Modafinil is the generic name for a medication prescribed to treat sleep disorders like narcolepsy and sleep apnea. This medication improves wakefulness for those with chronic conditions that lead to excessive sleepiness or fatigue.
The drug can be abused, usually in attempts to enhance mental performance.
What Is Modafinil?
It is not a stimulant, although it reduces tiredness. Scientists are not entirely sure how the medication works, but they believe it increases dopamine levels in the brain by inhibiting the reuptake of this mood-elevating, stimulating neurotransmitter.
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The medication is typically prescribed under the brand name Provigil. It was approved by the U.S. Food and Drug Administration (FDA) in 1998. Originally, modafinil was approved only for narcolepsy, but in 2003, it was also approved to treat shift work sleep disorder (SWSD) and hypopnea.
There are now several brand names of modafinil available, along with the generic version, for prescription use. Although modafinil is not believed to be addictive, it is abused as a “smart drug.” People who abuse modafinil believe the drug improves memory and cognition, not just alertness. By improving wakefulness, modafinil also appears to improve short-term memory.
It is a federally controlled substance, and any consumption of the drug outside of prescription use is an illegal form of misuse or abuse. Rising rates of modafinil abuse have led to questions about how far the human body can go with the help of “super drugs.”
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Modafinil was first synthesized in France in the 1970s, but it was not approved for prescription use in the United States until the 1990s.
In 1999, the U.S. Drug Enforcement Administration (DEA) classified modafinil as a Schedule IV drug, so it is not as tightly regulated as other stimulants, but it still requires a prescription.
The DEA scheduled modafinil so it would be regulated since the drug was found to trigger addictive or substance abuse behaviors similar to some other intoxicating drugs.
Prescription modafinil comes in 100 mg and 200 mg tablets, which may be divided up to different doses, depending on what the medication has been prescribed to treat.
While it is prescribed to treat rare sleep conditions, particularly narcolepsy, one estimate suggests that one in five adults has taken modafinil to improve cognitive performance, not for chronic illness as the medication should be used.
When modafinil is abused, the drug is intended to enhance work or academic performance. However, it appears to hinder mental performance in some cases.
A research study of 32 participants on modafinil and another 32 on a placebo found that people who took modafinil experienced slower reaction times on a timed mental test compared to those who took a placebo drug. Both groups made a similar number of errors, indicating that short-term memory does not improve significantly enough for modafinil to be considered a mental enhancer.
Another group suggested that slower response time could improve cognitive performance by reducing impulsivity, thus reducing distractibility while studying or working. However, there was no evidence in any research study to prove these suggestions.
While a separate study found that modafinil sped up reaction times rather than slowed them down, it did not improve the participants’ ability to reason, learn, or answer questions correctly.
For the most part, people who abuse modafinil do so for the same reasons stimulant drugs like Adderall and Ritalin are abused. Modafinil is mistakenly believed to be safer because it is not addictive like amphetamines and methamphetamines. Modafinil is in a different family of nootropic (smart) drugs, so it does not stimulate blood flow and risk heart, stomach, or brain damage.
Just because modafinil is “safe” compared to some stimulant drugs does not mean it is not risky.
Modafinil allows for more dopamine in the brain, which is a neurotransmitter involved not only in mood regulation, physical energy, and sleep cycles but also in the brain’s reward system. When this system in the brain is stimulated, you begin to associate that behavior with positive outcomes.
For example, when you eat a piece of candy, your reward system is stimulated because of the presence of simple sugar. When you exercise, your brain is stimulated by physical activity. This reinforces behaviors, whether good or bad. When a drug causes a surge of dopamine, it is immediately associated with positive outcomes even if the drug is very dangerous.
Side Effects of Modafinil Abuse
Even when modafinil is taken as prescribed, it may lead to side effects.
Your doctor can adjust your dose to help you manage these side effects. People who develop problematic, harmful side effects from taking modafinil without a doctor’s permission do not have a way to manage these, so they may suffer longer from issues related to their substance abuse.
Common side effects include:
People who take too much modafinil, especially due to substance abuse, may experience additional symptoms.
