Modafinil

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Summary sheet: Modafinil
Modafinil
Modafinil.svg
Chemical Nomenclature
Common names Modafinil, Alertec, Modavigil, Modiodal, Provigil, Modalert
Substitutive name Modafinil
Systematic name 2-[(Diphenylmethyl)sulfinyl]acetamide
Routes of Administration

WARNING: Always start with lower doses due to differences between individual body weight, tolerance, metabolism, and personal sensitivity. See responsible use section.



Oral
Dosage
Threshold 25 mg
Light 50 - 100 mg
Common 100 - 200 mg
Strong 200 - 300 mg
Heavy 300 mg +
Duration
Total 5 - 10 hours
Onset 20 - 60 minutes
Come up 20 - 60 minutes
Peak 3.5 - 5 hours
Offset 1 - 3 hours
After effects 2 - 6 hours









DISCLAIMER: PW's dosage information is gathered from users and resources for educational purposes only. It is not a recommendation and should be verified with other sources for accuracy.

Interactions
Alcohol
MXE
Dissociatives
DXM
MDMA
Stimulants
25x-NBOMe
25x-NBOH
Tramadol
MAOIs
Hormonal Birth Control
CYP2C19-substrates


Modafinil (also known by the brand names Provigil, Alertec, Modavigil, and others) is a eugeroic substance of the benzhydryl class that produces wakefulness-promoting and stimulant effects when administered. It is commonly used to enhance cognition, reduce fatigue, and increase alertness in both medical and non-medical contexts.

Modafinil is approved by the U.S. Food and Drug Administration for the treatment of obstructive sleep apnea, shift work sleep disorder and narcolepsy.[1] However, studies have shown that modafinil may also be useful off-label for alleviating the symptoms of depression,[2], bipolar disorder,[3] Parkinson's disease,[4] seasonal depressive disorder,[5] ADHD,[6] and various other conditions which have fatigue as a symptom.

Modafinil has also been used as a doping agent by various athletes due to its ability to produce physical stimulation.[citation needed] It has recently gained mainstream popularity for its use as a "smart drug" to improve memory, counteract the desire or need for sleep, and increase general productivity.[citation needed]

History and culture

Modafinil was originally developed in France by neurophysiologist professor Michel Jouvet and Lafon Laboratories. Modafinil originated with the late 1970s invention of a series of benzhydryl sulfinyl compounds, including adrafinil, which was first offered as an experimental treatment for narcolepsy in France in 1986. Modafinil is the primary metabolite of adrafinil, lacking the polar -OH group on its terminal amide,[7] and has similar activity to the parent drug but is much more widely used. It has been prescribed in France since 1994 under the name Modiodal, and in the US since 1998 as Provigil.

Chemistry

Modafinil is a synthetic molecule of the benzhydryl class. Benzhydryl compounds are comprised of two benzene rings attached to a single carbon molecule. Modafinil is classified as a sulphinyl benzhydryl molecule, as it also contains a sulfinyl group, a sulphur molecule double-bonded to an oxygen molecule, attached to the carbon of the benzhydryl group. From this sulphur group at R2, an acetamide group is bound at its free carbon through a carbonyl group to a terminal amine group. Modafinil is structurally analogous to fluorafinil, another benzhydryl stimulant.

While modafinil is a racemic mixture, a similar medication, armodafinil, consists of only the (−)-(R)-enantiomer of modafinil. Modafinil is a highly researched compound, with many derivatives created and studied[8].

Pharmacology

(R,S)-modafinil, mechanism of action.

