Provigil (Modafinil) vs. Adderall: Comparison

Provigil (modafinil) is a drug that was approved in 1998 for the treatment of excessive daytime sleepiness associated with narcolepsy.  It has since been granted FDA approval for the treatment of obstructive sleep apnea as well as shift work sleep disorder.  Adderall (mixed amphetamine salts) is a psychostimulant drug that was initially approved in 1996 for the treatment of attention-deficit/hyperactivity disorder (ADHD).

These two drugs have a lot in common in that they were both approved in the late 1990s, and are considered medically effective for the treatment of narcolepsy.  That said, Provigil seems to be superior in regards to promoting vigilance (hence the name “pro” + “vigil”) and Adderall is regarded as the superior option for treating ADHD.  Both drugs are commonly used off-label for cognitive enhancement among college students and business executives.

Provigil has an indecipherable mechanism of action, but is believed to alter dopamine, histamine, other monoamines, and stimulate orexin receptors.  Adderall is known to primarily increase dopamine and norepinephrine by inhibiting their reuptake.  Most would argue that Provigil is likely a safer long-term treatment option compared to Adderall due to the fact that abuse, tolerance, and dependence aren’t as common.

Provigil vs. Adderall: Comparison Chart

Below is a chart comparing the eugeroic drug Provigil with the psychostimulant Adderall.  As you can see, there are many general differences between the two drugs such as: drug type, ingredients, and dosing options.

Provigil vs. Adderall: What’s the difference?

As you can determine from the chart above, there are many obvious differences between Provigil and Adderall.  Adderall is classified as a “Schedule II” controlled-substance, whereas Provigil is considered a “Schedule IV” substance.  Both drugs are effective options for treating excessive daytime sleepiness associated with narcolepsy.

Adderall may produce a more potent improvement in cognition as a result of its significant effect on dopamine reuptake inhibition.  While Provigil also inhibits reuptake of dopamine reuptake, its effect on dopamine is considered weak.  Adderall was manufactured 2 years earlier than Provigil, has more dosing options, and is universally regarded as the more popular drug.

Abuse Potential

Provigil is classified as a “Schedule IV” substance in the United States, meaning it is regarded as having a low potential for abuse when compared to other “Schedule III” substances.  The fact that it has several medically accepted uses, and isn’t commonly abused means that prescriptions for Provigil can be refilled up to 5 times within 6 months.  Prescriptions for Schedule IV drugs like Provigil can be done without a physically printed signature from a doctor.

Prescriptions for Adderall are strictly regulated due to the fact that it has a high potential for abuse.  Those using Adderall often build rapid tolerance to the drug’s effect, requiring significantly higher doses to attain the same effect that they attained when starting.  Adderall is classified as a “Schedule II” controlled-substance due to the fact that it is commonly abused and is habit-forming.

Users of Adderall are much more likely to become psychologically or physically dependent upon the drug for functioning than they are Provigil. This is in part due to the fact that Adderall significantly increases dopamine concentrations, whereas Provigil elicits minor dopaminergic effects by comparison.  This means that Provigil users aren’t likely to experience psychological euphoria, whereas Adderall users may become addicted to the dopaminergic rush that the drug provides.

Drug addicts are more likely to prefer Adderall for the dopamine rush that it provides.  Some people even resort to snorting Adderall and end up experiencing stimulant psychosis as a result.  While it is possible to abuse Provigil, it isn’t as common due to the fact that it doesn’t seem to induce significant pleasure.  Ironically, Provigil is sometimes used as an off-label replacement therapy for those addicted to cocaine and/or amphetamines.

Cost: Which is more expensive?

Those comparing Provigil to Adderall for the treatment of narcolepsy probably want to know whether one is cheaper than the other.  Regardless of whether we’re talking about the “brand name” or “generic” version of each drug, Adderall is the cheaper option.  For a 30 day supply of brand name Adderall IR (immediate-release), you’ll end up paying approximately $300.

A 30 day supply of Adderall XR (extended-release) will cost you about $220, which is a little bit more reasonably-priced than the immediate-release option.  For a 30 day supply of 100 mg “brand name” Provigil, you’ll end up paying between $790 and $805, yet for the 200 mg pills, the cost will likely exceed $1000.  Generic Adderall (mixed amphetamine salts) should cost approximately $50 (immediate-release) and $75 (extended-release) for a 30 day supply.

