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Key takeaways
Armodafinil and modafinil are FDA-approved for treating excessive sleepiness due to narcolepsy, shift work disorder, and obstructive sleep apnea, with similar efficacy but different chemical structures and half-lives.
Both drugs, which require prescriptions, are considered low-risk for abuse as Schedule IV controlled substances and have off-label uses for conditions like cancer-related fatigue and psychiatric disorders.
Common side effects include headache, nausea, and insomnia, with armodafinil possibly having a longer duration of effectiveness and higher plasma concentrations later in the day compared to modafinil.
Insurance typically covers both medications, but costs can vary significantly—discount programs can reduce the price. Patients should consult a doctor for the most appropriate choice based on their health needs and conditions.
You might struggle with extreme sleepiness during the day if you work the night shift. But with proper treatment like armodafinil (Nuvigil) or modafinil (Provigil), you can stay awake and feel more alert. These medications can be prescribed if you’ve been diagnosed with shift work disorder (SWD), narcolepsy, or obstructive sleep apnea (OSA). As wakefulness-promoting agents, armodafinil and modafinil have stimulant-like effects.
While their exact mechanism of action is unknown, armodafinil and modafinil are believed to work in the central nervous system (CNS) and boost dopamine activity in the brain. Their effects may be similar to other stimulants, such as amphetamine (Adderall) and methylphenidate (Concerta). However, they are structurally different from other stimulants.
Both armodafinil and modafinil are Schedule IV drugs that carry a risk of abuse and dependence. They are controlled substances only available with a prescription.
| Main differences between armodafinil and modafinil | ||
|---|---|---|
| Armodafinil | Modafinil | |
| Drug class | Stimulant-like drug
Wakefulness-promoting agent |
Stimulant-like drug
Wakefulness-promoting agent |
| Brand/generic status | Brand and generic versions available | Brand and generic versions available |
| What is the brand name? | Nuvigil | Provigil |
| What form(s) does the drug come in? | Oral tablet | Oral tablet |
| What is the standard dosage? | 150–250 mg once per day | 200 mg once per day |
| How long is the typical treatment? | Long-term or as directed by a physician | Long-term or as directed by a physician |
| Who typically uses the medication? | Adults and young adults 17 years and older | Adults and young adults 17 years and older |
What are the main differences between armodafinil and modafinil?
Armodafinil, sold under the brand name Nuvigil, is a newer drug than modafinil. It was approved in 2007 as the R-enantiomer of modafinil. Enantiomers are molecules that are mirror images of each other—think left and right-handed gloves. In this way, armodafinil has a slightly different chemical structure than modafinil.
Armodafinil may have a longer half-life than modafinil. In some cases, armodafinil may be considered a stronger drug with better wakefulness effects. While both drugs can have similar side effects, some side effects may be more common in one drug versus the other.
Conditions treated by armodafinil and modafinil
Armodafinil and modafinil are prescription drugs that are FDA-approved to treat daytime sleepiness related to narcolepsy, shift work sleep disorder, and obstructive sleep apnea. These medical conditions are characterized by inadequate feelings of rest, which results in excessive sleepiness. Both drugs improve wakefulness in those who struggle with excessive fatigue and sleepiness throughout the day.
Armodafinil and modafinil have also been studied for off-label purposes. Some studies show that modafinil can be an effective treatment option for fatigue that occurs as a result of cancer and cancer treatment. In adults who are actively receiving cancer treatment, modafinil may help offset excessive tiredness from chemotherapy.
Lower doses of modafinil may be effective for treating fatigue symptoms in people with multiple sclerosis. However, most data suggest that it should not be used as a first-line option for this condition.
Other off-label uses include treatment for psychiatric disorders like depression and attention deficit hyperactivity disorder (ADHD). Armodafinil or modafinil may be effective for treating symptoms of these disorders, but they are not recommended as initial treatment options.
| Condition | Armodafinil | Modafinil |
| Narcolepsy | Yes | Yes |
| Shift work disorder | Yes | Yes |
| Obstructive sleep apnea | Yes | Yes |
| Cancer-related fatigue | Off-label | Off-label |
| Multiple sclerosis-related fatigue | Off-label | Off-label |
| Psychiatric disorders such as depression and ADHD | Off-label | Off-label |
Is armodafinil or modafinil more effective?