Although the exact mechanisms by which modafinil and its R-enantiomer, armodafinil, decrease sleepiness are not fully understood, evidence suggests that these agents promote wakefulness by acting directly or indirectly on many components of the sleep / wake circuit. Modafinil and armodafinil are hypothesized to inhibit GABA and promote dopamine, norepinephrine, histamine, and hypocretin / orexin.[9][10][11][12]

Modafinil and its R-enantiomer, armodafinil, increase both norepinephrine (NE) and dopamine (DA), possibly via their blockade of both the NE and DA reuptake transporters (NET and DAT, respectively). The actions of NE at alpha-adrenergic receptors and DA at dopamine D2 receptors are thought to contribute to the wake-promoting properties of modafinil. Orexin is a key component of the arousal system; thus, the hypothesized action of modafinil on the orexinergic system may help increase alertness. Additionally, modafinil may indirectly increase histamine, either by reducing GABAergic inhibition of histaminergic neurons or via actions at orexinergic neurons. The increase in histamine may contribute to both the wake-promoting effects of modafinil as well as the potential of modafinil to increase alertness.[9][11][13]

In genetically engineered mice lacking the dopamine transporter (DAT), modafinil lacked wake-promoting activity, suggesting that this activity was DAT-dependent. However, the wake-promoting effects of modafinil, unlike those of amphetamine, were not reduced by the dopamine receptor antagonist haloperidol in rats. In addition, alpha-methyl-p-tyrosine, an inhibitor of dopamine synthesis, blocks the action of amphetamine but does not block locomotor activity induced by modafinil.

Subjective effects

In comparison to traditional stimulants such as amphetamine, methylphenidate or cocaine, this compound induces an experience which is far less forceful, euphoric, and recreational. It instead emphasizes general wakefulness and motivation enhancement.

Disclaimer: The effects listed below cite the Subjective Effect Index (SEI), an open research literature based on anecdotal user reports and the personal analyses of PsychonautWiki contributors. As a result, they should be viewed with a healthy degree of skepticism.

It is also worth noting that these effects will not necessarily occur in a predictable or reliable manner, although higher doses are more liable to induce the full spectrum of effects. Likewise, adverse effects become increasingly likely with higher doses and may include addiction, severe injury, or death ☠.

Physical effects
Child.svg

Cognitive effects
User.svg


Experience reports

There are currently no anecdotal reports which describe the effects of this compound within our experience index. Additional experience reports can be found here:

Toxicity and harm potential

The long-term safety and effectiveness of modafinil as a drug of regular usage have not been determined.[15]

Anecdotal reports from people who have tried modafinil suggest that there do not seem to be any negative health effects attributed to simply trying this substance at low to moderate doses by itself or using it sparingly (but nothing can be completely guaranteed).

It is worth noting that as this compound is a commonly prescribed pharmaceutical, it is considerably less likely to have unpredictable adverse health effects than the typical research chemical. Nevertheless, it is strongly recommended that one use harm reduction practices if using this substance.

Lethal dosage

The median lethal dose at which 50% of participants die (LD50) from modafinil for human beings has never been reached. No life-threatening effects have taken place in clinical trials involving the administration of 1000mg to 1600mg of modafinil per day for 7 to 21 consecutive days. Intentional acute overdoses of 4500mg and 4000mg in two adult subjects and an accidental ingestion of 800mg by a three-year-old child did not result in any life-threatening effects or death.[16] After overdosing on 5000mg of modafinil in a suicide attempt, a fifteen-year-old female reported a severe headache, nausea, and tachycardia, but did not appear to have any lethal or long-term effects.[17]

Tolerance and addiction potential

The chronic use of modafinil can be considered as not addictive with a low potential for abuse. It does not seem to be capable of causing psychological dependence among most users.[citation needed]

Tolerance to many of the effects of modafinil develops with prolonged and repeated use. This results in users having to administer increasingly large doses to achieve the same effects. After that, it takes about 3 - 7 days for the tolerance to be reduced to half and 1 - 2 weeks to be back at baseline (in the absence of further consumption). Modafinil may present a cross-tolerance with all benzhydryl nootropics, meaning that after the consumption of modafinil, all related eugeroic compounds such as armodafinil and adrafinil will display a reduced effect.

Dangerous interactions

Warning: Many psychoactive substances that are reasonably safe to use on their own can suddenly become dangerous and even life-threatening when combined with certain other substances. The following list provides some known dangerous interactions (although it is not guaranteed to include all of them).

