Providing my experience for the following:
- Brand Quality
- Effects and Side-Effects
- Tolerance/Addiction/Withdrawl
- Adverse Skin Reactions
- Recreational Use/Tips
- Off-Label Treatment of Disease-Related Fatigue and Somnolence
Drug Quality By Brand
I have taken both legitimate Canadian modafinil (Alertec, 100mg) obtained via prescription, and Indian Ar/Modafinil (Sun Pharma Modalert 100mg, Waklert150) obtained via other means. Modalert results were inconclusive as shown below. In comparison to Alertec brand, Waklert feels "dirty", contaminated, or otherwise sub-par. It reliably produces more side-effects and less positive effects, limiting its potential for recreational use. This difference is present over long term use of a single brand (1 month) before switching, as well as when alternating brands daily. It should be noted that Waklert150 is Armodafinil, not Modafinil.
Sun Pharma pills were received in unopened blister packs of 10, Waklert manufactured in 08/2011 with an expiry date of 07/2013. Alertec pills were dispensed by a local pharmacy in Canada and later friend-sourced as necessary to continue the study.
Effects
It should be noted that I have Ehlers-Danlos Syndrome, Postural Orthostatic Tachycardia Syndrome, low DHEA-S (5.3ng/ml, reference range 10-23), and high testosterone (156pg/ml and non-athletic, reference range 44-148). This may or may not affect my experience of modafinil as compared to a control.
Alertec (Effective dose 300mg-400mg, Continued for 1 Month)
- +Sustained wakefulness, ~8 hours
- +Significantly increased mental stamina
- +Increased focus on task
- +Desire to take up a new hobby or activity.
- +Reduced overall sleep time needed.
- ~Ability to sleep 2 hours after dose: Extremely difficult.
- -Increased stomach acid, regular indigestion. Problematic if not sitting upright.
- -Pressure headache, dose-dependant in severity. Begins faintly at 300mg, blocks all productivity at 600mg.
Dosing prior to sleep: 200mg
- +Incredibly restful sleep in 2 hours.
- +Suitable for polyphasic sleep or daytime naps
- ~Feeling of having slept for 15+ hours.
- ~Constant, disjointed dreams.
- -Incessant awakenings / every 10 minutes.
Waklert (Effective dose 150mg, Taken in morning, Continued for 4 Months+)
- +Sustained wakefulness, ~12 hours with little difficulty
- +Slightly increased mental stamina
- +Reduced overall sleep time needed.
- ~Ability to sleep 2 hours after dose: Requires calmer surroundings than usual.
- -Slight headache, pain type.
- -Sensation of fever, but low measured body temperature.
- -Dry mouth, sore throat
- -Loss of appetite.
- -Nausia, slight.
Dosing prior to sleep: 75mg, 150mg
- No perceived effect on sleep.
Additional, Faded Side-Effects
- —Intermittent double-vision / visual distortion.
- -Intermittent Vertigo
- -Sensitivity to light, sound.
- ~Changes in taste. Not for better or worse, but a different taste altogether.
- -Dizziness
- -Nausia, moderate.
- -Neck stiffness.
- -Inability to focus on tasks - Forgetting what the task was, not racing thoughts.
Modalert
Single doses of 200, 400, 600mg did nothing but cause nausia and a general feeling of unwell. I also tried 800mg but threw up the pills shortly afterwards. That was all the pills I had.
It is very possible that these pills were not actually Modalert due to their source and lack of any positive effects, and as such these results can be discarded.
Adrafinil
For purposes of comparison, the prodrug Adrafinil as Olmifon had a calming, sedative effect at 600mg and headache with nausia at 1200mg. No effects were experienced below 600mg. Due to liver toxicity concerns, especially at such doses, further testing was not completed.
Tolerance and Addiction/Withdrawl
Tolerance seems to vary significantly between individuals. I have not experienced any withdrawl symptoms, and addiction is comparable to Starbucks.
