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Modafinil (Provigil)

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  1. How does modafinil work?
  2. How do I take modafinil?
  3. Side effects and contraindications

Other name: Provigil

Modafinil is a drug that promotes wakefulness and is licensed for treating people who experience excessive sleepiness due to narcolepsy. Research has suggested that it may be an effective treatment for the management of multiple sclerosis fatigue in some people where sleepiness is a factor in their fatigue. However following the findings of a safety review, the European Medicines Agency recommended that the use of modafinil should now only be associated with narcolepsy.

Recent studies which have reviewed previous research papers on modafinil have found no strong evidence for its use in treating MS-related fatigue. Although some potential benefits of the drug were identified, these studies concluded that evidence on the effectiveness of modafinil in treating MS fatigue was weak and inconclusive.

Amantadine is another drug which is sometimes used to treat fatigue in MS.

How does modafinil work?

It is thought that modafinil works by selective activation of a particular part of the brain called the hypothalamus. This area is thought to control normal sleep and wakefulness patterns. Unlike central nervous system stimulants, modafinil does not result in excessive tiredness (a 'crash' or rebound hypersomnia) as it wears off.

How do I take modafinil?

Modafinil is taken orally as tablets.

Side effects and contraindications

Modafinil is generally well tolerated with mild side effects, which can include headache, nausea, chest pain, loss of appetite and weakness. Modafinil reduces the effectiveness of contraceptive drugs so you will need to consider other birth control methods while taking the drug and for two months after stopping treatment.

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References

  • Rammohan KW, et al. Efficacy and safety of modafinil (Provigil) for the treatment of fatigue in multiple sclerosis: a two centre phase 2 study. Journal of Neurology, Neurosurgery and Psychiatry 2002;72(2):179-183. Summary
  • Littleton ET, et al. Modafinil for multiple sclerosis fatigue: does it work? Clinical Neurology and Neurosurgery 2010;112(1):29-31. Summary
  • Möller F, et al. HAGIL (Hamburg Vigil Study): a randomized placebo-controlled double-blind study with modafinil for treatment of fatigue in patients with multiple sclerosis. Multiple Sclerosis Journal 2011 Aug;17(8):1002-1009. Summary
  • Miller P, et al. The pharmacological and non-pharmacological interventions for the management of fatigue related multiple sclerosis. Journal of Neurological Sciences 2017;381:41-54. Summary
  • Yang TT, et al. Pharmacological treatments for fatigue in patients with multiple sclerosis: A systematic review and meta-analysis. Journal of Neurological Sciences 2017;380:256-261. Summary
  • Mücke M, et al. Pharmacological treatments for fatigue associated with palliative care. Cochrane Database of Systematic Reviews 2015; Issue 5. Art. No.: CD006788. Full article

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