Generic Provigil (modafinil) can be attained within the price range of $150 to $305 for a 30 day supply.  If you don’t have insurance to pick up the tab for name-brand Provigil, you’d save yourself a lot of money by going with the generic.  Based on cost comparison, both name-brand Adderall and generic (mixed amphetamine salts) are cheaper than name-brand Provigil and generic (modafinil).

Dosage & Formats

Provigil is manufactured in tablet form with just 2 dosing options of 100 mg and 200 mg.  Both doses are estimated to promote wakefulness for 6 to 8 hours.  This wakefulness-promoting effect allows those with narcolepsy to stay alert and remain productive throughout the day.

Adderall is manufactured in the format of immediate-release tablets and extended-release capsules.  The tablets offer a 4 to 6 hour duration of effect, while the extended-release tablets provide stimulation for up to 12 hours.  By comparison, Adderall has a greater number of available formats, and its “XR” (extended-release) version provides a longer effect than Provigil.

There are also a greater number of dosing options for Adderall users.  The “IR” (immediate-release) format is manufactured in 5 mg, 7.5 mg, 10 mg, 12.5 mg, 15 mg, 20 mg, and 30 mg.  The “XR” (extended-release) format is manufactured in doses of 5 mg, 10 mg, 15 mg, 20 mg, 25 mg, 30 mg.  This means there are double the Adderall formats compared to Provigil and triple the dosing options for each format.

Efficacy: Which drug is more effective?

It is difficult to determine whether Provigil is more effective than Adderall for the treatment of narcolepsy due to the fact that head-to-head comparison studies haven’t been conducted.  Since each drug was found to be superior to a placebo in double-blind, randomized trials, it should be thought that they are both highly effective treatments.  It would be logical to conclude that differences in perceived efficacy may be a result of individual variation.

Some people may find that Adderall (mixed amphetamine salts) alleviates their sleepiness better than Provigil (modafinil) and vice-versa.  Adderall XR may be a better option for those in need of longer-lasting wakefulness due to the fact that it remains effective for up to 12 hours.  Provigil tends to function well for 6 to 8 hours.

For other uses such as in the treatment of ADHD, it is important to highlight the fact that Adderall is an approved treatment, whereas Provigil is not.  That said, there is evidence to support the idea that using Provigil for ADHD is an effective option.  Many psychiatrists find that Provigil often helps those with ADHD that don’t respond well to first-line options like Adderall.

In regards to cognitive enhancement (i.e. nootropic) and studying, Adderall may pack a more potent punch due to the fact that it stimulates a greater release of dopamine.  For some individuals, dramatic increases in dopamine result in better performance, whereas for others, this effect can actually impede performance.  Neither drug should be regarded as a “more effective” option than the other.

Mechanisms of action

Provigil’s mechanism of action remains undeciphered, but certain aspects have been discovered.  It is known that Provigil inhibits reuptake of dopamine to a minor extent by binding to the dopamine transporter, and elevates histamine levels in the hypothalamus.  It also has some effect on other neurotransmitters including norepinephrine in the hypothalamus and ventrolateral preoptic nucleus, and serotonin in the amygdala and prefrontal cortex.

Various studies suggest that Provigil stimulates orexin receptors (OX1 and OX2).  Orexins are peptides in the brain that regulate wakefulness.  Deficient orexin levels can result in excessive daytime sleepiness.  By stimulating the receptors, Provigil increases orexins and users feel highly-awake and alert, rather than sleepy.

There is evidence indicating that Provigil likely increases activity in glutamatergic circuits, and reduces GABAergic activity.  Finally, Provigil is thought to enhance a process called “electronic coupling” which increases the efficiency of neural communication and may simultaneously increase gamma brain waves.  Adderall differs from Provigil in that its mechanism of action is well-understood.

Adderall is a more potent inhibitor of dopamine and norepinephrine than Provigil, and also stimulates the presynaptic release of dopamine and norepinephrine from presynaptic neurons.  The speculative mechanisms behind Provigil’s effect are considered much less concentrated than those behind Adderall, which primarily affect levels of dopamine and norepinephrine.

Medical Uses

Both Provigil and Adderall have been approved by the FDA for the treatment of narcolepsy.  Adderall is also approved for the treatment of ADHD, whereas Provigil is not.  Provigil is approved for the treatment of obstructive sleep apnea (OSA) and shift work sleep disorder (SWSD), whereas Adderall is not.  From an off-label perspective, both drugs have been investigated as antidepressant augmentation strategies and are still prescribed for this purpose.

