Provigil/Modafinil

DianaCox

Bad Cop
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For some reason, I can't post something I've been trying to post since last night. Trying a shorter post with no drug names in it.
 
Trying to post it here, as a test:
~~~~
(Been trying to post this since last night - some kind of website glitch going on. I have taken my first dose of 1/2 pill and I'm ZOOMING. Not sure I like it, but definitely feel like I'm hypercaffeinated or on speed.)

Ever since my Reglan debacle in 2009, I have had annoying attention span/memory issues. I was put on Adderall, a very low dose (5 mg/day, extended release form), but it was a very annoying drug to be on - I could only get it 30 days at a time, and it had to be a PAPER prescription, and my PCP was 25 miles away (you have to know how much I loved her then and miss her now!). So she would write it the way the original shrink did, which was for 3/day, so I only had to order it once every 3 months. But it was a major PITA, especially after a set of scripts she wrote for me and sent by mail disappeared.

So when I moved to AZ, I went to a new PCP to get set up with all the labs and meds I take, and he was NOT comfortable writing the script for a Schedule II controlled substance in an amount 3X what I was actually taking, especially since the feds are clamping down on prescription meds of all sorts, but especially controlled substances. Since I was dealing with high liver enzymes at the same time, we decided I would do a trial of stopping the Adderall altogether - getting rid of anything that might be taxing my liver that wasn't necessary (also cut back on Vits A, D and K). He mentioned switching to a different drug, but I figured it would be good to just not take anything for a while and see if I actually needed it anymore. And give my liver a rest.

Anyway, it's been 9 months, and in the meantime, my liver enzymes went higher - and then just as inexplicably went back to normal last time.

I had my yearly physical yesterday, and I talked to my PCP about the fact that my attention and memory issues were not horrible, but noticeable and very annoying. We talked about trying Provigil (which, somewhat hysterically, he couldn't remember the name of for several seconds), and I agreed.

So - anybody here take this stuff? He gave me 100 mg tabs, not slow release, and said I could try cutting them in half and seeing how it felt, and then play with dosing - if I needed more, take in two divided doses, or all at once in the AM. We could try the extended release later after I figure out how much I need.

Just curious - the drug is claimed to be a "cognitive enhancer" - anyone use it and have an opinion? And it's only Schedule IV (lesser category).

Modafinil is a wakefulness-promoting drug used for treatment of disorders such as narcolepsy, shift work sleep disorder, and excessive daytime sleepiness associated with obstructive sleep apnea.[6] It has also seen widespread off-label use as a purported cognitive enhancer. In English-speaking countries it is sold under the brand names Alertec, Modavigil, and Provigil. In the United States modafinil is classified as a schedule IV controlled substance and restricted in availability and usage, due to concerns about possible addiction potential. In most other countries it is a prescription drug but not otherwise legally restricted.

Modafinil acts as an atypical, selective, and weak dopamine reuptake inhibitor which indirectly activates the release of orexin neuropeptides and histamine from the lateral hypothalamus and tuberomammillary nucleus, respectively, by unknown mechanisms, all of which contribute to heightened arousal.[7][8][9]
OREXIN NEUROPEPTIDES? Maybe an appetite suppressant too?
 
TAKE THAT YOU STUPID SOFTWARE!!! I started the post with the title "Testing" then successfully posted a test post. Then I posted my drug post and it posted - and then I CHANGED THE TITLE OF THE POST!! HAH!
 
I am a huge proponent of modafinil/provigil/whatever trade name you're getting it under. I will proselytize it as much as I do DS - which is any time I can

I have only taken one dose post-DS, and my PCP told me not to take it now that I'm taking bupropion
 
Dr S asked that I bring a dose or two to the hospital for post-anesthetic waking up. I did, and I took one at the hospital.

I stopped taking moda because it's never enough to change one thing at a time. I decided I was stopping taking moda, as well as alcohol, and smoking cigars, around surgery. They were all crutches for me.