In a 12-week randomized, double-blind trial, both armodafinil and modafinil improved sleepiness in subjects working the night shift. The results found that armodafinil and modafinil were comparable and had similar safety scores.
In a meta-analysis of over 10 clinical trials comparing armodafinil and modafinil for obstructive sleep apnea, both drugs were found to be similarly effective for treating sleepiness. Patients taking either drug tolerated side effects and experienced improved daytime wakefulness.
Still, those who take armodafinil have higher plasma concentrations later in the day than those who take modafinil. Higher armodafinil levels in the body may result in better wakefulness than modafinil.
While either drug can be used to treat excessive daytime sleepiness, it is best to consult a healthcare provider for medical advice. Currently, no definitive studies say one is more effective than the other.
Coverage and cost comparison of armodafinil vs. modafinil
Armodafinil is usually prescribed as a 250 mg tablet taken once daily. It is widely available as a generic medication covered by Medicare and insurance plans. Generic Nuvigil can cost an average of over $600. However, this price may be lowered with a SingleCare discount card.
Depending on your insurance plan, modafinil may be covered. In fact, Medicare and most insurance plans cover modafinil for approved purposes. The average cost of modafinil may be over $900. At participating pharmacies, you may be able to use a SingleCare savings card for modafinil to save money.
| Armodafinil | Modafinil | |
| Typically covered by insurance? | Yes | Yes |
| Typically covered by Medicare? | Yes | Yes |
| Standard dosage | 150 mg (30 tablets) | 200 mg (30 tablets) |
| Typical Medicare copay | Varies | Varies |
| SingleCare cost | $30 | $23 |
Common side effects of armodafinil vs. modafinil
The most common side effects of modafinil and armodafinil include headache, nausea, dizziness, and insomnia. Modafinil may be more likely to cause other side effects, such as nervousness, nasal congestion (rhinitis), diarrhea, and back pain.
Both medications can also cause dry mouth, indigestion (dyspepsia), and anxiety. Side effects related to weight loss can also occur. Some people who take armodafinil or modafinil may experience decreased appetite.
Other rare but serious side effects include allergic reactions such as rash and shortness of breath. Psychiatric side effects such as depression or psychosis are also possible. Seek medical attention if you experience these side effects.
| Armodafinil | Modafinil | |||
| Side Effect | Applicable? | Frequency | Applicable? | Frequency |
| Headache | Yes | 17% | Yes | 34% |
| Nausea | Yes | 7% | Yes | 11% |
| Nervousness | Yes | 1% | Yes | 7% |
| Insomnia | Yes | 5% | Yes | 5% |
| Dizziness | Yes | 5% | Yes | 5% |
| Diarrhea | Yes | 4% | Yes | 6% |
| Back pain | No | – | Yes | 6% |
| Nasal congestion | No | – | Yes | 7% |
| Indigestion | Yes | 2% | Yes | 5% |
| Dry mouth | Yes | 4% | Yes | 4% |
| Anxiety | Yes | 4% | Yes | 5% |
| Decreased appetite | Yes | 1% | Yes | 4% |
This may not be a complete list. Consult your healthcare provider or pharmacist for possible side effects.
Source: DailyMed (armodafinil), DailyMed (modafinil)
Drug interactions of armodafinil vs. modafinil
Armodafinil and modafinil share many of the same drug interactions. These medications may affect how many drugs are metabolized or processed in the body. As a result, they can decrease the effectiveness of other medications or increase their side effects.
Armodafinil and modafinil may reduce the effectiveness of steroidal contraceptives. Alternative methods of contraception are recommended during treatment with armodafinil or modafinil and for one month after discontinuation of these drugs.
Armodafinil and modafinil may increase the clearance of cyclosporine from the body. Therefore, taking armodafinil or modafinil with cyclosporine may decrease its effectiveness.
