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So... Why Is Nuvigil Preferable?


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#1 sleepwalkingmama

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Posted 26 May 2013 - 10:22 PM

Just curious. I haven't received my official dx yet, but my sleep dr gave me some Nuvigil samples, and I have Adderall from my PCP. In the past, my dx was ADHD, and I was prescribed Adderall. I had to increase my dosage over time, but 30 mg of XR plus 10 of IR in the afternoon (I was falling asleep everyday at 4 pm...hmmm) seemed to do the trick, really with pretty minimal side effects. I took a 250 Nuvigil yesterday and felt kinda edgy and irritable, with a dull headache. Made me want to switch right back to the poison I know. Talk me into giving Nuvigil another shot?

#2 DeathRabbit

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Posted 26 May 2013 - 10:54 PM

Well, it's less habit forming and has less negative impacts on your brain chemistry over time. I was on adderall and the like for about 1.5 years, and it rewired something, I think in just that short treatment period. It's getting a bit better, even months after I stopped it, if I drank any caffeine, it felt like I mainlined crack. 20 oz sodas still do it to me a bit. And energy drinks, which I used to chug before to stay awake, if I have just one, I get a huge rush, and then a stupendous brain foggy crash. Neither sodas, nor energy drinks did anything like that to me before. In fact, it was astounding the lack of effect they had on me. I once chugged a 24 oz monster, then took a 4 hour nap.

 

That's a huge dose of Nuvigil to start with it seems. Maybe get a pill cutter and try taking half a dose in the morning, then the other half around lunch.



#3 exanimo

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Posted 27 May 2013 - 12:08 AM

Basically as DeathRabbit pointed out, it has less severe side affects than traditional stimulants like Aderall. These usually include higher pulse rates, blood pressure etc and sometimes heart palpitations and anxiety.

I also agree with DeathRabbit that starting you on 250 mg is a bit high. I think the two most common dosages are 150 mg and 250 mg. Studies have shown that while taking more than 250 mg is safe, there was no evidence of it working better past that dose. I don't know if it is a controlled release - but if it is than cutting it in half isn't beneficial either.

I know that Provigil (an isomer of mofandil - molelecularly the same but structurally different) gave me the worst headache ever for the first few days. But then it went away and I've since switched to Nuvigil since my insurance covers it.

One thing to remember is that there is no cure and the medications used to treat Narcolepsy are never going to make you normal. So you should expect to still have symptoms. The goal is to improve those symptoms as much as possible and as safely as possible. Also, as there is no cure, you will have to take these medications for an undetermined amount of time, so safety is very much a concern when picking medications and dosages.

If you prefer traditional stimulants, there is nothing wrong with that. Just be sure to educate yourself and to regularly take note of how your medications are affecting you over time. 

Good luck!



#4 MINItron

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Posted 27 May 2013 - 01:03 AM

Some people can't take the Vigils at all just like some people can't take traditional stimulants. I know that Provigil was not that great. Nuvigil works much better for me. I do get the headaches from time to time, right at the back of my neck, but only when it is wearing off. Nuvigil is a much cleaner med. With Ritalin and Provigil I would get headaches all the time as the dose was wearing off. 

 

Nuvigil isn't a control release the half-life is just that long. Provigil is made up of roughly half Nuvigil and half the other enatiomer. The enatiomer that they remove to make Provigil into Nuvigil is shorter acting, and responsible for most of the side effects such as smelly urine. 

 

I will admit that I have not taken the "harder" traditional stimulants. 



#5 NetiNeti

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Posted 03 June 2013 - 08:44 PM

Like everyone else said, it just works better for most people. Ritalin gave me all sorts of crazy behavior changes in the year I was on it and more severe crashes. The first two weeks or so of Nuvigil were rough, but now (and with proper cycling), its pretty awesome and reliable. And I sleep deeply at night. 



#6 sometimes

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Posted 08 June 2013 - 11:53 AM

There is currently a cost benefit when taking Nuvigil instead of Provigil.  Also Nuvigil prescriptions can be called into pharmacies, where other stimulants need an ink and paper Rx.  As someone else pointed out, Nuvigil has less habit forming potential than traditional stimulants.  And also, if your coworkers know, you are apt to experience less prejudice than if you were taking some other medication. 

 

On the other hand, I feel Nuvigil and Provigil are inaccurately portrayed in the media and pop culture.  Nuvigil increases my heart rate more than any other medication.  Also while taking Nuvigil, I have had difficulty with reading.  I would read a paragraph of text, but couldn't make sense out of it. It was like reading a list of random words.



#7 doinmdarndest

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Posted 10 June 2013 - 07:02 AM

I keyed in an article by hand, no link exists for it, from 1956 here because it reflects superior rx'ng practices that we have today for stimulants.  read it, it's right here in 'treatment' 

 

250mg/d nuvigil isn't so much, it took 1000mg/d to have me wakeful-but the stuff gave me severe mental lapses/dehydration.

 

for some it is not the better option.  good question you have there.



