Narcolepsy Treatment: Modafinil vs. Armodafinil

Modafinil and Armodafinil Overview

Modafinil (brand name Provigil) and armodafinil (brand name Nuvigil) are wakefulness-promoting agents that are commonly used to treat narcolepsy, shift work sleep disorder, and obstructive sleep apnea. These medications help you feel more alert and stay awake.

Please continue reading to learn more about armodafinil and modafinil, including how they are similar, how they are different, and which one—armodafinil/modafinil—may be right for you.

The main differences between armodafinil and modafinil include:

Armodafinil is the R-enantiomer of modafinil or the R-isomer of racemic modafinil. The chemical structure of these two drugs is slightly different with a different arrangement of molecules. You can think of one as the mirror image of the other, similar to how the thumb on your left hand is on the left and the thumb on your right hand is on the right.
Armodafinil (Nuvigil) is a newer drug, approved in 2007. Modafinil (Provigil) is an older drug, FDA approved in 1998.
Armodafinil has a longer half-life, stays in the body longer, and has longer-lasting effects compared to modafinil.
The recommended dose of modafinil is 200 mg once daily and that of armodafinil is 150 mg once daily.

Common Uses and Indications

Both armodafinil and modafinil improve wakefulness in people who struggle with excessive daytime sleepiness and fatigue. These symptoms are common in sleep disorders such as narcolepsy, shift work sleep disorder, and obstructive sleep apnea which are characterized by excessive sleepiness and feeling unrested. An expert in sleep medicine can diagnose these conditions based on guidelines in the Diagnostic and Coding Manual.

Armodafinil and modafinil are approved by the U.S. Food and Drug Administration (FDA) to treat the following conditions:

Narcolepsy (Excessive Sleepiness)

Narcolepsy is a chronic sleep disorder characterized by overwhelming and excessive daytime sleepiness and sudden attacks of sleepiness that disrupt daily life. People with narcolepsy struggle with staying awake for long periods, regardless of the circumstances. While there is no cure for narcolepsy, the condition can be treated. Lifestyle changes and medications can help manage the symptoms of excessive sleepiness.

Find out: How Much Sleep Do You Need Each Night?

Shift Work Sleep Disorder (SWSD)

Shift work sleep disorder is a disorder of the circadian rhythm (the body’s natural day-night or sleep-wake cycle). It affects people who work the night shift and stay awake during normal sleeping hours. Symptoms of SWSD can include excessive sleepiness, insomnia (difficulty sleeping), or both.

Obstructive Sleep Apnea (OSA)

Obstructive sleep apnea is a sleep-related breathing disorder in which affected individuals repeatedly stop breathing during sleep for brief periods. Untreated obstructive sleep apnea is linked to serious health problems like diabetes, heart attack, and stroke.

Find out: Can Sleep Apnea Be Controlled With Medication?

Other Uses of Armodafinil and Modafinil

In addition to the above, armodafinil and modafinil are used off-label to treat cancer-related fatigue and fatigue related to multiple sclerosis. They may also be prescribed to people with a medical condition such as ADHD (attention deficit hyperactivity disorder) or depression. Notably, modafinil has fewer side effects and is better tolerated than traditional stimulant drugs such as Adderall (amphetamine/dextroamphetamine salts), Vyvanse (lisdexamfetamine), and methylphenidate (Ritalin, Concerta).

Find Savings On Your Narcolepsy Medications

Pharmacokinetics and Mechanism of Action

Pharmacokinetic Profiles and Duration of Action

Modafinil and armodafinil have similar wakefulness effects. They also have a similar half-life of 13-15 hours. However, the blood levels of armodafinil stay in the body much longer than modafinil despite having the same terminal half-lives.

Studies show armodafinil stays in the body longer than modafinil. Plasma concentrations (blood levels) of armodafinil in the body are higher later in the day compared to modafinil. Armodafinil, therefore, produces longer-lasting effects and may provide better wakefulness than modafinil, especially in the latter part of the day.

Mechanism of Action

The exact mechanisms of how armodafinil and modafinil work are unknown. It is believed that these medications affect sleep-promoting neurons in the brain. Scientists think they work by boosting dopamine levels in parts of the brain that control sleep and wakefulness. Dopamine is a naturally occurring brain chemical in the central nervous system that is involved in the sleep-wake cycle. Higher levels of dopamine as a result of armodafinil/modafinil treatment may be responsible for improved wakefulness.

