Provigil vs. Nuvigil

My doctor has suggested to try Provigil or Nuvigil as an augmentation to CPAP therapy to treat my residual daytime sleepiness.

I'm interested in hearing feedback from anyone who has used either of these drugs, or especially people who have tried both. Did you notice any differences between the two? The cost of the drug is not a factor in this case, only the pros/cons of the drug effects.

Thanks!

I have taken both. Nuvigil is supposed to last longer. I could not tell a difference between the two. Dosages of Provigil can vary widely. I haven't heard of anyone who took more than the 250 mg Nuvigil. I didn't have any side effects. What currently works for me is Provigil 400 mg in the morning. Good Luck.

Aloha! I've taken both Provigil or Nuvigil for some time now. As I'll elaborate on a little further below, I don't notice any difference between the two. Most of the information I've seen praising the improvements in Nuvigil have come from the manufacturer. I have a friend/co-worker from India who takes modafinil (generic name for Provigil/Nuvigil) and I swapped him a couple Provigil's for a couple of Indian modafinils. Seemed like the same stuff.

Provigil/Nuvigil/modafinil is interesting stuff. Through my excessive daytime sleepiness adventures I've gotten to know a handful of people who have taken that and other (prescribed) wakefulness agents. Upon comparing notes, I've found my experience - sometimes it works great, other times it almost has a paradoxical effect - is not unusual. It's very gentle in terms to how it kicks in and wears off. I haven't felt any jitters or other things I felt with stronger drugs or 12.5 cups of coffee. There is no rebound like there is with stronger meds. I believe this is a med they have switched to for military pilots who need to stay awake for long periods of time on a mission.

Another plus is I haven't read of any real downsides to it. Unlike some of the stimulants, I didn't find any issues with short term memory .. in fat some consider it a nootropic. You can always find some kind of misinformed fear mongering by a journalist who has to have something to write about on a given day. One always has to weight the risks against the benefits and in this case, that was a pretty easy decision for me. I'd be happy to answer any questions you had or discuss it further. If it's covered by some kind of insurance (It's prohibitively expensive - even the new generic) - I'd give it a try.

Your mileage will undoubtedly vary; particularly if you use the air conditioner.

I am not as knowledgeable as Sgt_Pepper, but I have tried both. No difference at all. I noticed absolutely nothing. I would agree that this is a medication with few down sides for me. I felt a bit zippy the first three days I took it, but now I feel normal, just more alert and awake. For me, no side effects.

Good luck! I hope you find the medication that is right for you.

In a nutshell. Use which ever one allows you to buy it for less.

Nuvigil and Provigil have exactly the same active ingredient in them, only the ratio of the two main isomers are different between the two. An isomer is a chemical that has the same molecules in the final structure, but they differ in the final shape of the structure. Nu and Pro both have two versions (ismoers) of the same chemical. Both isomers have the clinical effect of making you feel awake without a stimulation effect. One of the isomers was found to be very short acting, so the vast majority of the clinical effects of both drugs could be contributed to only one isomer.

Drugs are given fairly short patent period to allow the developers (Cephalon in this case) to recoup the development costs, and then the formula is allowed to go generic and be produced by anyone. Pro was coming towards the end of its patent period, and another company sued Cephalon over the patent to be allowed to make a generic. Seeing the writing on the wall, Cephalon developed Nu. Nu has more of the longer acting isomer than pro for a given amount, and this allowed them to get a brand spanking new patent (expires in 2023). Their marketing team started offering discounts on Nu, and trying to get doctors to prescribe Nu. The reason is that if a doc prescribes Pro then the pharmacy is allowed to substitute the generic version; but there is a twist to that which I will mention in a minute. If the doc prescribes Nu then there is no generic, and the pharmacy can not substitute another drug, like Pro, even if the effects are exactly the same. So Nu is being pushed hard.

I mentioned a little twist with generic Pro... The company that sued Cephalon actually won. The judgement was that they are allowed to produce a generic version of Pro, and they were granted a short time period as the exclusive providers of the generic version. So they are currently the only company allowed to produce a generic version. Assuming no further legal decisions, that exclusion period ends in October. Right now Pro and the generic version are both selling at a very high price. This is a move by Cephalon and the exclusive generic to milk the last few months of near monopoly out of the drug. Once it goes true generic then multiple companies will begin production, and the price of generic Pro should drop like a rock to more reasonable levels as they all compete for business.