What do I like?
  1. being able to go on mental cruise control and drive for long distances. I also used cigars for this.
  2. being awake without getting tired.
  3. I didn't find it speedy, or like drinking too much coffee. I found it more like a push that kept me awake. I could decide I'd been up long enough, lay down, and go to sleep. Good luck doing that with coffee.
  4. It did suppress my appetite.
  5. It is, for me, a cognitive enhancer. I think. It's hard to a/b test it.
What do I dislike?
  1. Pee smells really strong and bad.
  2. it takes hunting and pill chopping to find the right dose.
  3. It's expensive. Even though I have a prescription, it's $900 to fill it at Walgreen. I started buying it from India, where it's about $1/dose.
It sounds like you took too much. Here is the FAQ from /r/afinil on reddit.

I have a friend who weighed about the same as I did. He took one pill and said it was like a rocket taking off, then he had the zoomies all night. I never had that experience, exactly. As my weight started going down pre-surgery, I did feel edgier.
 
I need to pay attention to this thread.

I spent last evening crying...I seldom actually cry...worried about "losing" Mr Sue, because he's so...different...than how he used to be.

Causes of tears:
1--he went to the grocery store with a written list of six items to buy...and came home without two of them. Reason? The deli counter was understaffed, took too long and made him "nervous." (First time in 44 years I've heard him claim that he was nervous.) We were in kind of a hurry to get dinner assembled and into the fridge before the housekeeping ladies arrived. But, failing that goal would not have been the end of the world. We could have waited until they left. Anyway...he apparently put so much pressure on himself that he "forgot" 33% of the six-item list in his rush to get home.

2--Helen Reddy, singing "You and Me Against the World," specifically the lines that go:
And when one of us is gone,
And one of us is left to carry on,
Then remembering will have to do,
Our memories alone will get us through.
Think about the days of me and you,
Of you and me against the world.

And Mr Sue seems at times to be cognitively slipping away, and I'm physically shot to hell and my BIL is gonna go next time he sneezes and I have no idea who will be in charge of my sister and even Helen Reddy has moved into assisted living. So I cried.

More about my situation...I don't like the new neurologist. He says that silent strokes do not cause mood problems. (Peer-reviewed lit seems to disagree.) Previous neuro says silent strokes don't exist. (Ditto.) And so far, I can't find much recent stuff on how to deal with post-stroke mood issues.

More about you, @DianaCox ... I take a shit ton of hydrocodone. Not as much as my Rx allows...but more than
I want to take. One PCP would write three scripts, two post-dated. Next PCP just doubled the dosage. But NEW PCP seems to have super-power privileges! I wait until about 5-6 weeks after the last script...don't want to seem too anxious...but my 30-day Rx is more than I really need in a month because the previous PCP doubled it. And I call the doctor's office for a "refill." And somehow, she is allowed to electronically transmit the Rx to CVS, and her office calls back and says that the pharmacy has been contacted. (Oh, and I ZOOM, too...like many elderly folks, I've begun experiencing a paradoxical reaction to hydrocodone...I hurt less, but I'm WIDE AWAKE! I write long posts, like this one. Next time I call you and just rattle on, you are allowed to ask if I've recently medicated.)

So, maybe you need a doctor with super powers. Ask at the pharmacy how that works.


BLESS-ED are the DEPRESS-ED.
 
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I am prescribed Nuvigil, or armodafini. I originally tried the Provigil but it didn't do much for me. The Nuvigil 250 mg) makes a huge difference in my life. I haven't taken it post op, but certainly intend to down the road once I need my brain to work at a high level and stay awake.

