Is it safe to buy modafinil online

Modafinil is the psychomotor type of CNS stimulant. Its mechanism of action is not clear but it seems to be related to the dopaminergic and adrenergic systems. It acts by decreasing GABA and increasing Glutamate levels. It is used for Excessive Daytime sleepiness disorders (EDS) which include narcolepsy, Obstructive sleep apnea (OSA), and Shift work sleep disorder. It is also used off-label as Cognition Enhancer. It may be used for Attention deficit syndrome in children and other psychiatric illnesses in adults like depression and bipolar disorder. It can also be used to hasten the effect of general anesthesia after same-day surgeries in patients with certain medical conditions. However, it is FDA approved only for Excessive Daytime sleepiness disorder (EDS).

Common adverse effects of Modafinil include insomnia, headache, nervousness, hypertension, and nausea, some of which are dose-related. It should not be used in pregnancy, hypertension in pregnancy, breastfeeding, hypertension with angina, and myocardial infarction. It should be sued with caution in patients with hepatic and renal impairments.

History:

“Adrafinil” the active metabolite of Modafinil is first discovered by a French pharmaceutical company ‘L. Lafon Ltd’ in 1974. Earlier this drug acted as a 'eugeroic' meaning a 'wakefulness-promoting agent'. Then the clinical trial for its use in narcolepsy was started and these trials weren’t successful, so all the progression of the drug was stopped.

However, in 1976 active metabolite "Modafinil" of Adrafinil was discovered 1976 which was proved to be very effective for the treatment of narcolepsy. Experiments were done for its use in narcolepsy and the results were tremendous. It had dramatic effects on people's ability to stay awake and alert for extended periods.

It was given to French soldiers during the first Gulf War in 1991. It was officially registered in France in 1992. It was first released in France under the brand 'Modiodal' in 1994 and was soon introduced throughout Europe and worldwide during the 1990s and early 2000s.

Modafinil came to the United States in 1998 under the brand name ‘Provigil’. It was initially granted FDA approval as a narcolepsy treatment. Food and Drug Authority (FDA) approved the drug for the treatment of Shift work sleep disorder (SWSD) and Obstructive sleep apnea (OSA).

That may seem like the nail in the final resting place for legitimate use of Modafinil and other CNS stimulants in the country, yet it is a long way from it. Modafinil is still very famous among undergraduates. While it very well may be gotten as a solution to treat Excessive Sleep Disorder (ESD), it is ordinarily acquired by students illicitly through a companion

With its effect on cognition, it is popularized as a smart drug and is used by students and workers for cognition enhancement. Due to its phenomenal effects, scientists keep on digging more and more. Recently, a study presents a newly identified neuronal population located in the basal forebrain that has never previously been published and suggests that these modafinil-immunoreactive neurons might be involved in forebrain functions such as sleep-wake control and cognition.

Modafinil is viewed as Schedule IV medications by the Drug Enforcement Administration (DEA), which implies they have a "moderate potential for misuse”.

Uses:

Modafinil is used for Excessive Daytime sleepiness disorders (EDS) which include narcolepsy, Obstructive sleep apnea (OSA), and Shift work sleep disorder. It is also used off-label as Cognition Enhancer. It may be used for Attention deficit syndrome in children and other psychiatric illnesses in adults like depression and bipolar disorder. It can also be used to hasten the effect of general anesthesia after same-day surgeries in patients with certain medical conditions. However, it is FDA approved only for Excessive Daytime sleepiness disorder (EDS).

• Excessive Daytime sleepiness disorder(EDS):

• Narcolepsy:

Narcolepsy is a chronic sleep disorder that is characterized by extreme daytime drowsiness followed by sudden severe sleep attacks. These patients are usually found sleeping in offices, schools, and workplaces. Narcolepsy is a lifelong disease that does not have any cure. It is sometimes accompanied by catalepsy, a loss in muscle control, and even paralysis brought on by strong emotions such as laughter.

According to the studies which compare Modafinil and other CNS stimulators, Modafinil is the most effective drug for the treatment of narcolepsy with minimal side effects like tolerance, dependence, and withdrawal. Hence, it is proposed as the first line by Food and Drug Enforcement (FDA).