Most insurance companies give a pretty good discount for using a generic, so that is typically the way to go. If I get the name brand it costs me $30 per month, but generic only costs me $5 per month. I swapped from Nu to Pro, and will be getting the generic version myself. Now Singular needs to go generic and I will be spending a total of $50 less a month on drugs.

I hope you enjoyed this short lesson on how drug companies play the system to keep us paying more each month.

Simple answer: three easy differences, and a couple more complicated but really important ones for you.

First, Nuvigil (armodafinil) requires a smaller overall quantity than Provigil (modafinil) for the same effect; 250 mg of Nuvigil = 400 mg of Provigil.

Second, after Nuvigil got out of clinical trials, practitioners noticed that many patients were discovering that if they took Nuvigil along with eating a meal it wasn't working as well. Turns out many people need an empty stomach for 30-45 minutes on Nuvigil to get it absorbed and working. (It generally works ok later on in the day regardless, just not immediately.) This isn't the case with Provigil, which works on a full stomach as well. Nobody really knows why this is the case, since the biochemistry of both drugs is poorly understood.

Third, as described, Cephalon (now owned by Teva) is doing everything under the sun to get people to switch to their newly protected drug for the next 20 years, so Nuvigil would probably be cheaper for you for the next few months until Provigil goes fully generic. And yes, I generally agree with Blindrage's assessment of the industry.

Blindrage wrote:One of the isomers was found to be very short acting, so the vast majority of the clinical effects of both drugs could be contributed to only one isomer.

Sort of but not exactly, and for policebox this is actually pretty important especially after skimming through his previous threads.

I'm not a big fan of the FDA granting full patent protection to reformulated versions of existing drugs, of which Nuvigil is just one of many. (Lunesta is another, for instance.) One of the reasons they historically have done so (prior to the drug companies realizing it was a gravy train), though, is that right side isomers (hence the "ar" attached to "modafinil") generally do have less unintended side effects.

In the case of Provigil, two of those are tachycardia and hypertension, and both are issues for policebox.

policebox wrote:My heart rate is another issue, it has been fast my entire life. I've looked back at my medical records and tachycardia has been noted since I was at least 18 years old. Generally, my resting heart rate is between 100-110 bpm, with the average of all the readings I've recorded being in the high 90s. I've had this investigated and so far, it's been labeled an idiopathic sinus tachycardia

Based on this, for several reasons I'm actually concerned that your doctor didn't immediately bring that up when you had your discussion. At the very least, it complicates prescribing any stimulant as you've got to be very, very careful - a lot of doctors would probably order a treadmill test while someone with sinus tachy or another heart condition is taking the drug to make sure it's not doing anything to the heart that it's not supposed to. Second, as many people with any sort of tachy tend to be sensitive to stimulants, deciding on the right dose for you might require a bit of work as well.

But most importantly, it indicates someone who isn't that familiar with either drug, since in general a doctor who knows a patient may be contraindicated for a drug but still thinks it's worthwhile and knows a right side isomer is available is immediately going to suggest it - because it's less likely to produce complications.

policebox wrote:I have to adhere to a no tyramine diet because of taking an MAO inhibitor

This is actually even more important, since many MAOIs do wacky things to brain chemistry, and while not absolutely contraindicated with the -finils are something they watch really closely. This is because one of the best guesses on one of the ways the latter work - unfortunately, nobody really knows for sure - is they're dopamine reuptake inhibitors. The problem is that if you're on something like Nardil, you can end up with an amplifier effect when you add anything to the mix (that is, what you're adding is waaaay more potent than it is normally), so you've got to be really, really, really careful - to the point that if you decide you really want to try a stimulant, they may try to find another anti-depressant for you.

I'm not trying to scare you off; both are useful drugs and have less side effects than amphetamines when you've got nothing else interacting with them. Unfortunately, it sounds like you do. You've got to make sure whoever might prescribe them does the work on how they'll interact with everything else you've got, which clearly doesn't sound like it's happening for whatever reason. Make sure it does before you go forward.

Finally, one other point: my general feeling about them is that you try them when you've run out of all other possibilities regarding sleep, and I'd really encourage you to work with your doctor to think about what might be going on besides apnea if your numbers are low but you're still exhausted as you've reported. That points to something else going on which might be worth investigating, even if it means you walk around like a zombie for a while longer until they figure it out.

old64mb wrote:Simple answer: three easy differences, and a couple more complicated but really important ones for you.

