Provigil vs. Adderall: Differences, similarities, and which is better for you

Drug overview & main differences | Conditions treated | Efficacy | Insurance coverage and cost comparison | Side effects | Drug interactions | Warnings | FAQ

Provigil and Adderall are two prescription medications used in the treatment of narcolepsy as well as other disorders. Narcolepsy is a chronic neurological sleep disorder that affects the brain’s ability to control your sleep and wake cycles. This can lead to frequently interrupted sleep at night and therefore excessive daytime drowsiness. It is estimated that as many as 200,000 people in the United States have narcolepsy. Narcolepsy can affect daily activities and the safety of others, as someone who suffers from narcolepsy may be excessively tired while driving or operating equipment. Provigil and Adderall are both approved in the treatment of narcolepsy but are not the same type of drug, and we will discuss their differences.

What are the main differences between Provigil and Adderall?

Provigil (modafinil) is a prescription drug that promotes wakefulness but is different from other traditional central nervous system (CNS) stimulants such as Adderall. The mechanism of action by which Provigil promotes wakefulness is not completely understood, though it is thought to be done by actions in specific regions of the brain. While other CNS stimulants seem to work through mechanisms involving dopamine or sympathomimetic pathways, Provigil does not appear to affect these pathways.

Provigil is available in oral tablets in strengths of 100 mg and 200 mg. Provigil is considered a schedule IV controlled substance by the Drug Enforcement Agency (DEA). Provigil should be used cautiously in patients with a history of drug abuse.

Adderall is a combination of amphetamine salts, containing a 3 to 1 ratio of dextroamphetamine (d-amphetamine) and levoamphetamine (l-amphetamine). It is a prescription drug used in the treatment of narcolepsy and, more commonly, attention deficit hyperactivity disorder (ADHD).

Other CNS stimulants you may be familiar with include Ritalin, Focalin, and Vyvanse. Adderall immediate-release oral tablets are available in strengths of 5 mg, 7.5 mg, 10 mg, 12.5 mg, 15 mg, 20 mg, and 30 mg. Adderall XR is an extended-release capsule formulation and is available in strengths of 5 mg, 10 mg, 15 mg, 20 mg, 25 mg, and 30 mg.

The DEA deems Adderall a schedule II narcotic drug. Due to the fact that Adderall is habit-forming and has a high potential for abuse, there are restrictions and guidelines for obtaining this drug, which vary by state. Adderall should be used cautiously in patients with a history of drug abuse.

Main differences between Provigil and Adderall
	Provigil	Adderall
Drug class	Wakefulness-promoting stimulant (psychostimulant)	Central nervous stimulant
Brand/generic status	Brand and generic available	Brand and generic available
What is the generic name?	Modafinil	Amphetamine salts (d-amphetamine and l-amphetamine)
What form(s) does the drug come in?	Oral tablets	Oral tablets and extended-release capsules
What is the standard dosage?	200 mg once daily	5 mg once or twice daily titrated up to 60 mg/day
How long is the typical treatment?	Long-term (indefinite)	Long-term (indefinite)
Who typically uses the medication?	Adolescents 17 years of age and older; adults	Children and adolescents 3 years of age and older; adults

Conditions treated by Provigil and Adderall

Provigil and Adderall are both approved by the Food and Drug Administration (FDA) in the treatment of narcolepsy, but each drug has other indications as well. Adderall is most commonly prescribed for its indication to treat ADHD. Provigil has been used off-label in the treatment of ADHD. Off-label use is the use of a medication for an indication that has not been approved by the Food and Drug Administration (FDA). Provigil is approved in other sleep-related disorders as well, including shift work disorder and sleep apnea.

Condition	Provigil	Adderall
Narcolepsy	Yes	Yes
Attention hyperactivity deficit disorder (ADHD)	Off-label	Yes
Shift work sleep disorder	Yes	No
Obstructive sleep apnea	Yes	No
Fatigue	Off-label	No

Is Provigil or Adderall more effective?

The American Academy of Sleep Medicine published standard practice guidelines, which include both Provigil and Adderall as effective agents in the treatment of narcolepsy and excessive sleepiness. Both medications have the potential to be habit-forming, but the narcotic status of Adderall indicates its potential for habit formation and abuse is more prevalent. Modafinil has been shown to have a low incidence of adverse events and is well-tolerated with less potential for abuse as compared to other CNS stimulants. For these reasons, it is typically considered a first-line treatment for narcolepsy.