Provigil is considered a popular off-label treatment for ADHD and many studies highlight its efficacy.  It may also be prescribed for chronic fatigue syndrome, delayed sleep phase syndrome, depersonalization disorder, fibromyalgia, jet lag, multiple sclerosis, and Parkinson’s disease.  It has been investigated in cases of drug addiction and to help people lose weight. (Read: Provigil and weight loss).

Adderall has been investigated for cognitive rehabilitation among stroke patients and refractory depression.  In rare cases, some psychiatrists may prescribe Adderall for anxiety disorders if they suspect a dopaminergic link.  Although using Adderall for weight loss can be effective, doctors will not prescribe it for this purpose due to its abuse potential and rebound effect upon withdrawal.

By comparison, Provigil has three approved medical uses whereas Adderall only has two.  Provigil is also considered a safer, more effective off-label treatment over Adderall for many conditions due to its low potential for abuse.  Provigil should be regarded as a more versatile medication by comparison.

Popularity

Comparing the popularity of Provigil with that of Adderall is difficult due to the fact that they are in different classes.  As of 2012, Adderall was ranked as the 70th most prescribed drug of the year, whereas Provigil was the 137th most prescribed drug.  In 2013, it was estimated that Adderall (mixed amphetamine salts) held down approximately 38% of the ADHD medication market-share.

Provigil is thought to be the forefront option for treating narcolepsy.  In terms of global “brand name” recognition, Adderall is universally considered more popular.  More people know of Adderall and have used it than Provigil.  Although Provigil is popular among those being treated for narcolepsy, Adderall XR’s popularity may be catching up.

Adderall is a cheaper option than Provigil and the extended-release (XR) provides a longer-lasting effect when compared to Provigil.  Furthermore, there are an array of dosing options and multiple formats for Adderall, whereas Provigil is only manufactured in 2 doses.  Most would agree that Adderall is significantly more popular than Provigil.

Side Effects

Adderall may carry significantly more side effects than Provigil.  Common side effects associated with Adderall include: abdominal pain, appetite reduction, diarrhea, dizziness, dry mouth, fever, headache, insomnia, irritability, nervousness, vomiting, and weight loss.  Common side effects associated with Provigil include: dizziness, headaches, insomnia, nausea, and nervousness.

The ability of Adderall to substantially increase dopamine may be related to the greater number of side effects.  Provigil isn’t considered quite as potent as Adderall and most users don’t experience unwanted side effects.  There is an array of side effects associated with Adderall, but very few side effects associated with Provigil.

Usage of Adderall is well-known to stunt growth of youth over a short-term and simultaneously reduce their weight.  Provigil is not known to reduce height or significantly reduce weight among users.  In part, this may be due to the fact that it doesn’t pack as much of a dopaminergic, stimulatory punch as Adderall.  By comparison, Provigil would seem to have a favorable side effect profile.

Withdrawal

It is well known that discontinuation from Adderall, especially those that used it over a long-term or at high doses, is extremely difficult.  In fact, Adderall withdrawal symptoms may be protracted in that they persist for months long after the drug has been cleared from the body.  Common symptoms experienced upon discontinuation of Adderall include: psychomotor slowing, cognitive impairment, exacerbation of ADHD symptoms, sleepiness, and excess fatigue.

Upon discontinuation of Adderall, many people experience worse attentional deficits than prior to using the drug.  This is due to the fact that over time, the drug uses up dopamine stores, downregulates dopamine receptors, and the brain becomes dependent upon it to perform cognitively demanding tasks.  When the supply is cut or reduced, the brain is left with less receptors and low dopamine until it finds a way to restore homeostatic functioning.

This restoration process can take much longer than most sources suggest.  Due to the fact that Provigil doesn’t have as significant of an impact on dopamine, you won’t be left with nearly as severe of a depletion or receptor downregulation upon discontinuation.  This means that most people find Provigil withdrawal to be mild by comparison.  In fact, many medical professionals suggest that there is “no withdrawal” associated with Provigil.

Similarities (Recap): Provigil vs. Adderall

Below is a synopsis of the similarities shared by Provigil and Adderall.