First, Nuvigil (armodafinil) requires a smaller overall quantity than Provigil (modafinil) for the same effect; 250 mg of Nuvigil = 400 mg of Provigil.

Second, after Nuvigil got out of clinical trials, practitioners noticed that many patients were discovering that if they took Nuvigil along with eating a meal it wasn't working as well. Turns out many people need an empty stomach for 30-45 minutes on Nuvigil to get it absorbed and working. (It generally works ok later on in the day regardless, just not immediately.) This isn't the case with Provigil, which works on a full stomach as well. Nobody really knows why this is the case, since the biochemistry of both drugs is poorly understood.

Third, as described, Cephalon (now owned by Teva) is doing everything under the sun to get people to switch to their newly protected drug for the next 20 years, so Nuvigil would probably be cheaper for you for the next few months until Provigil goes fully generic. And yes, I generally agree with Blindrage's assessment of the industry.

Blindrage wrote:One of the isomers was found to be very short acting, so the vast majority of the clinical effects of both drugs could be contributed to only one isomer.

Sort of but not exactly, and for policebox this is actually pretty important especially after skimming through his previous threads.

I'm not a big fan of the FDA granting full patent protection to reformulated versions of existing drugs, of which Nuvigil is just one of many. (Lunesta is another, for instance.) One of the reasons they historically have done so (prior to the drug companies realizing it was a gravy train), though, is that right side isomers (hence the "ar" attached to "modafinil") generally do have less unintended side effects.

In the case of Provigil, two of those are tachycardia and hypertension, and both are issues for policebox.

policebox wrote:My heart rate is another issue, it has been fast my entire life. I've looked back at my medical records and tachycardia has been noted since I was at least 18 years old. Generally, my resting heart rate is between 100-110 bpm, with the average of all the readings I've recorded being in the high 90s. I've had this investigated and so far, it's been labeled an idiopathic sinus tachycardia

Based on this, for several reasons I'm actually concerned that your doctor didn't immediately bring that up when you had your discussion. At the very least, it complicates prescribing any stimulant as you've got to be very, very careful - a lot of doctors would probably order a treadmill test while someone with sinus tachy or another heart condition is taking the drug to make sure it's not doing anything to the heart that it's not supposed to. Second, as many people with any sort of tachy tend to be sensitive to stimulants, deciding on the right dose for you might require a bit of work as well.

But most importantly, it indicates someone who isn't that familiar with either drug, since in general a doctor who knows a patient may be contraindicated for a drug but still thinks it's worthwhile and knows a right side isomer is available is immediately going to suggest it - because it's less likely to produce complications.

policebox wrote:I have to adhere to a no tyramine diet because of taking an MAO inhibitor

This is actually even more important, since many MAOIs do wacky things to brain chemistry, and while not absolutely contraindicated with the -finils are something they watch really closely. This is because one of the best guesses on one of the ways the latter work - unfortunately, nobody really knows for sure - is they're dopamine reuptake inhibitors. The problem is that if you're on something like Nardil, you can end up with an amplifier effect when you add anything to the mix (that is, what you're adding is waaaay more potent than it is normally), so you've got to be really, really, really careful - to the point that if you decide you really want to try a stimulant, they may try to find another anti-depressant for you.

I'm not trying to scare you off; both are useful drugs and have less side effects than amphetamines when you've got nothing else interacting with them. Unfortunately, it sounds like you do. You've got to make sure whoever might prescribe them does the work on how they'll interact with everything else you've got, which clearly doesn't sound like it's happening for whatever reason. Make sure it does before you go forward.

Finally, one other point: my general feeling about them is that you try them when you've run out of all other possibilities regarding sleep, and I'd really encourage you to work with your doctor to think about what might be going on besides apnea if your numbers are low but you're still exhausted as you've reported. That points to something else going on which might be worth investigating, even if it means you walk around like a zombie for a while longer until they figure it out.

Thank you for your thoughtful and specific reply. I appreciate you taking to look at my prior posts, seeing the struggles I've experienced, and offering relevant input.