Only your healthcare provider can diagnose narcolepsy and decide which treatment is best for you.

Coverage and cost comparison of Provigil vs. Adderall

Provigil is a prescription medication that is typically covered by commercial insurance. Coverage by Medicare plans may vary or require special exceptions to be made. Provigil can cost more than $950 out-of-pocket, but with a coupon from SingleCare, you could get a 30-day supply of the generic for less than $60.

Adderall is a prescription medication that is typically covered by commercial insurance. Coverage by Medicare plans also may vary or require special exceptions to be made. The out-of-pocket price for Adderall can be more than $300. With a SingleCare you can purchase the generic form for substantially less. Just present a SingleCare Adderall coupon at select pharmacies and ask for the generic.

	Provigil	Adderall
Typically covered by insurance?	Yes	Yes
Typically covered by Medicare Part D?	No	No
Standard dosage	30, 200 mg tablets	60, 30 mg tablets
Typical Medicare copay	n/a	n/a
SingleCare cost	$60-$270	Check price with pharmacist

Common side effects of Provigil vs. Adderall

While Provigil and Adderall do cause some similar adverse events, data on the prevalence of side effects from Adderall is unavailable in the package insert. Both drugs are known to cause serious side effects such as hypertension (high blood pressure) and tachycardia (increased heart rate). Provigil and Adderall are both known to cause a loss of appetite as well.

Provigil may cause headaches and nausea in a significant number of patients. These side effects can affect daily living and productivity, and if they are bothersome and persistent, you should speak with your provider to discuss alternatives. Do not suddenly stop taking these drugs without your provider’s knowledge as you may experience withdrawal symptoms.

The following list is not intended to be an all-inclusive list of potential side effects. You should consult your healthcare provider for a full list of side effects.

	Provigil		Adderall
Side effect	Applicable?	Frequency	Applicable?	Frequency
Headache	Yes	34%	No	n/a
Nausea	Yes	11%	No	n/a
Nervousness	Yes	7%	No	n/a
Anxiety	Yes	5%	No	n/a
Chest pain	Yes	3%	No	n/a
High blood pressure	Yes	3%	Yes	Not defined
Tachycardia	Yes	2%	Yes	Not defined
Palpitation	Yes	2%	Yes	Not defined
Insomnia	Yes	5%	Yes	Not defined
Loss of appetite	Yes	4%	Yes	Not defined
Vomiting	No	n/a	Yes	Not defined
Weight loss	No	n/a	Yes	Not defined
Dry mouth	Yes	4%	Yes	Not defined
Dizziness	Yes	5%	Yes	Not defined

Source: Provigil (DailyMed) Adderall (DailyMed)

Drug interactions of Provigil vs. Adderall

Adderall should be avoided in combination with monoamine oxidase inhibitors (MAOIs) such as selegiline and Linezolid. MAO inhibitors slow amphetamine metabolism, increasing the amphetamine’s effect on the release of norepinephrine and other monoamines from the nerve endings causing headaches and other signs of hypertensive crisis. While it is unknown if Provigil has the same effect when given with MAOIs, it is recommended to avoid this combination as well.

Serotonergic drugs combined with Adderall may increase the incidence of serotonin syndrome. This syndrome can result in the patient feeling agitated, dizzy, and having an increased heart rate. Common antidepressants such as selective serotonin reuptake inhibitors and selective norepinephrine reuptake inhibitors have serotonergic activity and should be used cautiously in combination with Adderall.

The following table does not list every possible drug interaction for Provigil and Adderall. Consult your pharmacist or doctor for a complete list and professional medical advice.