Always conduct independent research (e.g. Google, DuckDuckGo, PubMed) to ensure that a combination of two or more substances is safe to consume. Some of the listed interactions have been sourced from TripSit.

  • 25x-NBOMe & 25x-NBOH - 25x compounds are highly stimulating and physically straining. Combinations with Modafinil should be strictly avoided due to the risk of excessive stimulation and heart strain. This can result in increased blood pressure, vasoconstriction, panic attacks, thought loops, seizures, and heart failure in extreme cases.
  • Alcohol - Combining alcohol with stimulants can be dangerous due to the risk of accidental over-intoxication. Stimulants mask alcohol's depressant effects, which is what most people use to assess their degree of intoxication. Once the stimulant wears off, the depressant effects will be left unopposed, which can result in blackouts and severe respiratory depression. If mixing, the user should strictly limit themselves to only drinking a certain amount of alcohol per hour.
  • DXM - Combinations with DXM should be avoided due to its inhibiting effects on serotonin and norepinephrine reuptake. There is an increased risk of panic attacks and hypertensive crisis, or serotonin syndrome with serotonin releasers (MDMA, methylone, mephedrone, etc.). Monitor blood pressure carefully and avoid strenuous physical activity.
  • MDMA - Any neurotoxic effects of MDMA are likely to be increased when other stimulants are present. There is also a risk of excessive blood pressure and heart strain (cardiotoxicity).
  • MXE - Some reports suggest combinations with MXE may dangerously increase blood pressure and increase the risk of mania and psychosis.
  • Dissociatives - Both classes carry a risk of delusions, mania and psychosis, and these risk may be multiplied when combined.
  • Stimulants - Modafinil may be dangerous to combine with other stimulants like cocaine as they can increase one's heart rate and blood pressure to dangerous levels.
  • Tramadol - Tramadol is known to lower the seizure threshold[18] and combinations with stimulants may further increase this risk.
  • MAOIs - This combination may increase the amount of neurotransmitters such as dopamine to dangerous or even fatal levels. Examples include syrian rue, banisteriopsis caapi, and some antidepressants.[19]
  • Hormonal Birth Control - Modafinil reduces the effectiveness of hormonal birth control for up to a month after use by increasing the activity of the enzyme CYP3A4/5.[20] Notably, the same enzyme is inhibited by grapefruit juice.[21]
  • CYP2C19-substrates - Modafinil may prolonge the elimation of some anxyolitics like diazepam, propranolol and clomipramine, resulting in higher systemic exposure to those drugs.[22]

Although Modafinil may cause nausea and acid reflex, it should not be taken together with omeprazole (which is a CYP2C19-substrate).[22]

Legal status

Modafinil is legally approved for medical purposes worldwide. However, it is illegal to sell and possess in most countries without a prescription.

  • Australia: Modafinil is listed as a Schedule 4 (prescription only) drug in Australia and it can be prescribed sleep apnea and narcolepsy.[23]
  • Austria: Modafinila is classed as NR (prescription only, repeated dispense prohibited) [24]
  • Canada: Modafinil is listed as a Schedule F prescription drug in Canada and can be prescribed for human and veterinary use.[25]
  • Germany: Modafinil is a prescription medicine, according to Anlage 1 AMVV.[26]
  • Russian Federation: Modafinil is classed as a Schedule II substance. [27]
  • Switzerland: Modafinil is listed as a "Abgabekategorie B" pharmaceutical, which requires a prescription.[citation needed]
  • United Kingdom: Modafinil is a licensed prescription-only medicine (POM) in the United Kingdom.[28] It is not a criminal offence to possess this medicine without a valid prescription. This medicine can legally be obtained with a valid prescription or through legal import of the medicine for personal use as outlined in Section 13 of the Medicines Act 1968.[29]
  • United States: In the United States, modafinil is a Schedule IV controlled substance. It is illegal to buy, sell, or possess the drug without a prescription or DEA license.[30]