• ADHD: Adderall is considered a clinically effective treatment for ADHD and is frequently prescribed. Although Provigil isn’t approved to treat ADHD, it is commonly prescribed for this condition and evidence suggests that it’s an effective option.
• Depression adjunct: Among individuals with refractory depression, both Provigil and Adderall are considered effective adjuncts when used in combination with an antidepressant.
• Efficacy: There’s no evidence to suggest that either drug is more effective over the other in regards to treating narcolepsy.
• Generic availability: Both substances are manufactured in generic formats. Provigil is sold under the generic “modafinil” and Adderall is sold as “mixed amphetamine salts.”
• Half-life: The estimated elimination half-life of Provigil is 12 hours and that of Adderall is thought to be between 11 and 13 hours; making the drugs very similar.
• Narcolepsy: Each drug has been approved by the FDA for the treatment of narcolepsy, specifically helping reduce daytime sleepiness.

Differences (Recap): Provigil vs. Adderall

Listed below is a synopsis of differences between Provigil and Adderall.

• Abuse potential: Adderall is regarded as having a high potential for abuse and dependence, thus it is more strictly regulated. Provigil is regarded as having a relatively low potential for abuse and isn’t considered to be habit-forming.
• Cost: The cost of Adderall is significantly cheaper than that of Provigil, especially when “brand name” versions of each drug are compared. Generic Adderall is also cheaper than generic Provigil.
• Duration of effect: Adderall IR has a duration of effect spanning between 4 to 6 hours, and Adderall XR has a duration of effect spanning up to 12 hours. Provigil has a duration of effect somewhere between that of both Adderall formats, ranging between 6 to 8 hours.
• Formats: Provigil is only manufactured in tablet format, whereas Adderall is manufactured in immediate-release (IR) tablets and extended-release (XR) capsules.
• Ingredients: Provigil is comprised of “modafinil,” which is different from the mixed amphetamine salts (75% dextroamphetamine / 25% levoamphetamine) within Adderall.
• Investigational uses: Provigil has been investigated for the treatment of mood disorders, depersonalization, jet lag, and various sleep-related conditions. Adderall has been investigated mostly for refractory depression and cognitive rehabilitation.
• Legal classification: In the United States, Provigil is classified as a “Schedule IV” substance and Adderall is considered a “Schedule II” controlled-substance.
• Manufacturer: Provigil is manufactured by Cephalon Inc. and Adderall is manufactured by Shire Pharmaceuticals.
• Mechanisms of action: The drugs have similar aspects to their mechanisms of action, but differ in a number of ways. Adderall is primarily regarded as a reuptake inhibitor of dopamine and norepinephrine, whereas Provigil is thought to elicit effects on dopamine, norepinephrine, glutamate, GABA, orexin peptides, and electronic signaling.
• Medical uses: Provigil and Adderall are approved to treat narcolepsy, but differ in other approved uses. Provigil can be prescribed for obstructive sleep apnea and shift work sleep disorder – Adderall cannot.  Adderall can be prescribed for ADHD – Provigil cannot.
• Popularity: Despite the fact that both drugs are relatively popular, Adderall receives more universal recognition than Provigil.
• Side effects: Provigil is believed to carry significantly fewer side effects compared to Adderall.
• Withdrawal: There is no literature suggesting significant discontinuation symptoms associated with Provigil withdrawal. However, there is significant documentation highlighting the tribulations associated with Adderall discontinuation.

Which drug is better? Provigil vs. Adderall.

From the perspective of treating narcolepsy, neither Provigil nor Adderall should be considered superior to the other.  They are both clinically effective substances and have proven themselves as effective treatments.  Some would argue that Provigil is better due to the fact that it tends to have less side effects, has less potential for abuse and dependence, and minimal discontinuation symptoms.

Some users may argue that Adderall is better due to the fact that it stimulates greater increases in dopamine, allowing for increased alertness and cognitive function.  Adderall also is manufactured in more formats and comes with more dosing options than Provigil, making it more appealing to some.  Generally, determining whether one drug is better than the other is largely a matter of individual experimentation.

You will need to work with your doctor or psychiatrist to determine whether you seem to get better results with one substance over the other.  Certain people may enjoy the reduced dopaminergic effect associated with Provigil and find that using Adderall makes them too jittery.  Similarly, others may find that Provigil isn’t potent enough and that Adderall does a better job at improving cognitive function.

Which drug do you prefer: Provigil or Adderall?

If you’ve had the experience of using both Provigil and Adderall, feel free to share a comment below comparing them.  Mention whether you found one to be better than the other for treating a certain condition (e.g. narcolepsy), side effects experienced, and discontinuation difficulties.  Discuss any specific reasons that you may have preferred one drug over the other.