Modafinil in doses of 200 or 400 mg is effective in treating Excessive daytime sleepiness in narcolepsy. Patients who experienced residual late-day sleepiness may be fit from split 400 or 600 mg/day Modafinil. Modafinil does not benefit cataplexy.

• Obstructive Sleep apnea:

Obstructive sleep apnea is a disorder that includes sleeps disordered breathing and Excessive daytime sleeping. It is also associated with pulmonary hypertension, stroke, congestive heart failure, myocardial ischemia, and arrhythmias. CPAP is the most effective treatment which manages apnea and hypopnea episodes, eliminates arterial desaturation, and improves the quality of life.

In Some patients, EDS persist despite optimal use of CPAP. For these patients, Modafinil is used. However, Modafinil cannot be used alone for Obstructive sleep apnea (OBS). CPAP should be continued in these patients because Modafinil does not reverse the associated adverse cardiovascular effects.

The recommended dosage of Modafinil for patients with narcolepsy or OSA is 200 mg taken orally once a day as a single dose in the morning.

• Shift Work Sleep Disorder:

Shift work sleep disorder (SWSD) is a circadian rhythm sleep disorder characterized by insomnia, excessive sleepiness, or both affecting people whose work hours overlap with the typical sleep period. Insomnia can be the difficulty to fall asleep or waking up before the individual has slept enough.

Modafinil has shown drastic improvement in the symptoms of this disorder. It also improves the quality of life in these patients; however, its effect on cognition of these is unclear. FDA approved this drug for SWSD.

The recommended dosage of Modafinil for patients with SWD is 200 mg taken orally once a day as a single dose approximately 1 hour before the start of their work shift.

In patients with severe hepatic impairment, the dosage of Modafinil should be reduced to one-half of that recommended for patients with normal hepatic function

• Off-label uses:

Cognitive Enhancer:

Modafinil is known as a "smart drug". It is being used by students for enhancing their performance. Cognitive-enhancing drugs, such as methylphenidate and modafinil, which were developed as treatments, are increasingly being used by healthy people. Modafinil not only affects 'cold' cognition but also improves 'hot' cognition, such as emotion recognition and task-related motivation. The lifestyle encouraging the use of ‘smart medication’ raises both wellbeing worries such as moral issues, remembering pressure and expanding dissimilarity for society. As a general public, we need to consider which types of psychological improvement (for example pharmacological, work out, deep rooted learning) are satisfactory.

Psychiatric disorders:

Attention deficit syndrome:

Modafinil is effective in children and adolescents with ADHD. However, it is not approved by FDA due to severe dermatological reaction for example Steven Johnson Syndrome.

Bipolar depression:

Modafinil is helpful in bipolar depression in the dosage of 100-200 mg. Since it can precipitate mania in patients with bipolar disorder, caution is required if using this drug.

Depression:

It is also effective for treating depressive disorder.

Recovery from General anesthesia:

It can also be used to hasten the effect of general anesthesia after same-day surgeries in patients with certain medical conditions.

Routes of administration:

It is only present in the form of oral pills.



Modafinil v/s Amphetamine (Adderall):

Provigil is the brand name for Modafinil. Modafinil is a weaker stimulant than Adderall so it produces fewer psychoactive and euphoric effects as well as fewer alterations in mood, perception, thinking, and feelings typical of other CNS stimulants. It enhances wakefulness. The mechanism of action of this drug is different from that of amphetamine. Modafinil is effective orally. There is some evidence to indicate the potential for abuse and physical dependence with Modafinil but overall it is categorized as SCHEDULE IV as compared to Adderall SCHEDULE I by the Drug and Enforcement Authority (DEA). It causes fewer side effects and less dependence and withdrawal effects According to Lippincott, Modafinil is more effective than Adderall for Narcolepsy and is considered the first-line for narcolepsy by FDA.

Modafinil v/s Methylphenidate:

Modafinil and methylphenidate are both CNS stimulators but they have a different mechanism of action. Methylphenidate can also be used for narcolepsy; however, Modafinil is more efficacious. For cognition, these are equally effective but due to the fewer side effects associated with modafinil, it is preferred over methylphenidate for cognition.

