Is Provigil Addictive?
Addiction Risk Seen in Wakefulness Drug Provigil
WebMD News Archive
March 17, 2009 - Provigil promotes wakefulness without getting you hooked.
But now it seems that addiction may very well be a Provigil risk.
Provigil (generic name, modafinil) is FDA approved for promoting wakefulness
in people with narcolepsy, sleep apnea, and shift work sleep disorder. Because
of its relatively benign safety profile, it's often prescribed "off
label" for people complaining of fatigue.
Some prominent scientists have suggested that responsible, healthy adults
should be allowed to use safer stimulant drugs such as Provigil and even
Ritalin to boost intellectual creativity.
But now researchers led by Nora D. Volkow, MD, director of the National
Institute on Drug Abuse (NIDA), report evidence that Provigil might be more
addictive than thought.
"There is an increasing use of this medication, and people have promoted
the off-label use of stimulants and Provigil as cognitive enhancers with the
belief that these drugs are safe," Volkow tells WebMD. "But these drugs
have side effects, and their use without proper medical oversight could lead to
abuse and addiction."
In their pilot study, Volkow's team recruited 10 healthy men who underwent
two sets of PET brain scans after taking either Provigil (200 milligrams or 400
milligrams) or an inactive placebo pill.
The brain scans showed that Provigil blocks dopamine transporters, the
molecules that remove dopamine from brain synapses. This increases the amount
of dopamine in the brain -- the brain's "reward" mechanism.
Addictive drugs such as cocaine and methamphetamine trigger the same
mechanism, although they do it much faster and more powerfully than Provigil
"The changes we are observing in dopamine concentrations with modafinil
are equivalent to those we have reported for [Ritalin] in the human brain,"
Volkow says. "So not only does [Provigil] increase dopamine in the human
brain, but does it by similar mechanisms to Ritalin and cocaine, by directly
blocking the dopamine transporter. It is not working by some distinct,
Volkow notes that Provigil has no effect on mice lacking dopamine
transporters. This indicates that while the drug may have other effects in the
brain, its dopamine-enhancing effect is crucial.
Provigil: How Addictive Is It?
David Weinshenker, PhD, associate professor of human genetics at Emory
University, Atlanta, has performed some of the mouse studies Volkow cites.
Weinshenker agrees with Volkow that Provigil shares at least one brain
receptor with cocaine, but he downplays the drug's addiction potential.
"What is Provigil's street value? It is zero. There are not addicts
walking around buying and selling modafinil," Weinshenker tells WebMD.
"Most people who take Provigil don't report euphoria or being high. They
don't even report feeling particularly stimulated, like caffeine. In terms of
addiction and withdrawal, it just doesn't do that."
Weinshenker notes that because of Provigil's relative safety, its possible
benefits are being explored for a wide number of disorders, including ADHD,
autism, and depression. He says the drug offers a major benefit over
amphetamine-like stimulants in that it promotes wakefulness without the sleep
rebound -- a need for extra sleep when the drug wears off.