Drug	Drug class	Provigil	Adderall
Selegiline Isocarboxazid Phenelzine Linezolid	Monoamine oxidase inhibitors (MAOIs)	Yes	Yes
Fluoxetine Paroxetine Sertraline Citalopram Escitalopram	Selective serotonin reuptake inhibitors (SSRIs)	Yes	Yes
Venlafaxine Duloxetine Desvenlafaxine	Selective norepinephrine reuptake inhibitors (SNRIs)	No	Yes
Sodium bicarbonate Sodium lactate	Antacid	No	Yes
St. John’s Wort	Supplement	Yes	Yes
Topiramate	Antiepileptic	No	Yes
Tramadol	Opioid pain reliever	No	Yes
Sumatriptan Rizatriptan Eletriptan Zolmitriptan Naratriptan Frovatriptan	5HT3 Antagonists (Triptans)	No	Yes
Desipramine Protriptyline Amitriptyline Nortriptyline	Tricyclic antidepressants	No	Yes
Omeprazole Esomeprazole Pantoprazole Rabeprazole Lansoprazole	Proton pump inhibitors (PPI)	No	Yes

Warnings of Provigil and Adderall

Provigil and Adderall have each been associated with an increase in cardiac events such as chest pain and palpitations. Adderall has been linked to an increase in strokes and myocardial infarctions. These may be more likely to occur in patients with pre-existing cardiac conditions. Prescribers should screen for these conditions and use extreme caution in prescribing these drugs for patients who may have cardiac abnormalities.

Provigil and Adderall have been associated with moderate increases in blood pressure and heart rate. These parameters should be monitored when patients take stimulants.

Provigil and Adderall can exacerbate behavior disturbances in patients with pre-existing psychiatric disorders. These patients should be monitored closely if stimulants are necessary. Patients with a significant psychiatric history may be more at risk.

Long term use of Adderall in children and adolescents has been linked to growth suppression. Patients experiencing slow growth while on stimulants may be encouraged to temporarily pause treatment. Oftentimes, healthcare providers recommend taking breaks from treatment when children are not in school, such as on weekends, holidays, and summer breaks.

There have been cases of Provigil and Adderall abuse in college students. They may take the drugs, sometimes over the recommended dosages, to increase wakefulness for the purposes of studying and longer hours of productivity.

Provigil has been linked to incidences of Stevens-Johnson syndrome (SJS). SJS is a type of severe skin reaction where the skin blisters and peels leaving painful, raw areas on the skin. This can lead to other serious infections, including sepsis.

If you have experienced allergic reactions to Provigil, Adderall, or similar drugs, you should not take them.

Frequently asked questions about Provigil vs. Adderall

What is Provigil?

Provigil is a prescription medication that promotes wakefulness and is used to treat narcolepsy. It is considered a controlled substance by the DEA. Provigil is available as an oral tablet in two strengths, 100 mg, and 200 mg.

What is Adderall?

Adderall is a CNS stimulant used in the treatment of narcolepsy and ADHD. It is considered a schedule II narcotic by the DEA due to its abuse potential and is available by prescription only. Adderall is available in a variety of strengths in both immediate-release tablets and extended-release capsules.

Are Provigil and Adderall the same?

Provigil and Adderall each treat narcolepsy, but they are not the same. Provigil’s mechanism is not fully understood, but Adderall is known to work in pathways of the central nervous system. Adderall is considered more addictive with a higher potential for abuse than Provigil.

Is Provigil or Adderall better?

Provigil and Adderall are both effective treatment options for narcolepsy. Provigil is generally regarded as a first-line treatment for narcolepsy due to it having a better tolerability profile.

Can I use Provigil or Adderall while pregnant?

Provigil and Adderall are pregnancy category C, meaning there are no adequate, controlled studies to establish safety. These drugs should only be used in pregnancy when the benefit clearly outweighs the risk.

Can I use Provigil or Adderall with alcohol?

Patients on Provigil and Adderall should limit their intake of alcohol. Specifically, alcohol can increase the serum blood concentrations of Adderall, and therefore significant alcohol consumption should be avoided.

Is Provigil a controlled substance?

Provigil is considered a schedule IV controlled substance by the Drug Enforcement Agency (DEA) due to its potential to be habit-forming. It should be used cautiously in patients with a history of substance abuse.

Does Provigil help you focus?

Provigil helps regulate the sleep-wake cycle, leading to a more alert and productive wake cycle and better sleep. It is used off-label in the treatment of ADHD.

Can you take modafinil every day?

Provigil is a controlled substance and can be habit-forming. Patients who must be on it long term should be monitored closely for signs of dependence or abuse.