Modafinil & Shift-Work Disorder: Medical Guide

Modafinil is a drug belonging to the group of nootropics and it exerts psychostimulant and wake-promoting effects. It is used to treat excessive sleepiness associated with shift-work disorder.

What Is Shift-Work Disorder?

Shift-work disorder is a sleep disorder that is characterized by excessive sleepiness most commonly in people who work at night. Across the world, millions of people work in night shifts. There is not a lot of official data, but according to one Princeton University study, between 7 and 15 percent of the workforce in industrialized countries is involved in some sort of night work, despite evidence of its harmful effects on health.

The World Health Organization (WHO) classified shift-work disorder as a possible cause of cancer. Cancer is one of the long-term consequences of shift-work disorder, but the lack of sleep causes acute consequences as well. The fatigue is the most common, which is why your brain cannot receive and process information in the right way, thus leading to lethargy.

Patients with shift-work disorders may also develop heart problems that are caused by continuous work that is in contrast to one’s biological rhythm. Shift-work disorder also cause hormone imbalance, thus leading to increased consumption of carbohydrates by 35-40%. Patients with this disorder have higher risk of cardiovascular disease and metabolic disorders, such as diabetes.

Use of Modafinil in the Treatment of Shift-Work Disorder

Many clinical studies showed that promoting wakefulness with nootropics significantly improved night-time alertness in people who work at night. Modafinil, and its derivative called Armodafinil, are one of the most important drugs from the class of nootropics. Unlike analeptics (such as Amphetamine), Modafinil has much lower potential for abuse.

Modafinil works by increasing the release of monoamines (such as Noradrenaline) and histamine in hypothalamus. Increased release of histamine in hypothalamus is considered to be the main reason why Modafinil has lower abuse potential than amphetamine.

Clinical studies have also demonstrated that Modafinil prevents memory impairment that occurs due to the sleep deprivation. It has been proved that Modafinil may exert benefits in patients with HIV, Parkinson’s disease and multiple sclerosis.

In the article published in Industrial Psychiatry Journal, Dilip Gude states that Modafinil may significantly decrease the risk of morbidity and complications of shift-work disorder.

In one placebo-controlled clinical trial conducted in the USA on a total of 32 patients between the ages of 18-55 years, it was demonstrated that Modafinil improves vigilance, alertness and neurobehavioral performance during night shifts.

A double-blind, three-month, randomized clinical trial was conducted on 209 patients suffering from shift-work disorder. These patients were divided into two groups. One group was taking 200mg of Modafinil and another group was taking placebo one hour before the start of each shift. Effects were measured with the Multiple Sleep Latency Test. This study demonstrated that Modafinil significantly reduces excessive sleepiness associated with shift-work disorder and significantly improves performance in night shifts in comparison with placebo. It has been also shown that Modafinil does not affect daytime sleep negatively as was the case in placebo group.

The recommended dose of Modafinil in the treatment of shift-work disorder is 200mg, one hour prior shift. You should swallow the tablet whole, with sufficient amounts of water. You can take the tablet regardless of meals.

Use of Modafinil during Pregnancy and Breastfeeding

Generally, pregnant women should avoid working night shifts as it may adversely affect fetus. Clinical trials showed that use of Modafinil during pregnancy may cause growth retardation and spontaneous abortion. Therefore, this smart drug should be used during pregnancy only if benefits to the mother outweigh the risk to the fetus.

There are no data on whether Modafinil is excreted in breast milk. Due to possible adverse effects on infants, use of this medicine should be avoided during breastfeeding.

Adverse Effects of Modafinil

The FDA states that safety of Modafinil has been evaluated on more than 3500 patients and that this evaluation showed that it is generally well tolerated and most of its adverse effects are mild and transient.

Most frequent side effects of Modafinil include nausea, headache, rhinitis, diarrhea, digestion problems, insomnia, anxiety, and nervousness. These adverse reactions occur in more than 5% of patients taking the nootropic. Approximately 8% of patients taking Modafinil had to discontinue its use due to adverse effects.

In addition, Modafinil may also cause following side effects:

• Dry mouth
• Constipation
• Flatulence
• Excessive thirst
• Eosinophilia
• Paresthesia
• Nosebleeds
• Pharyngitis
• Lung Disorder
• Excessive sweating
• Presence of blood in urine
• Lazy eye
• Eye pain
• Vertigo
• Emotional liability
• Tremor
• Taste disturbances
• Flu-like symptoms
• Chills

You should call your doctor at once if you notice any of these side effects.

Modafinil and Other Drugs

There are 75 major and 243 moderate interactions of Modafinil with other drugs. That’s why it is very important that you inform your doctor about all medicines you are taking prior starting Modafinil.

Modafinil should not be used concomitantly with following medicines:

• Opioid analgesics, such as Oxycodone, Hydrocodone, Fentanyl, Butorphanol, Alfentanil, and others. Modafinil reduces blood concentrations of these drugs making them less effective.
• Axitinib – a drug used to treat breast cancer. Taking Axatinib concomitantly with Modafinil may decrease efficacy of Axatinib in treating breast cancer.
• Bosutinib – a drug used to treat leukemia. Modafinil reduces efficacy of Bosutinib in treating leukemia.
• Citalopram – a selective serotonin reuptake inhibitor used to treat depression, anxiety and social phobia. The concomitant use may lead to increased levels of this drug in the blood, thus leading to increased incidence of adverse effects.
• Guanfacine – a drug used to treat high blood pressure (hypertension).
• Sofosbuvir – a drug used to treat hepatitis C. The concomitant use reduces antiviral effects of this medicine making it less effective in treating hepatitis C.
• Tenofovir – a drug used to treat HIV. The concomitant use reduces blood levels of this drug, making it less effective in treating HIV.

Please note that you should also inform your doctor about herbal products you’re taking, as some of them may interact with Modafinil.