modafinil vs adderall

 

Modafinil is a drug that goes by the brand name Provigil, designed to treat narcolepsy while Adderall, mixed with amphetamine salts, is a psychostimulant drug initially approved in 1996 to treat Attention Deficit/Hyperactivity Disorder (ADHD). Despite lingering similarities in drug approval and treatment fields, Modafinil is considered as having superior benefits for mental alertness and overall vigilance. Modafinil has also been granted approval to treat work shift sleep disorder as well as excessive daytime sleepiness associated with obstructive sleep apnea and is associated with cognitive enhancement, leading it to be used for increased overall mental productivity and focus.

History

Modafinil was originally developed in France from its predecessor adrafinil. Modafinil is the primary metabolite contained in adrafinil and is more widely used than its parent drug. Its use started in France in 1994 under the name Modiodal and in the U.S. has been widely sold as Provigil. Adderall was introduced as an instant-release drug in 1996 while Adderall IR’s generic version was first introduced to the market in 2002.

Uses and Various Applications

Modafinil has label uses for narcolepsy, shift work sleep disorder and excessive daytime sleepiness associated with obstructive apnea. Off the label, multiple sclerosis patients have reported decreased neurological fatigue from issues. A test done by Cephalon, producers of modafinil, involved 72 people diagnosed with various degrees of multiple sclerosis taking doses of the drug for nine weeks and self-reporting fatigue levels over the period on standardized scales. Participants of the study who were taking low doses of modafinil reported feeling less fatigued on the scale, with a significant statistical difference in the fatigue scores for those who were taking the actual modafinil dose versus participants taking the placebo. A higher dose of modafinil did not have a significant increased effect for its users.

The application of modafinil in its off-label treatments also includes treatment of fatigue and sedation amongst a variety of conditions. These would include depression, fibromyalgia, chronic fatigue syndrome, myotonic dystrophy, opioid-induced sleepiness, spastic cerebral palsy and Parkinson’s disease. In primary biliary cirrhosis, modafinil has been able to improve the body’s reactions to fatigue and daytime somnolence symptoms.

The use of modafinil has also been investigated as a viable replacement to amphetamine within military circles. This use would be in combat situations where military personnel encounter sleep deprivation such as in lengthy missions. Modafinil’s use has been indicated by the French government, where the Foreign Legion used the drug for their covert operations. Further, the Indian Air Force has confirmed that modafinil is included in their contingency plans. The United States military has also approved modafinil’s use in selected Air Force missions. Modafinil was the only drug approved by the United States Airforce as a “go pill” to reduce fatigue during various operations. The drug is also used by astronauts on long-term missions at the International Space Station, according to the Canadian Medical Association Journal. It helps the crew to gain optimal performance when fatigued. With the reduced quality of sleep astronauts experience, modafinil helps to improve sleep time as well as with circadian rhythms.

Adderall, comparatively, is used mainly for the treatment of ADHD. The use of Adderall over time has been seen to improve brain development and nerve growth. Studies of MRI scans over time have shown that long-term treatment using Adderall leads to a decrease in abnormal brain structure and function in people suffering from ADHD. Improvements of the right caudate nucleus of the basal ganglia have also been recorded in subjects having ADHD and using this drug. With its long-term use, Adderall reduces the core symptoms of ADHD including hyperactivity, inattention, and impulsivity. This produces improvements in an individual’s quality of life and enables them to enhance their academic performance.

A review in 2015 with numerous clinical trials found that low Adderall dosages produced slight yet unambiguous improvements in the cognition, working memory, long-term episodic memory as well as some aspects of attention. These tests were on normal and healthy adults. Doses of this drug can also serve to improve memory consolidation, thereby improving an individual’s ability to remember information. Studies also show the use of Adderall improves the user’s motivation to perform tasks as well as causing an increase in wakefulness. This would translate to more goal-oriented behavior. It is in this context that some students use for help in test-taking, with 5-35% of college students using the drugs for performance enhancement.

Adderall is also used by some athletes for performance enhancements such as increased endurance as well as alertness. Further, amphetamines have been proved to improve muscle strength, acceleration, athletic performance and endurance in normal, healthy adults. This goes hand in hand with an improved reaction time overall. The body’s power output is also increased by increasing the body’s core temperature limit. This accesses the body’s reserve capacity and incorporates it into the body’s working mainframe, resulting in actions such as jumping higher and throwing further.

Recreationally, Adderall tablets have been abused and have a high potential to be abused. This is because of the drug’s ability to create a false sense of well-being. Increases in dopamine levels cause the body to become increasingly addicted to the drug, requiring higher doses to achieve the same state of euphoria over time.

Side Effects

Reports by Teva Pharmaceuticals have shown that one-third of participants in clinical trials reported experiencing headaches. 11% of the participants reported nausea, while less than 10% of the participants reporting other negative side effects. These included nervousness, diarrhea, insomnia, anxiety, dizziness and gastrointestinal problems.

More adverse and serious effects have included severe skin rashes and other allergy-related side effects. Only six cases of severe reactions from modafinil have been reported since the beginning of its marketing in the United States up to 2007. Recently, severe cases have also been quite minimal. The long-term safety and effectiveness of modafinil have not yet been quantified, although experts across the board and patients alike claim the drug has very minimal side effects.
On the other hand, Adderall has very many and varied side effects. These are primarily determined by how much Adderall is consumed beforehand. Recreational doses of Adderall involve higher doses, hence making recreational users more susceptible to severe side effects than their therapeutic counterparts.

