Wednesday, August 5, 2009

Provigil Use In Autoimmune Disease

Image found here.

I'm trying to make a list of all the things that I must be sure to pack for our upcoming road trip. My meds are first on the must-pack-and-not-forget list.

Sigh. I remember the good old days when packing meant throwing a change of clothing and my toothbrush in a bag.........

One of the medications that is important to me especially during travel or other days that will require a heightened sense of focus and an energy boost is Provigil, or modafinil. Terese and I call this my yippee skippee pill.

You can read more about this drug here. Modafinil promotes wakefulness by an action similar to amphetamines, although their chemical structures are different. It is prescribed most commonly for people dealing with daytime fatigue as a result of obstructive sleep apnea and narcolepsy.

I consider modafinil my ace-up-my-sleeve drug, only to be used when I have been dealt a seriously crummy hand of cards. It was prescribed to me by my neurologist after he had evaluated me extensively for various autoimmune-related issues.

Modafinil has several positive effects for me: About 30 minutes after I take it, I feel a renewed sense of energy. My brain fog seems to clear somewhat and I can count on functioning reasonably well for about three to four hours. It feels like I've consumed a triple shot latte, but the effects arrive more gradually and taper more slowly than a post coffee crash. It also does not seem to cause my blood sugar to drop either, as I have frequently noticed with caffeine.

Sounds great, right?

Unfortunately, modafinil also has its disadvantages.

The energy created by this medication is not authentic energy - I only feel as though I have my old reserves back. If I don't monitor myself carefully, I will overstep my limits and pay for this with a three day crash and burn session.

Some people experience a kind of euphoria when taking this medication. It does have addictive properties similar to those of amphetamines, and is considered a schedule IV drug, meaning that is a controlled substance and must be prescribed and closely monitored by your physician. Unfortunately for me, or maybe fortunately, depending on how you look at it, I don't seem to experience the euphoric effects.

Modafinil is also extremely expensive. If you filled your prescription at Costco, a 100 pill purchase of the 200 mg version of modafinil would cost $1100. Yikes. I am fortunate that my insurance covers most of the cost of this prescription.

I have found that I get the best "bang for the buck" with this medication if I take it very infrequently. The effects are much less pronounced if I take it for several days in a row. My body seems to become quickly acclimated to its use, so I only take it when I know that I need a serious boost.

There are other possible problems in using this medication. These were taken from the Provigil website:
  • Although modafinil has not been shown to produce functional impairment, any drug affecting the CNS may alter judgment, thinking or motor skills. Patients should be cautioned about operating an automobile or other hazardous machinery until it is reasonably certain that PROVIGIL therapy will not adversely affect their ability to engage in such activities.
  • Patients with a recent history of myocardial infarction or unstable angina should be treated with caution. PROVIGIL tablets should not be used in patients with a history of left ventricular hypertrophy or in patients with mitral valve prolapse who have experienced the mitral valve prolapse syndrome when previously receiving CNS stimulants. There were also a greater proportion of patients on PROVIGIL requiring new or increased use of antihypertensive medications compared to patients on placebo. Increased monitoring of blood pressure may be appropriate in patients on PROVIGIL.
  • PROVIGIL may interact with drugs that inhibit, induce, or are metabolized by cytochrome P450 isoenzymes.
  • The effectiveness of steroidal contraceptives may be reduced when used with PROVIGIL tablets and for one month after discontinuation of therapy.
  • The concomitant use of PROVIGIL and alcohol has not been studied and should be avoided.
  • For me, modafinil is one of several tools used in my management of autoimmune fatigue. It may be helpful for others as well, but only after careful assessment, prescription, and ongoing monitoring by your physician.


    Denise @ Sunflowers, Chocolate and Little Boys said...

    I will have to ask my Rheumy if this is something I can try....I need all the extra energy I can get.

    Anonymous said...

    My rhuemy prescribed this.
    Is it odd that I felt teary after wards?

    Anonymous said...

    I take Nuvigil, which is the same I think. I was first diagnosed with Chronic Fatigue Syndrome but then my joints started swelling along with the pain, so now it's Psoriatic Arthritis. Anyway, I went on Nuvigil in January and it was a lifesaver! I could function again.I still have to pace myself, but at least I can take care of my kids (2 and 4 yrs). I take it everyday. I didn't have it for 2 days because the pharmacy had to order it and the first day I was in a caffiene fueled fog and the second day I was down.

    My Rheumy told me something very important about it that I haven't heard elsewhere. It was (under the name Provigil)first used in the Gulf I War on soldiers so they could work 36 hr shifts. They found that it depleted amino acids in the brain which eventually led to a crash. That is why it becomes ineffectual over the long term. He gives me an amino acid supplement called Sentra AM - it's a medical food supplement - to replace the depleted amino acids. Anybody taking it should look into this - ask your doctor. Also, unexpectedly, my joint pain disappeared when I first started taking it back in January. As soon as I stopped because I ran out and have to drive 1hr to Beverly Hills to get it from the Rheumy because pharmacies don't have it, the joint pain immediately returned and got worse each day. When I got back on it dissipated, but, unfortunately, the damage had already been done. My joints, especially in fingers and toes, started swelling then the pain got worse and I got the PA diagnosis a few weeks ago. I wonder if I hadn't been off those amino acids for a week if that would have happened (?). So, try the amino acids - there's no way to replicate the combination in foods either. And, if you find a doctor who prescribes it, some insurance companies (blue cross blue shield for example) only charge whatever your prescription copay is.

    Anonymous said...

    hey, i just started researching myself about this medication. My reumatologist in norway says that there is nothing to do for my fatigue (from artrithis and possibly sj√łgrens). And I wont let that be it. Im so tired. I am moving to LA in august, and I really need a good rheumatologist that can help me with this. Maybe you don´t want to say a doctors name here. but I would love to email with you (you who take the nuvigil?) I really would appreciate all the help I could get! Im starting my MA at a school there, but Im so tired. I think this medicine would be so good for me.

    Anonymous said...

    Provigil (or Nuvigil) did help somewhat with my fatigue, but I just replaced it with the generic for Ritalin.

    I find it works much better for me - much more energy & clearer head. Also, it is MUCH cheaper. Its a Godsend.

    Sandy @ Safe Use Of Nuvigil said...

    I find that Nuvigil is much more effective than Provigil.

    Anonymous said...

    I've been taking 1/4 of a Nuvigil for over a year now in addition to Wellbutrin, and its been a real help for the fatigue I feel from PsA. I agree that it doesn't create energy, it wakes up your mind so you can push through, and pushing through creates more energy for next time. My psychiatrist gave it to me, not my rheumatologist.