#8 tjunderw

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Posted 10 June 2013 - 11:32 AM

I agree with everything posted. Everyone tolerates medications differently but I believe Nuvigil is definitely worth giving another shot. When I started Nuvigil I had headaches and dry mouth but that wore off after a few days. On Adderall I felt manic and my heart raced, but Nuvigil does not give me the jitters or midday crash being a non-stimulant. My pal WebMD says "It is not known how armodafinil works to increase wakefulness. It is thought to work by affecting certain substances in the brain that control the sleep/wake cycle." As a new substance, it's expected that your body would need time to adjust to the Nuvigil which could explain feeling a little irritable and off but you know your body best. I personally prefer Nuvigil and say give it a week, try splitting the pills in half, see how you feel and if it doesn't work for you it doesn't work and you stick to what benefits you. Good luck-and drink lots of water!



#9 chavo2177

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Posted 11 June 2013 - 08:56 AM

Right now i am on Modafinal 200/ in the morning and 200 at noon.. Does not seem to do the trick at all, i even have a energy drink or 2



#10 vidar

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Posted 12 June 2013 - 09:03 PM

Why do we prescribe nuvigil so much?

 

The following is very blunt.  I'm not saying this to sound crass (remember, I'm a patient too), but because it's how the current system works.  I think the more you know about the current system the more educated about it you can be. 

 

 

Definitive Cons:

-It's not because it costs less. On the population level, I'm skeptical if it's cost effective to prescribe it in any other fashion other than step therapy (where you must try X and Y before getting Z, Z being nuvigil).

-It's not because insurance co-pays are less either.

-For Narcolepsy insurance approval of easy but for idiopathic hypersomnia, not so easy (in general).

 

Theoretical Pros:

-Once daily dosing. 

 -Supposedly less addictive (and if one of your patients does miss use it, it's to your legal advantage to them miss use a drug that's supposedly less addictive).  In reality, data from fMRI and PET indicate it's still addictive.  I know many cases where it's been ODed on or with. It's also used as a party hard drug ie binge on alcohol and stay up all night because of it.

-Supposedly it doesn't increase your blood pressure as much and supposedly they are fewer side effects. 

 

Do the theorotical pros reflect the experience on this forum?  Doubtful.  Do you they reflect you experiences? 

 

Reality:

 

1) Some patients have excellent results on it. I suspect that this is based likely on severity of underlying symptoms and genetics. So while not alot have an excellent result (at least among MDs I know and have spoken to on this and numerous patients I've spoken to), enough do that it makes it  worth prescribing first because of number 2...

   

2) Your medical doctor only has to write one prescription every 6 months. Which means he (or his medical assistant) doesn't have to spend 5 minutes looking your information up to verify that he's writing for the correct medication/dose. Multiple  5 minutes times 100 (500minutes, or about 8 hours) every month.  Times 5.  I'd save 40 work hours of paper work 6 months for every 100 patients on the medication. That's 10 work days a year.  One whole year less of paper work over a career.  Don't laugh. Think about, it.  This was one of the main points the reps used to market MDs on this medication last i saw a rep for this drug.   

 

3) It's a schedule III medication.  Less liability prescribing it compared to a schedule II which are what the other stimulant medications are.  In the current legal environment, MDs want to minimize risk.  Being hauled infront of the state board because you messed up your paper work is stressful and costly. And worse can happen.

 

 

In summary: Sometimes it works and when it does there is less paperwork to fill out and less personal legal risk.



#11 MINItron

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Posted 16 June 2013 - 01:16 AM

According to studies that I have read lately the relative addictive potential of medications really isn't that important when you are talking about narcoleptics. The lack of orexin seems to interfere with the formation of addictions. This is why you see so many of us taking amphetamines in fairly large doses for years without experiencing addiction. 

 

Personally I think the most important thing is to find the medication that works best for YOU. There is someone who reports horrible side effects with every single wakefulness promoting agent that they prescribe for Narcolepsy. 



#12 ApparentlyNarcoleptic

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Posted 25 June 2013 - 06:16 PM

MINItron, I couldn't agree more!  I took nuvigil for about two weeks.  The first week I took 75mg, and I found it useless.  I didn't feel awake or alert or really anything, and I was still ready for a nap all the time.  The second week I took 150mg and after a few days I realized I had become manic, extremely anxious, and I was having some trouble breathing.  I called my doctor immediately and we agreed I would stop taking it.  I could actually feel all of my symptoms go away as the medication wore off.  On the flip side, I have read MANY reports of people who have had much success with nuvigil.  For whatever reason, it just wasn't right for me.  So far it is the only daytime medication I have tried.  I look forward to finding something that works for me.  There are a lot of options out there, and it's going to take some trial and error to figure it out.  I'm keeping my hopes up :-)



#13 NetiNeti

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Posted 26 June 2013 - 07:25 AM

I felt that way the first few days too. Then I got headaches. And extreme light sensitivity. 

 

2 weeks later, everything stopped (my body adjusted), now it works fine. The first week or so was the worst though.