Physical side effects of Adderall may vary according to the individual but can include. Sexual side effects in males may include erectile dysfunction, frequent or prolonged erections. Abdominal side effects could include nausea, weight loss, abdominal pain and a loss of appetite. Nosebleeds, a dry mouth, blurred vision and excessive grinding of teeth are other known side effects of this drug. Drug-induced nasal congestion, reduced seizure threshold a movement disorder called tics could also occur. Other physical effects of the use of Adderall would include the contraction of the urinary bladder sphincter resulting in difficulty in urinating and in deeper faster breaths when used in larger doses. Adderall could also have pain-relieving effects and could affect the gastrointestinal tract in unexpected ways. This would either result in the slowed movement of content in the digestive system or increased motility if the smooth muscles of the tract are relaxed.

Psychologically, effects of Adderall could lead to increased alertness, apprehension, concentration and a decreased sense of fatigue. However, other effects of the drug could include mood swings and insomnia. Less commonly, those under the influence of Adderall suffer from anxiety, irritability, restlessness and a change in libido. The user’s personality and mental state when taking the drug would determine some of these psychological effects. Delusions and paranoia can occur in heavy users with psychosis also being a possible side effect for long-term therapeutic users, although chances are quite rare.

onditioned placed preference has also been observed in those taking therapeutic doses, causing them to like spending time in places they had previously used Adderall.

Cases of Overdose

As of 2004, the FDA is not aware of any fatal overdoses involving an overdose in modafinil alone. Further, clinical trials have involved taking up to 1200mg per day for 21 days, and known occurrences of one-time 4500mg did not appear to cause life-threatening effects. Only adverse effects were observed inclusive of palpitations, insomnia, anxiety, irritability, confusion, nervousness and nausea.

Adderall has had cases of overdoses that have led to the death of patients. Despite the severity of effects of overdoses in humans depending largely on the degree of overdose as well as the individual’s drug tolerance, Adderall overdoses result in severe effects. These include cardiogenic shock, cerebral hemorrhage, circulatory system collapse, acute amphetamine psychosis, serotonin syndrome as well as excessive adrenergic nerve activity. All these effects could lead to the death of an individual. Further, a major overdose could also cause rapid muscle breakdown as opposed to increased muscle strength in normal doses. Fluid accumulation in the lungs, pulmonary hypertension and reduced levels of Carbon (IV) oxide in the blood could also occur.

In the urinary system, failure to produce urine and kidney failure have been recorded to occur in cases of Adderall overdose. Hyperpyrexia, a condition where one has an extremely elevated core body temperature, could also occur. This would be counter-intuitive to Adderall’s effects on an increased power output during muscle contraction.

Addiction

Modafinil is a Schedule IV controlled drug. This means it has a low potential for abuse, as a result of its low dopaminergic effects. Low physical euphoria levels cause modafinil to be a weak reinforce if used for abuse.  Adderall is a Schedule II controlled drug, holding a much higher potential for abuse. This is because the major part of its composition is amphetamine salt which greatly stimulates the Central Nervous System. Amphetamines cause psychological dependency and habit forming in individuals, thereby causing addiction. The John Hopkins Medical school has well documented bad withdrawals symptoms caused directly from Adderall. This is due to its increased dopamine levels that cause a false sense of well-being.

Recap of Information

The following are the similarities between Modafinil and Adderall:
• Treatment of ADHD: Both these medicines are capable of treating ADHD, with Adderall being the clinically approved option. However, modafinil is also prescribed to treat ADHD and has a lot of evidence backing it as a viable option.
• Efficacy: Both modafinil and Adderall are considered effective adjuncts, possibly able to be used with an antidepressant
• Generic Availability: Both substances have their generic versions available for sale
• Half Life: The similarity of their half-lives is high. With modafinil having a 12-hour half-life and Adderall having an 11-13 hour half life
• Treatment of Narcolepsy: Both these substances are FDA-approved to treat narcolepsy
• Use with antidepressants: Both substances are considered effective depression adjuncts among individuals suffering from refractory depression

The following table outlines the differences between Modafinil and Adderall:

Area of Difference Modafinil Adderall
Abuse Potential Low abuse potential. This drug does not have a high dependency rate and is not prone to addiction This drug has a high abuse potential with individual’s experiencing more dependency. There are higher risks of addiction with this drug
Legal classification Schedule IV, showing less stringency due to low possibility of addiction Schedule II, showing a higher level of stringency due to its proven high levels of possible addiction
Side Effects Side effects are minimal Side effects are numerous and varied. They have also been seen to be very severe in numerous cases
Withdrawal Little if any withdrawal symptoms that would not last more than one month Excessive withdrawal symptoms leading to both psychological and physical tribulations on discontinuing the drug
Cases of overdose No documented case of a fatal overdose due to purely modafinil’s overuse A number of documented deaths due to the overuse of Adderall. Overdose of Adderall could also lead to excessive complications that would lead to it as an indirect cause of death

 

Sources:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3480574
https://www.theguardian.com/lifeandstyle/2013/may/03/brain-enhancing-drugs-mj-hyland
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1737733
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3221356
http://news.bbc.co.uk/1/hi/uk_politics/6083840.stm
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2691437
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4319252
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3666194
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2769923
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4340791
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3353150
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3785407

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