I see it as a cognitive enhancer only in the way of it helping overcome some cognitive deficits. I don't think it does much for you if you aren't excessively sleepy in the day and/or have attention or concentration issues. For me, without the medication, I would feel like I am an addict for sleep. Getting back to sleep would be the first thought I would have every morning. My energy would be low and I would be desperate to fit in a nap during the work day. Other people noticed I always seemed sleepy. I had a hard time keeping up with some aspects of my job (documentation). I don't have sleep apnea or other conditions which would explain the excessive sleepiness. I do have recurrent depression for which I take medication and am doing well. I figure this may be a residual symptom. When I take Nuvigil, I feel much more like myself. It is like drinking a cup of coffee and it lasting alll day, no increase of anxiety or nervousness, which may happen with caffeine. My psychiatrist prescribes it.
 
Duckman:
One half pill, which I took about 10 AM, was very intense for about 10 hours. I came down gently. It's now 10 PM and while I still feel slightly more intense than normal, I'm pretty sure I won't have any trouble getting to sleep at my normal bedtime of 12:30-1 AM. (With my tiny little helpers.)

I'd like the up part to be more gentle. The down part was fine. I'm wondering if the same dose, but extended release, would be better.

Script for 30 days was just under $75. It is generic of course.

Spiky:
I'm so sorry. I know you'll find a neurologist who will help you and Mr. Sue. And maybe some trials of medication could help. If things seem to be progressing, that calls for some more intensive diagnostics, to make sure it isn't something else. Normotensive hydrocephalus?

There are a number of clinical trial going on for ALZ and associated disorders around here: http://www.mayo.edu/research/centers-programs/alzheimers-disease-research-center - I plan to bring my father there when he moves in with us. Maybe they'll let me in on some new stuff.

And Charles too. He's emotionally more labile (easily angered, gets choked up about stuff more like I do), and let's just say we're remembering things differently.

Caitlyn:
I'd like to feel "normal" again too.

I never used to forget things - all our doctors' appointments, kids' schedules, shopping needs (I didn't make lists), case law, molecular biology - it was almost always right at my beck and call. Now, if I get an idea while looking online at something else, and don't immediately stop what I'm doing and go open another window to search it, it's gone. Poof. I don't remember things without a list. I MUST write all appointments on the white board.

My doctor mentioned Nuvigil if the Provigil didn't work well. I'm glad there are options.
 
OK. What I have on hand from Walgreens is Mylan modafinil, 200mg. It's 50/50 armoda/moda.
12.3 Pharmacokinetics
Modafinil is a 1:1 racemic compound, whose enantiomers have different pharmacokinetics (e.g., the half-life of R-modafinil is approximately 3 times that of S-modafinil in adult humans). The enantiomers do not interconvert. At steady state, total exposure to R-modafinil is approximately 3 times that for S-modafinil. The trough concentration (Cmin,ss) of circulating modafinil after once daily dosing consists of 90% of R-modafinil and 10% of S-modafinil. The effective elimination half-life of modafinil after multiple doses is about 15 hours. The enantiomers of modafinil exhibit linear kinetics upon multiple dosing of 200 mg to 600 mg/day once daily in healthy volunteers. Apparent steady states of total modafinil and R-modafinil are reached after 2 to 4 days of dosing.
source linked to by Mylan's website

I think your doctor is right to direct you to Nuvigil (or generic). It sounds like the S-moda is rough on you. If you can, see if your PCP will write a prescription for like 10 Nuvigil or generic, like @CaitlynR is taking. This is armoda, which should be a slower climb. The release is the same.

Good luck.
 
Agreed that armodafinil usually has a more gentle onset and I think lasts longer. For me it lasts about 12 hours, so I never take a dose later than morning as it would interfere with sleep later.

Diana, you may consider if anxiety or depression is affecting your cognition abilities, as the type of problems you mention are sensitive to mood disorders. You might also consider seeking out speech therapy, as speech therapists often work with people to learn how to compensate for these challenges. Finally, if it gets to the point that you are really concerned, seek out a neuropsychological assessment. That is the only good way to fully understand what problems exist and with repeat testing can detect any changes over time.
 

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