There is some evidence to indicate the potential for abuse and physical dependence with Modafinil but overall it is categorized as SCHEDULE IV as compared to Methylphenidate SCHEDULE I by the Drug and Enforcement Authority (DEA).

Modafinil v/s Armodafinil:

Armodafinil is the R enantiomer of Modafinil. Both are FDA-approved drugs for Obstructive sleep apnea. Armodafinil have a longer half-life compared to Modafinil. In some cases, Armodafinil may be considered a stronger drug with better wakefulness effects while both have similar side effects.

They are both equally addictive controlled substances and are categorized as Schedule IV medications by the Drug Enforcement Administration (DEA). As per efficacy, Adderall is two times more potent than Ritalin according to the study of “Official Journal of the American Academy of Pediatrics”.

Body as a whole:

• Headache
• Back pain
• flu syndrome
• Chest pain
• Chills
• Neck rigidity

Central Nervous System effects:

In addition, they have the following undesirable effects Undesirable side effects of Adderall usage include

• Nervousness
• Insomnia
• Anxiety
• Dizziness
• Depression
• Paraesthesia
• Somnolence
• Hypertonia
• Dyskinesia
• Hyperkinesia
• Agitation
• Confusion
• Tremors
• Emotional lability
• vertigo

Rarely, it can cause psychoses or mania in individuals with bipolar disorder or depression. No specific antidote is present in the case of overdose. Overdosing should be managed with supportive care.

Cardiovascular effects:

In addition to its CNS effects, Modafinil causes

• Palpitations
• Cardiac arrhythmias
• Hypertension
• Anginal pain
• Circulatory collapse
• Headache, chills, and excessive sweating may also occur.

Because of its cardiovascular effects, modafinil should not be given to patients with cardiovascular disease.

GI system effects:

Modafinil acts on the GI system, causing:

• Anorexia,
• Nausea,
• Vomiting,
• Abdominal cramps
• Diarrhea.
• Dry mouth
• Dyspepsia
• Constipation
• Abnormal liver function
• Flatulence
• Mouth ulceration
• thirst

Dependence and Withdrawal symptoms:

Due to its effect of producing a feeling of wellbeing and enhancing cognitive functions. It is categorized as a SCHEDULE IV drug which implies that this is the drug with low potential for abuse and low risk of dependence. So these drugs if used for a prolonged period can cause dependence. Its Withdrawal symptoms include:

• Depression
• Poor concentration
• Unusual tiredness
• Stomach aches
• Vomiting
• Sleepiness
• Shortness of breath

These symptoms appear a day or two after you stop taking them. It may take few days to weeks depending on age and period of use.

Tolerance:

Repeated use of a drug causes a gradual decrease in the response to the drug. People who want to lose abuse this medicine and often face tolerance. A gradual increase in the dose of these drugs is required to keep the normal degree of their effects.

There is no evidence that tolerance can occur with Modafinil.

Respiratory:

• Rhinitis
• Pharyngitis
• Lung disorder
• Epistaxis
• Asthma

Skin:

A severe Allergic reaction to this drug is rare but can occur. A severe dermatological reaction can occur if this is used for Attention Deficit disorder in children.

Special senses:

• Amblyopia
• Abnormal vision
• Taste perversion
• Eye pain

Urogenital:

• Urine abnormalities
• Hematuria
• Pyuria

Lymphatic:

Eosinophilia

Metabolic:

Edema

Contraindications:

It should not be or used with caution used in pregnancy, hypertension in pregnancy, breastfeeding, hypertension with angina, and myocardial infarction.

It should be used with caution in patients with hepatic(half doses in severe disease) and renal impairments( half normal dose if severe; monitor blood pressure and heart rate in hypertensive patients. Avoid alcoholic beverages when using the drug. Discuss risks and benefits with your doctor before use in special cases.

It should not be used in Pediatricsics in any indication Serious Rash, including Stevens-Johnson Syndrome requiring hospitalization and discontinuation of treatment has been reported in adults and children in association with the use of modafinil.

Can I take Modafinil if I am pregnant or breastfeeding?

