Modafinil

PROVIGIL

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Pronunciation: moe-DAF-i-nil

Modafinil ballicule: receptor binding, kinetics and half-life diagram — Mechanism of action: Modafinil ballicule

Modafinil PROVIGIL mascot mnemonic cartoon — Visual mnemonic: Modafinil mascot
**“Moe daffodil is Pro-vigilant”**

What it isDopamine reuptake inhibitor and wake-promoting agent; narcolepsy, OSA-related sleepiness and shift-work disorder.

Why this oneIt promotes wakefulness with less sympathetic activation and lower abuse potential than amphetamine.

What limits itIt induces CYP3A4 enough to fail oral contraceptives, so alternative contraception is essential. Serious rash including SJS can occur.

Modafinil molecular structure (skeletal formula) — Molecular structure: Modafinil

FDA-approved for

narcolepsy/shift-work/OSA sleepiness (1998)

Off-label

depression-related fatigue
ADHD

FDA label

Read the full label on DailyMed ↗

FDA dosing	Population	Start	Max
Narcolepsy	Adult	200 mg QAM	400 mg QD (no consistent added benefit)
Obstructive sleep apnea	Adult	200 mg QAM	400 mg QD (no consistent added benefit)
Shift work disorder	Adult	200 mg QD, ~1 h before shift

Renal Undefined

Hepatic Reduce to one-half the recommended dose in severe hepatic impairment.

Instructions

Consider lower dose and close monitoring in geriatric patients.

Available strengths

tab 100, 200 mg

Cautions

Serious rash including Stevens-Johnson syndrome, TEN, DRESS
Angioedema and anaphylaxis
Multi-organ hypersensitivity reactions
Persistent sleepiness (caution driving)
Psychiatric symptoms (use caution with psychosis, depression, mania)
Cardiovascular events (avoid with LVH or mitral valve prolapse syndrome)

Adverse reactions

Headache
Nausea
Nervousness
Rhinitis
Diarrhea
Back pain
Anxiety
Insomnia
Dizziness
Dyspepsia

Pregnancy May cause fetal harm based on animal data; intrauterine growth restriction and spontaneous abortion reported.

Lactation Unknown whether excreted in human milk; exercise caution.

Cost

Modafinil (PROVIGIL)

What pharmacies pay · NADAC 9/30/26

Strength		#/mo	generic $/mo	CostPlus
100 mg	tab	30 qd	$7.44	not offered
200 mg	tab	30 qd	$10.31	not offered

Generic entry2012

NO BOXED WARNINGS

Principal riskIt induces CYP3A4 enough to fail oral contraceptives

Classes and tags

Clinical profile

Therapeutic safety burden2 / 4

Overdose danger2 / 4

Weight-gain liability0 / 4

Sedation liability0 / 4

QT / Torsades0 / 4

Direct muscarinic antagonism0 / 4

Embryofetal risk2 / 4

Legacy pregnancy categoryC

Defining liabilitySerious rash, psychiatric activation and CYP-mediated interactions; misuse potential is present.

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Memory aids: interaction avatars

CYP2C19 inhibitor (weak)

CYP3A4 inducer (moderate)

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