Here are a few updates:

I've finished seeing the cardiologist regarding the tachycardia. I completed a treadmill stress test, wore a cardiac event monitor for a month, wore a Holter monitor for 48 hours, had an echocardiogram, several ECGs, as well as labs to check thyroid and other metabolic functions. All the tests/labs were normal, except for the sinus tachycardia. I believe the final determination was that I have inappropriate sinus tachycardia. I've been prescribed atenolol which has reduced my mean resting heart rate from 97.7 bpm to 88.9 bpm. With the cardiologist I've discussed increasing the dose of atenolol to see if I can further decrease my heart rate; however, since I am normotensive, I have to careful not to drive the associated decrease in blood pressure too low. So far, I have not experienced any side effects or problems using atenolol.

As far as the MAOi, I discontinued taking it several months ago due to the spontaneous hypertensive events it intermittently caused. At this point, I'm not taking any antidepressents.

With the successful reduction of heart rate and no longer taking any other drugs which have stimulant properties (Parnate), I feel comfortable trying Provigil/Nuvigil to see if it helps with the daytime fatigue and sleepiness. When it comes to walking around like a zombie any longer, that's not something I can really tolerate doing. I've already felt like a zombie for six years, it having cost me jobs, delayed my education, and alienated my relationships. My life has been utterly destroyed already, so my patience has worn out.

Instead of following my sleep doctor's suggestion in trying to force myself to sleep from midnight to 8am (which I tried, but made my life an utter hell), I opted to just let me body sleep when it wants to sleep and records the results. In a letter to my sleep doctor, I described this experiment as follows:

"I have taken great care to observe and analyze my sleep, in order to try to better-define the specific difficulties I experience. Upon reviewing my sleep diaries, CPAP data, and nearly fifteen years of my medical records, I would say that the major complaint from which I suffer is best characterized by the description of delayed sleep-phase disorder (DSPD). After suffering tremendously in an attempt to force myself to sleep on a prescribed schedule (midnight to 8 am) I decided to see what would happen if I allowed myself to sleep on my body’s “natural” schedule. Under these conditions, I tend to have peak mental alertness between about midnight to 4 am; I then become drowsy around 5 am, quickly fall asleep, and sleep until around noon (when I am naturally aroused). Thus, I get between seven to eight hours of sleep per “night”, with very few awakenings or disturbances. Although this sleep is far more refreshing than when I try to force myself to sleep between midnight and 8 am, there is one complication. After being awake for two to three hours, I sometimes grow excessively sleepy and am compelled to nap for about another two hours. Despite my attempts to force myself to stay awake and not nap, if I don’t take a nap when the urge comes over me, I get extremely nauseated and experience body wide physical weakness/fatigue. Upon awakening from these naps, I do not feel refreshed and I generally feel ill and dysfunctional until around midnight, when I begin to experience a refreshing amount of mental and physical alertness. Additionally, when reviewing past medical records, these patterns of sleep have been pervasive throughout my adult life and previous attempts to at treatment to normalize my sleep phase have been unsuccessful. I believe the reason for this is that treatments have relied on a diagnosis of primary insomnia associated with major depressive disorder, rather than the true cause."

I sometimes wish (but do not know if it would have made any difference) that my sleep studies would have been conducted during the times I "naturally" sleep (4 am to noon) rather than 11pm to 6am, when they were actually done.

Since the MAOi was at one time helpful in normalizing my sleep schedule, I've thought about starting it again, in light of me taking a beta-blocker, which might work to prevent the spontaneous hypertensive side effects caused by the MAOi. I'm going to discuss this, along with Provigil/Nuvigil, and other options with the doctor tomorrow.

First, thanks for taking the time to read the long post.

Second, what a challenge you've been through and keep going through. I'm glad I was able to help a little bit.

Third, your paragraph on sleep does make me think there's more that can be done for you on the sleep side - especially since there are in fact 24 hour studies.

Anyway, I'll refrain from more for now since I think you have the tools you need to have an educated conversation with the doctor about Nuvigil and its risks - as I said, it may be contra'd for you, but at least now you know why. Let us know how it turns out and good luck.

Policebox, check to see if your insurer has an in-home sleep study provision. Mine told me about the option after denying a 'titration' study and just sending me an APAP out of the gate. In fact, they also said in their letter, that they feel the in-home test data is more valid and would waive co-pays.

I don't know if your handle has a professional connection, but if it does, know that I'm a retired po-po here in Florida.