Food and Drug Authority (FDA) for pregnancy categorized Modafinil as Category C so it can be used in pregnancy with caution. If you have mild to moderate symptoms, it should be avoided but if severe, it should be taken for maintaining normal functioning. For breastfeeding it is classified as L3 i.e. moderately safe, however, there is the possibility that side effects to the breastfeeding infant may occur.

How quickly does the treatment work?

The action of Modafinil is rapid with a peak concentration occurring at 2-4 hours.

Is it safe to take Modafinil?

Yes, it’s safe to take Modafinil if you have Excessive sleep disorders and if taken as directed by your physician but taking it for off-label uses like cognition enhancement, depression and bipolar may cause side effects. It is not safe for children, so should not be used.

How long does a dose of Modafinil last?

The effects produced by Modafinil usually disappear after about 16-22 hours. However, it can remain in your body for up to 4 days after the initial dose.

Are there any side effects of the treatment?

Yes, there are side effects of using Modafinil such as nausea, loss of appetite, fever, trouble sleeping. You should get back to your doctor if these effects persist. It may also increase your blood pressure and cause palpitations.

Do I require a prescription for taking Modafinil?

Yes, you need a proper prescription by certified Heath care professional for taking Adderall. Otherwise, it is illegal to have Modafinil as it is classified as a controlled substance by Drug Enhancement Authority (DEA)

Why is it not safe to buy Modafinil online?

It is not safe because this drug may be fake. FDA strongly discourages consumers from buying online because of the issue of counterfeit. Online Pharmacies which sell substance-controlled drugs without a prescription poses threat to public health.

I cannot swallow the capsule, what should I take?

If you are facing difficulty in swallowing tablets, there is nothing can you do. Do not break or crush the tablet. It should be taken as a whole. There is no liquid form of this medication available commercially. You need to swallow it as a whole or consult your doctor for the change of the medication.

Is this treatment a safe option for children?

No, Modafinil is not safe for children and is not approved by Food and Drug Enforcement Authority (FDA). It may cause a severe dermatological reaction such as Steven Johnson syndrome in pediatrics, so it should not be used in children.

How long do I have to take Modafinil?

This depends on your medical condition and response to the medication. The doctor may stop the medication to check whether there is improvement in symptoms and whether the medication is still needed. You need to adhere to the directions of your primary care physician cautiously.

However, its use for a longer period is not systematically evaluated, so it should not be used for extended time i.e. more than 9 weeks in narcolepsy and more than 12 weeks in Obstructive sleep apnea(OBS)

Can I take Modafinil with other medication?

Certain drugs shouldn’t be used alongside modafinil because some drugs decrease their efficacy and the interaction of some drugs with it can cause lethal effects. Drugs that cause severe interactions include

• Abemaciclib
• Antibiotics for example Clarithromycin

Drugs for cancer for example

• Abemacicilib
• Erlotinib
• Medications for the treatment of HIV
• Abacavir
• dolutegravir
• Stomach acid drugs:

H2 receptor antagonists such as:

• Famotidine
• Ranitidine

Proton pump inhibitors such as:

• omeprazole
• lansoprazole

If modafinil and Proton pump inhibitors must be used together, the patient should be monitored closely for the signs and symptoms of GIT bleeding or any other symptom of PPI reduced efficacy.

• Acetaminophen; caffeine
• Amantadine
• Amphetamine
• Aprepitant
• Malarial medication
• Artemether
• Lumefantrine
• Barbiturates
• Bupropion
• Monoamine oxidase inhibitor (MAOI) antidepressants. For example selegiline

It should not be used with Vit C and grapefruit.

Is Modafinil hard on the liver?

In therapeutic doses, it rarely affects the liver. so it is completely safe for the liver. However, in case of overdosing it causes liver injury and ultimately liver failure if not treated promptly.

Can I(healthy individual) take Modafinil for Cognition enhancement?

Modafinil is very effective for cognition. It enhances both cold and hot cognition but lifestyle use of 'smart drugs' raises both safety concerns as well as ethical issues, including coercion and increasing disparity in society but its use should be discouraged because every cannot afford it and this creates discrimination among society.