- Back pain
- Reduced appetite
- Stomach upset, leading to belching
- Trouble with bowel movements
- Dry mouth
- Flushing or redness of the skin
- Dry skin
- Feeling like one is always moving or shaking
- Heartburn and indigestion
- Muscle stiffness
Some side effects are less common, but riskier.
- High blood pressure
- Somnolence, or excessive sleepiness
- Insomnia or other troubles sleeping
- Ulcers or sores inside the mouth
- Runny nose or nasal congestion
- Swelling in the fingers, toes, hands, or feet
- Tingling or burning sensations on the skin
Minimal Addiction Research
There is not enough medical research on the consequences of modafinil abuse to understand whether the drug is technically addictive. People who abuse the substance fall into patterns of repeated misuse, and there are rare instances of physical dependence, indicating a risk of addiction to the chemical.
An older study from 2009 involved 10 male participants whose brains were scanned before and after they took modafinil. The images showed higher levels of dopamine in the brain after consuming the drug, which is a hallmark trait of other substances of abuse, like cocaine or meth. This small survey was one of the first involving modafinil, and it is still one of the few pieces of research available on how modafinil can impact the brain.
Doctors are clear that modafinil is a safer option than amphetamines, but that does not mean the drug is safe. Interactions and side effects do occur. Overdose and withdrawal may be rare, but there have been instances of these problems.
There are records of hospitalizations associated with modafinil, but this may or may not indicate an overdose.
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Signs of harm associated with modafinil, which may be due to metabolism problems or taking too much, include the following:
- Chest pain
- Heart palpitations
- Difficulty breathing
- Sore throat
- Blistering or peeling skin
- Very red rash
- Numbness, pain, or severe tingling in the limbs
- Extreme muscle weakness
- Easy bruising or bleeding
- Panic attacks
- Sudden increase in activity (mania)
- Aggression toward oneself or others
- Sudden, intense depression
- Thoughts of suicide
Experiencing these life-threatening symptoms is more likely when the drug is mixed with other substances, both over-the-counter and prescription medications.
The following drugs interact badly with modafinil:
- Phenobarbital or other barbiturates
- Benzodiazepines like Valium, Xanax, and Klonopin
- Antifungal medications
- Antidepressants, especially MAO inhibitors
It is also important to avoid drinking alcohol while taking modafinil, as this can cause complex, harmful side effects in the brain.
When the body experiences withdrawal, it is because the brain and body are physically dependent on the presence of a chemical to maintain normalcy.
There is little medical information on whether modafinil leads to physical dependence, although there have been some reports that the drug can do this. Drugs that adjust neurotransmitters like dopamine have a component of physical dependence.
- Trouble thinking and concentrating
- Persistent depression
- Exhaustion or fatigue
- Low physical and emotional energy
- Shortness of breath
Although these symptoms are not life-threatening, they may be uncomfortable, so working with a detox program to safely manage these and remain sober while the body ends its modafinil dependence is essential.
The Danger of Abuse
In some instances, modafinil is prescribed off-label to treat disorders not associated with sleep.
There is some suggestion that since the drug allows dopamine to remain bioavailable to neurons for longer, it can help to treat cocaine and amphetamine addiction. There has been a limited off-label application of this drug for this purpose. Since modafinil itself may trigger substance abuse, it is not a good substance to moderate cravings for other drugs that release dopamine.
Whether a drug has known addiction risks or not, misusing any prescription drug, diverting it for nonmedical abuse, or stealing it for recreational or performance-enhancing reasons is illegal and risky to your long-term health.
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(November 30, 2016). Why Can’t We All Take Modafinil? VICE. from https://www.vice.com/en_au/article/ava7za/why-cant-we-all-take-modafinil
(November 14, 2014). “Smart Drug” Modafinil Does Not Make You Smarter. Live Science. from https://www.livescience.com/48762-modafinil-drug-impaired-cognition.html
(March 17, 2009). Cognitive Enhancement Drug May Also Cause Addiction. Nature.com. from https://www.nature.com/news/2009/090317/full/news.2009.170.html
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