentally -- I wouldn't realize I'd missed a meal until I'd missed four or five. I always had a "Hmm, dinner's in an hour or so, right?" feeling then, but I never felt properly hungry. I went back to my doctor, he said "Oh yeah, decrease in appetite, that is a side effect now that you mention it." My weight loss has slowed down a lot since, because I'm making sure I eat two meals of three, but I am still losing weight because it allows me to have smaller portions and still feel perfectly full. 128.122.253.229 10:22, 5 November 2006 (UTC)

There are several papers on this topic, and it seems that modafinil is about as good as amphetamines at reducing appetite, but has fewer side effects. I'm not aware of any studies demonstrating long-term efficacy of modafinil for weight loss (and I am aware of studies showing that amphetamines do not show long-term efficacy), so if you're looking to lose weight, modafinil may not be for you.

Provigil also used to treat fatigue in fibromyaliga

It shows up in the fibromyalgia blogs for treating fibrofog and fatigue, so it seems like that should show up in the literature about it at some point. Might be worthwhile research lead. --Aunt Amanda 06:13, 24 October 2006 (UTC)

There should be no original research on Wikipedia, according to policy.

That said, there more than just anecdotal evidence that it helps with "brain fog" and fatigue. There is literature out there, but it's generally fairly technical. In my experience, brain fog is mostly influenced by norepinephrine, dopamine and glutamate, and modafinil elevates all of these, though I suspect desoxyn does a better job of it. As for fatigue, that depends on a number of factors. Many kinds of fatigue will respond to augmenting these same neurotransmitters, and also to raising testosterone levels. As a potentially interesting anecdote, I have found that buprenorphine does a fairly good job with both of these, though in my case they were caused by an adverse reaction to a neuroleptic medicine (levomepromazine) rather than fibromyalgia. It also restored my hormone levels to normal; before starting therapy, they were so off that the lab told my doc to investigate whether I was undergoing an unauthorized sex-change treatment. Cost me 30% muscle and bone mass. Zuiram 05:48, 3 November 2006 (UTC)

prolapse mitral valve?

I USED to have prolapse mitral valve, but it got better. From reading the article, it seems I can't use modafinil. Is this true, and could the article elaborate more on it? 204.117.11.226 17:54, 29 November 2006 (UTC)ClintJCL

Study drug?

Does anyone know why modafinil is not very commonly used as a study drug? You so often hear reports about ritalin, ect. being misused by students to stay awake, but I have never seen anything in the news about modafinil being used this way despite it being a Schedule IV (less than many other study drugs). And it does work for non-narcoleptic people, that's what the military studies are showing. Nor do the side effects look very common. I don't understand why everyone isn't using this drug. Is it hard to obtain? Do people not know of its existence? Although it was released in 2000. Can you cast any light on this?? It just seems very strange to me, surely this is exactly what one would look for in a study drug, yet I have never heard anything on the news about it being used that way. 128.122.253.212 01:31, 2 December 2006 (UTC)

What I'm going to say may sound preachy but I think it is a valid opinion and no offense is intended. I have read before that effective learining involves consolidating information learned while awake and attentive into different parts of the brain while asleep. This is confirmed by this section borrowed from a wikipedia article on memory: "Short-term memory is supported by transient patterns of neuronal communication, dependent on regions of the frontal lobe (especially dorsolateral prefrontal cortex) and the parietal lobe. Long-term memories, on the other hand, are maintained by more stable and permanent changes in neural connections widely spread throughtout the brain. The hippocampus is essential to the consolidation of information from short-term to long-term memory, although it does not seem to store information itself. Rather, it may be involved in changing neural connections for a period of three months, or more, after the initial learning. One of the main functions of sleep is thought to be to improve consolidation of information, as it can be shown that memory depends on getting sufficient sleep between training and test, and that the hippocampus replays activity from the current day while sleeping." Effective learning stragies involve adequeate periods of awake attentive learning and SLEEP. In my opinion, strategies that bypass millions of years of brain evolution ultimately fail. From my experience so far, Ritalin and Adderall consistently and reliably promote vigilance and attention in both ADD and non-ADD patients, however the effects of Provigil are less robust. Perhaps this is why it is not as sought after. In addition, the number of patients prescribed Ritalin and Adderall vastly exceeds the number of Provigil patients, thus it is more readily available.--Psychofarm 14:52, 2 December 2006 (UTC)

Hercules: Why are people not allowed to use Modafinil as a recreational drug? Who says that the production costs are so high and people get injured and addicted. Thats nonsens. Modafinil is just a simple synthesized drug. I have a dream that one day modafinil will be sold like Aspro/Aspirin... This orphan status is a hoax anyway, they just want to make money. That's all.