After 3 months of daily use, all effects of Waklert have faded slightly. This includes negative effects, as well as the duration of effect, which may support the theory of long-term tolerance being caused by changes to liver enzyme concentrations affecting the metabolism of modafinil. Most importantly, sustained daytime wakefulness remains, but may best be described as sustained "not being asleep". It continues to be effective enough for my uses, but I do not believe it would be effective against sleep deprivation at this point. Following abstinence, the effect of reduced sleep need as well as a reduced daytime wakefulness continues for an additional day. This effect is drastically reduced on the second day without the drug, and eliminated on the third. Abstinence for a full week from last dose, followed by a re-dose, provides limited, increasing effect until the third day of re-dosing. This suggests an effective CMax is reached within 2-3 days, as well as eliminated in the same time frame following chronic use. The effects at this point appear to be the same as those experienced a week prior, suggesting that tolerance is influenced by a medium- or long-term process.
One study concludes "steady state appeared to be reached within 7 days", therefore a longer abstinence period may be required for adequate comparison.
Adverse Skin Reactions
Waklert produced spots in mouth during the first week of 150mg daily.
- Day 5 - Small, flat, white discolourations, 3-4 in total, spread out within 1” on the right inner cheek. With no change in dosing, these were observed regularly over the course of a couple days and appeared to disappear.
- Day 8 - Two mouth ulcers have formed, also on the right inner cheek.
- Day 9 - Ulcers have grown to approximately 1cm each, and a new ulcer formed on the right inner lip.
- Day 11 - Lip-ulcer has grown and merged with one cheek-ulcer to create a 1” square-shaped ulcer, while the other ulcer has not changed in size. Over the course of the next few days, one ulcer was discovered at the back of the throat (too high to cause pain during eating).
- Day 14 - Ulcer discovered in the left nostril. Medication stopped.
- Specific dates were not recorded after this point.
Ulcers did not appear to change in size, however the large 1” ulcer appeared to be causing significant damage to the tissue as it was forming a noticeable indentation. High-dose curcumin formulation (oil, phosphatidylcholine, curcumin extract) was taken orally at approximately 3g/day, as well as some applied directly to the 1” ulcer. [See note] All ulcers soon retreated, showing only a slight indentation caused by the lone cheek ulcer and a pit accented by discoloured black ridges left by the large ulcer. Curcumin supplementation was dropped to 1g/day, and Waklert restarted as the cheek healed. Within a week all damage appeared to be fully healed.
Concomitant use of both drugs from that point onwards has not produced ulcers. Later discontinuation of curcumin for one month ended with the formation of 6 new mouth ulcers, each approximately 1cm in diameter.
[Systemic corticosteroids are a possible treatment option. The efficacy of curcumin is comparable to corticosteroid therapy, but without need of a prescription.]
Please be aware that treating a drug reaction with the intent to continue using that drug is not entirely safe, and may act to cover up serious internal damage taking place.
Recreational Use/Tips
- Modafinil is unlikely to completely remove the feeling of being tired once it has already taken hold, but it is excellent for extending the time before you feel any worse. Therefore, modafinil should be taken 1-2 hours prior to when you expect to feel tired for the most efficient overnight recreational use. This can be stacked in order to stay awake for long timeframes, but with decreasing benefits and increasing difficulty of prediction. If modafinil normally provides you with 12 hours of wakefulness prior to feeling tired, taking an additional dose (timed to take effect as the first dose wears off) may only provide you with an additional 10 hours, followed by 8, and so on. If you should miscalculate and take a dose too late, allowing yourself to feel tired for some time, benefits of further doses decrease rapidly. If you take a dose too early, you may experience side-effects similar to taking double your usual dose, likely ruining your experience with a massive headache. However, with some experience, planning, and luck, you can stay awake and relatively alert for multiple days with almost no effort. This use is likely to significantly reduce sleep quality immediately afterwards, but with less fatigue than would be expected from only 1~3 hours of sleep. Leading into the next point,
- It can also be used to improve one's ability to wake up with less exhaustion on the following day after taking it. An excellent example of this is taking modafinil early in the day of a late-night event in order to function the next day at work/school with only 2-3 hours of sleep. It could be taken the morning after instead of the day before, but that usually compounds any nausia you may be experiencing.