Is Nuvigil Stronger Than Provigil?

Nuvigil (arnomodafinil) may be stronger than Provigil (modafinil). Studies comparing armodafinil to modafinil have also shown that a 150 milligrams (mg) single dose of armodafinil produces effects comparable to a 200 mg single dose of modafinil. This suggests armodafinil is the stronger medication on a milligram to milligram basis. In other words, armodafinil administration may be more effective than modafinil administration in treating daytime sleepiness in people with sleep disorders.

Efficacy and Performance: Clinical Studies and Findings

Which is Better: Armodafinil or Modafinil?

Both armodafinil and modafinil significantly improve excessive sleepiness in patients with narcolepsy, shift work disorder, and obstructive sleep apnea. Placebo controlled clinical trials have shown that modafinil and armodafinil significantly improved sleepiness in healthy subjects with acute sleep loss in the nocturnal period, i.e., short-term sleep deprivation. More than one clinical trial has found that armodafinil and modafinil are well-tolerated and effective in promoting wakefulness in people with narcolepsy.

Open label studies, double blind studies, and head-to-head trials comparing modafinil & armodafinil have not found that one drug is significantly more effective than the other.

Randomized clinical trials and meta-analyses suggest that armodafinil and modafinil have comparable efficacy and safety profiles in treating sleep disorders. Response rates, tolerability, and compliance for armodafinil and modafinil are also similar.

How Effective is Modafinil for Narcolepsy?

Modafinil is clinically proven to be effective in treating sleepiness associated with narcolepsy. It can also help people with shift work disorder and obstructive sleep apnea. Provigil (modafinil) starts working 30-60 minutes after you take the medication, a bit longer if you take it with food.

Which Lasts Longer Modafinil or Armodafinil?

Armodafinil lasts longer than modafinil. Based on pharmacokinetic studies, the R-enantiomer of modafinil (armodafinil) stays in the body longer and produces longer-lasting effects compared to modafinil.

One multi-centric, randomized, double-blind, parallel-group study done with comparative doses of modafinil and armodafinil in people with shift work sleep disorder confirmed that armodafinil resulted in longer maintenance of wakefulness. In comparison, the modafinil group had poorly sustained wakefulness in the last one-third of the night shift.

Comparison of Patient Outcomes: What is Better for Me Modafinil or Armodafinil?

It is best to consult a doctor to decide between armodafinil vs modafinil for the treatment of sleep disorders or address any other concerns that you may have.

Learn more about armodafinil uses and side effects.

Side Effects and Safety Profiles

The adverse event incidences and interactions with other drugs for armodafinil and modafinil are similar. Common adverse effects of both medicines include headache, insomnia, dizziness, nausea, dry mouth, nervousness, weight loss, and diarrhea.

Each person’s reaction to a medicine and severity of adverse effects is different. The incidences of side effects may be more common with one medication or the other for you, and you may prefer one over the other, armodafinil versus modafinil.

Common Side Effects of Modafinil

Headache
Dizziness
Drowsiness
Insomnia
Gastrointestinal side effects (abdominal pain, heartburn, gas, nausea, diarrhea, constipation)
Loss of appetite
Dry mouth
Unusual taste
Excessive thirst
Flushing
Sweating
Nosebleeds
Muscle tightness
Back pain
Numbness or tingling
Uncontrolled shaking
Confusion
Eye pain or vision problems

Common Side Effects of Armodafinil

Headache
Dizziness
Insomnia
Problems with concentration and focus
Uncontrolled shaking
Numbness and tingling
Gastrointestinal symptoms (stomach pain, heartburn, nausea, vomiting, diarrhea, constipation, loss of appetite)
Dry mouth
Increased thirst
Excessive sweating
Frequent urination

Long-Term Safety and Risks

Rare but serious side effects of armodafinil and modafinil include allergic reactions to either medication. Symptoms of an allergic reaction may include skin rash, hives, itching, blistering or peeling skin, wheezing, difficulty breathing, shortness of breath, swelling of face, tongue, or throat.

This is a life-threatening medical emergency. Stop taking armodafinil or modafinil and seek medical attention immediately.

Note: If you are allergic to modafinil, more than likely, you are allergic to armodafinil as well, and vice versa.