Armodafinil and modafinil may also increase the levels of certain drugs, including Prilosec (omeprazole), Valium (diazepam), and Dilantin (phenytoin). Increased drug levels may lead to adverse effects.
| Drug | Drug Class | Armodafinil | Modafinil |
| Estinyl (ethinyl estradiol)
Aygestin (norethindrone) |
Steroidal contraceptive | Yes | Yes |
| Neoral (cyclosporine) | Immunosuppressant | Yes | Yes |
| Dilantin (phenytoin) | Anticonvulsant | Yes | Yes |
| Valium (diazepam) | Benzodiazepine | Yes | Yes |
| Inderal (propranolol) | Beta blocker | Yes | Yes |
| Prilosec (omeprazole) | Proton pump inhibitor (PPI) | Yes | Yes |
| Anafranil (clomipramine) | Tricyclic antidepressant (TCA) | Yes | Yes |
This may not be a complete list of all possible drug interactions. Consult a healthcare provider about all the medications you may be taking.
Warnings of armodafinil and modafinil
Both armodafinil and modafinil can cause serious rash. In cases of severe rash, these drugs should be discontinued immediately.
Doses of armodafinil or modafinil may need to be adjusted to improve sleepiness during the day. While optimizing doses, persistent sleepiness can still occur. Therefore, it’s important to avoid driving or participating in dangerous activities when first starting a drug like armodafinil or modafinil.
Armodafinil and modafinil may cause psychiatric symptoms, especially in those with a history of psychosis, depression, or mania. These medications should be monitored or even discontinued in severe cases of psychiatric effects.
Stimulant-like drugs may cause adverse effects on the heart and cardiovascular system. Those with high blood pressure may need to be monitored when first starting armodafinil or modafinil. Consult a healthcare provider if you experience chest pain, shortness of breath, or palpitations (pounding heartbeat).
Frequently asked questions about armodafinil vs. modafinil
Are armodafinil and modafinil the same?
Armodafinil and modafinil contain similar ingredients, but they are not the same. Armodafinil contains the R-enantiomer of modafinil, while modafinil contains a racemic mixture of R- and S-modafinil.
Is armodafinil or modafinil better?
Armodafinil and modafinil are similar in effectiveness, tolerability, and safety. However, armodafinil may have higher levels in the body over the course of the day, so its effects may last longer than those of modafinil.
Can I use armodafinil or modafinil while pregnant?
No. The use of modafinil or armodafinil is not usually recommended during pregnancy. Discuss your treatment options with a healthcare provider if you are pregnant or breastfeeding.
Can I use armodafinil or modafinil with alcohol?
It is not recommended to take armodafinil or modafinil while drinking alcohol. Drinking alcohol while on armodafinil or modafinil may increase the risk of adverse effects, such as dizziness, headache, and nausea.
Can you take armodafinil and modafinil together?
Armodafinil and modafinil should not be taken together as they contain similar active ingredients. Combining them may increase the risk of adverse effects.
Sources
- Nuvigil highlights of prescribing information, U.S. Food and Drug Administration (2017)
- Pharmacokinetics of armodafinil and modafinil after single and multiple doses in patients with excessive sleepiness associated with treated obstructive sleep apnea: a randomized, open-label, crossover study, Clinical Therapeutics (2010)
- A phase 3 randomized, placebo-controlled, double-blind, clinical trial of the effect of modafinil on cancer-related fatigue among 631 patients receiving chemotherapy: a University of Rochester Cancer Center Community Clinical Oncology Program Research base study, Cancer (2010)
- Modafinil in treatment of fatigue in multiple sclerosis. Results of an open-label study, Journal of Neurology (2002)
- Modafinil in the treatment of depression, Ugeskrift for Læger (2012)
- Armodafinil versus modafinil in patients of excessive sleepiness associated with shift work sleep disorder: A randomized double blind multicentric clinical trial, Neurology Research International (2011)
- Effects of modafinil and armodafinil in patients with obstructive sleep apnea: A meta-analysis of randomized controlled trials, Clinical Therapeutics (2016)
- Armodafinil and modafinil have substantially different pharmacokinetic profiles despite having the same terminal half-lives: analysis of data from three randomized, single-dose, pharmacokinetic studies, Clinical Drug Investigation (2009)
- Modafinil-induced psychosis: A case report, Archives of Neuropsychiatry (2015)
- How stimulants may affect your heart, Harvard Health (2022)