See also

External links

References

  1. Provigal (Manufacturer's Website) | http://www.provigil.com/
  2. Fava, M., Thase, M. E., DeBattista, C., Doghramji, K., Arora, S., Hughes, R. J. (September 2007). "Modafinil augmentation of selective serotonin reuptake inhibitor therapy in MDD partial responders with persistent fatigue and sleepiness". Annals of Clinical Psychiatry: Official Journal of the American Academy of Clinical Psychiatrists. 19 (3): 153–159. doi:10.1080/10401230701464858. ISSN 1040-1237. 
  3. Frye, M. A., Grunze, H., Suppes, T., McElroy, S. L., Keck, P. E., Walden, J., Leverich, G. S., Altshuler, L. L., Nakelsky, S., Hwang, S., Mintz, J., Post, R. M. (August 2007). "A placebo-controlled evaluation of adjunctive modafinil in the treatment of bipolar depression". The American Journal of Psychiatry. 164 (8): 1242–1249. doi:10.1176/appi.ajp.2007.06060981. ISSN 0002-953X. 
  4. Vliet, S. A. M. van, Vanwersch, R. A. P., Jongsma, M. J., Gugten, J. van der, Olivier, B., Philippens, I. H. C. H. M. (September 2006). "Neuroprotective effects of modafinil in a marmoset Parkinson model: behavioral and neurochemical aspects". Behavioural Pharmacology. 17 (5–6): 453–462. doi:10.1097/00008877-200609000-00011. ISSN 0955-8810. 
  5. Lundt, L. (August 2004). "Modafinil treatment in patients with seasonal affective disorder/winter depression: an open-label pilot study". Journal of Affective Disorders. 81 (2): 173–178. doi:10.1016/S0165-0327(03)00162-9. ISSN 0165-0327. 
  6. Biederman, J., Pliszka, S. R. (March 2008). "Modafinil improves symptoms of attention-deficit/hyperactivity disorder across subtypes in children and adolescents". The Journal of Pediatrics. 152 (3): 394–399. doi:10.1016/j.jpeds.2007.07.052. ISSN 1097-6833. 
  7. Ballas, C. A., Kim, D., Baldassano, C. F., Hoeh, N. (1 July 2002). "Modafinil: past, present and future". Expert Review of Neurotherapeutics. 2 (4): 449–457. doi:10.1586/14737175.2.4.449. ISSN 1473-7175. 
  8. De Risi, C., Ferraro, L., Pollini, G. P., Tanganelli, S., Valente, F., Veronese, A. C. (1 December 2008). "Efficient synthesis and biological evaluation of two modafinil analogues". Bioorganic & Medicinal Chemistry. 16 (23): 9904–9910. doi:10.1016/j.bmc.2008.10.027. ISSN 0968-0896. 
  9. 9.0 9.1 Morrissette, D. A. (December 2013). "Twisting the night away: a review of the neurobiology, genetics, diagnosis, and treatment of shift work disorder". CNS Spectrums. 18 (s1): 42–54. doi:10.1017/S109285291300076X. ISSN 1092-8529. 
  10. Touitou, Y., Bogdan, A. (February 2007). "Promoting adjustment of the sleep–wake cycle by chronobiotics". Physiology & Behavior. 90 (2–3): 294–300. doi:10.1016/j.physbeh.2006.09.001. ISSN 0031-9384. 
  11. 11.0 11.1 Darwish, M., Kirby, M., D’Andrea, D. M., Yang, R., Hellriegel, E. T., Robertson, P. (November 2010). "Pharmacokinetics of armodafinil and modafinil after single and multiple doses in patients with excessive sleepiness associated with treated obstructive sleep apnea: A randomized, open-label, crossover study". Clinical Therapeutics. 32 (12): 2074–2087. doi:10.1016/j.clinthera.2010.11.009. ISSN 0149-2918. 