Cost and Accessibility

Prescription Requirements

Both medications, modafinil and armodafinil, are available by prescription only.

Cost Comparison

Generic armodafinil is more expensive than generic modafinil. However, generic armodafinil may be slightly less expensive than brand name Provigil.

Insurance Coverage and Availability

Both modafinil and armodafinil are available in lower-cost generic versions. They are widely available and covered by Medicare and private health insurance plans.

Common Questions

Are Armodafinil and Modafinil the Same?

Armodafinil and modafinil are not the same. However, they share many similarities. Both are wakefulness-promoting agents with stimulant-like effects. Both modafinil/armodafinil are schedule IV drugs with a low potential for abuse and dependence.

Key similarities when comparing armodafinil and modafinil include:

Armodafinil (R-modafinil) and modafinil have a similar chemical structure. Armodafinil is the R-enantiomer of modafinil (mirror image).
Both are stimulant-like prescription drugs. Each of these medicines is classified as a sleep disorder medicine or wakefulness-promoting agent.
Metabolism and elimination are similar with both medications metabolized by liver enzymes and eliminated in the urine.
Both drugs are available as oral tablets and taken in single doses once per day.
Brand name and generic versions are available for both.
Armodafinil and modafinil are prescribed in outpatient clinics to people over the age of 17 for narcolepsy, shift work disorder, and obstructive sleep apnea.
Both drugs can be used long-term, as directed by a physician, to control symptoms of daytime sleepiness.
Armodafinil and modafinil cause similar adverse effects and have similar drug interactions.

How Quickly Does Armodafinil Start Working?

Armodafinil starts working within 2 hours of taking a dose. Peak plasma concentrations of this drug are reached in 1-2 hours. Keep in mind, however, that it can take a few days for armodafinil to reach a steady state blood concentration and have its full effects. Even then, this drug may not completely treat your symptoms and you may have some excessive residual sleepiness.

Can You Sleep on Armodafinil?

You can sleep on armodafinil, but you need to time the dose properly because this medication can cause insomnia as a side effect (difficulty falling asleep and staying asleep). Remember, both armodafinil and modafinil are wakefulness-promoting agents, so taking these drugs before bedtime may cause trouble sleeping.

What is the Best Time to Take Armodafinil?

The best time to take armodafinil is in the morning if you are taking this medicine to treat narcolepsy or obstructive sleep apnea.

The best time to take armodafinil is one hour before your shift starts if you are taking this medicine for shift work sleep disorder and want to prevent excessive sleepiness while at work.

As noted, armodafinil is an effective treatment for excessive sleepiness and daytime sleepiness. It can help you stay awake and alert for 12-15 hours at a time. But it’s important to time the dose of this medication correctly. Taking it too late in the day may cause problems with sleep latency (time taken to fall asleep).

Can Armodafinil Help Me Stay Awake and Alert?

Armodafinil can help you stay awake and alert, but there may be some residual excessive sleepiness. You should continue taking precautions while driving and doing other potentially hazardous activities until you are sure you are fully awake and alert.

Remember, armodafinil is not a substitute for getting enough sleep. Continue to practice good sleep habits. Also, continue to use breathing devices for obstructive sleep apnea, such as a CPAP machine, as prescribed by your healthcare provider.

Does Armodafinil Cause Euphoria?

Armodafinil is not known to cause euphoria (feeling high). It is a schedule IV controlled substance with a low potential for abuse and dependence. However, armodafinil does have psychoactive effects and can affect your mood, since it affects the dopamine level in your brain.

Does Armodafinil Give You Energy?

Armodafinil can give you energy by making you feel more awake and alert and less tired.

What Does Taking Armodafinil Feel Like?

Taking armodafinil can make you feel more awake, alert, and energetic and reduce symptoms of excessive daytime sleepiness related to narcolepsy, shift work disorder, or obstructive sleep apnea. You may, however, experience side effects such as headache, dizziness, and insomnia, especially when you first start treatment with armodafinil. These side effects usually go away once your body adjusts to the medicine.

Is Armodafinil Being Discontinued?

Armodafinil (Nuvigil) 100 mg and 200 mg tablets are listed in the FDA’s Discontinued Drug Product List. However, they were not withdrawn for reasons of effectiveness or safety (there are no postmarketing reports of serious adverse events). Nuvigil continues to be available as 50 mg, 150 mg, 200 mg, and 250 mg tablets.