  12. Erman, M. K., Yang, R., Seiden, D. J. (2012). "The effect of armodafinil on patient-reported functioning and quality of life in patients with excessive sleepiness associated with shift work disorder: a randomized, double-blind, placebo-controlled trial". The primary care companion for CNS disorders. 14 (4): PCC.12m01345. doi:10.4088/PCC.12m01345. ISSN 2155-7772. 
  13. He, B., Peng, H., Zhao, Y., Zhou, H., Zhao, Z. (December 2011). "Modafinil treatment prevents REM sleep deprivation-induced brain function impairment by increasing MMP-9 expression". Brain Research. 1426: 38–42. doi:10.1016/j.brainres.2011.09.002. ISSN 0006-8993. 
  14. Udert, K. M., Larsen, T. A., Gujer, W. (1 December 2006). "Fate of major compounds in source-separated urine". Water Science and Technology. 54 (11–12): 413–420. doi:10.2166/wst.2006.921. ISSN 0273-1223. 
  15. Banerjee, D., Vitiello, M. V., Grunstein, R. R. (1 October 2004). "Pharmacotherapy for excessive daytime sleepiness". Sleep Medicine Reviews. 8 (5): 339–354. doi:10.1016/j.smrv.2004.03.002. ISSN 1087-0792. 
  16. The National Library of Medicine - PROVIGIL | http://dailymed.nlm.nih.gov/dailymed/lookup.cfm?setid=fd75a8a7-a8ab-4141-9af9-989a220b9c19
  17. Neuman, G., Shehadeh, N., Pillar, G. (15 August 2009). "Unsuccessful Suicide Attempt of a 15 Year Old Adolescent with Ingestion of 5000 mg Modafinil". Journal of Clinical Sleep Medicine : JCSM : Official Publication of the American Academy of Sleep Medicine. 5 (4): 372–373. ISSN 1550-9389. 
  18. Talaie, H.; Panahandeh, R.; Fayaznouri, M. R.; Asadi, Z.; Abdollahi, M. (2009). "Dose-independent occurrence of seizure with tramadol". Journal of Medical Toxicology. 5 (2): 63–67. doi:10.1007/BF03161089. eISSN 1937-6995. ISSN 1556-9039. OCLC 163567183. 
  19. Gillman, P. K. (2005). "Monoamine oxidase inhibitors, opioid analgesics and serotonin toxicity". British Journal of Anaesthesia. 95 (4): 434–441. doi:10.1093/bja/aei210Freely accessible. eISSN 1471-6771. ISSN 0007-0912. OCLC 01537271. PMID 16051647. 
  20. Robertson, P (2002). "Effect of modafinil on the pharmacokinetics of ethinyl estradiol and triazolam in healthy volunteers". Clinical Pharmacology & Therapeutics. Springer Nature. 71 (1): 46–56. doi:10.1067/mcp.2002.121217. ISSN 0009-9236. 
  21. Bailey, D. G.; Dresser, G.; Arnold, J. M. O. (2012-11-26). "Grapefruit-medication interactions: Forbidden fruit or avoidable consequences?". Canadian Medical Association Journal. Joule Inc. 185 (4): 309–316. doi:10.1503/cmaj.120951. ISSN 0820-3946. 
  22. 22.0 22.1 https://www.rxlist.com/provigil-drug.htm
  23. Modafinil 
  24. Rezeptverordnung | https://www.ris.bka.gv.at/GeltendeFassung.wxe?Abfrage=Bundesnormen&Gesetzesnummer=10010358
  25. National Association of Pharmacy Regulatory Authorities - Regulations Amending the Food and Drug Regulations (1184 — Modafinil) | http://napra.ca/Content_Files/Files/FDR-Project1184-Modafinil-Oct122006.pdf
  26. AMVV - Verordnung über die Verschreibungspflicht von Arzneimitteln 
  27. "Narcotics". 
  28. MHRA (April 3, 2013). "MHRA license for Modafinil in UK" (PDF). MHRA. 
  29. "Medicines Act 1968 Section 13". 
  30. Placement of Modafinil Into Schedule IV - U.S. Department of Justice | http://www.deadiversion.usdoj.gov/fed_regs/rules/1999/fr0127.htm