- Modafinil can affect one's sense of intoxication, which may not be noticed by your companions. It nearly doubles my perceived alcohol tolerance with no indication apart from the number of empty glasses on the table. This can lead to poisoning if careless. Do not drink any more than you normally would, even if you do not feel or act drunk. The same goes for other drugs, especially if the quality of those drugs varies.
- It should go without saying, but try not to combine modafinil with a dopamine reuptake inhibitor, MAOI, or anything else acting on dopamine. If necessary, be extremely careful. 1mg sublingual liquid selegiline (mao-b inhibitor) with 25mg modafinil (1/12 my standalone dose) caused significant tremor and moderate panic, something I don't wish to experience again.
- If using daily, allow up to 2 weeks to become accustomed to the drug. Apart from two unexpected moments of slight euphoria, I was somewhat disappointed until 9 or 10 days in, which is when reduced sleep needs and increased mental stamina became evident.
- Prior to use, be aware of any unique features of your body such as moles, dry skin areas, etc. Observe for changes until about 2 weeks after your last dose. Real drug rashes are extremely rare, but dangerous, with a high mortality rate. For most, aggravation of pre-existing allergies is more likely (but also serious if left unattended). Perhaps more dangerous is not being aware of your body, then later discovering something you think is new but has actually been there forever.
Off-Label Treatment of Disease-Related Fatigue and Somnolence
I use modafinil for enhanced productivity, simply due to being awake for a normal amount of time. Without modafinil I would wake up after 12-16+ hours of sleep and make it no longer than 8 hours before sleeping again. If I actually did something during that time such as wash clothes, I could barely get everything into the washer without needing to lie down. A great inconvenience for sure, but not the source of my misery. Every time I did lie down, I would fall asleep for hours. After every shower I would sleep on the bathroom floor for about 2 hours. When cleaning a room the priority would always be something I could lie down on, because I would be there in about 10 minutes, and fast asleep. This shortens each day considerably. Even in the best case scenario of having no “chores” to do, a shower and dinner cuts off another 4 hours, leaving me with just 4 hours before I had to sleep again.
Try to imagine being awake for only 4 hours every day. What could you do in that time? If something involves standing for more than 10 minutes, subtract 2 hours. If it involves moderate exercise, that’s all you’re doing today.
I could function like that on a basic level. I tried to limit myself to one room to reduce cleaning needs. With careful planning I spaced out my use of cookware and dishes to reduce the time lost. The rest of the time was spent getting groceries and then recovering from that. But life is never that simple.
People expect you to be as you appear. Normal. Someone in his early twenties is supposed to go out and party all the time, spend time with friends and family, and still be ready to do something at a moment’s notice. All while working full-time or going to school. They look at you and see that you don’t look sick. Maybe a little tired, but not sick. Your family mistakes your exhaustion for boredom, happily suggesting to do something exciting and then feeling distanced and unloved when you turn them down. Your friends think at best you’re boring, at worst you think you’re better than them. So it comes to a simple decision. One that can result in significant regret, hardship and stress. Do you push everyone around you away so that you can keep functioning the way you have been, or do you try to hold those relationships together at your own expense? I chose the latter. I did just enough to keep contact. I went to special events and celebrated birthdays, had weekly lunch with my grandparents, left the instant messenger on all day and kept the phone next to me to stay in contact with everyone else. And every time I did something, it set me back. Everything in my life suffered to keep these relationships afloat. I couldn’t think clearly enough to remember what I did 5 minutes prior. Priorities shifted considerably and I only did what I deemed to be absolutely necessary. I didn’t clean for months at a time, and I didn’t shower or change clothes unless I had to go out. Often I wouldn’t eat because I didn’t have time nor energy to make anything, and when I did, the dishes were never clean. Sanitation held a lower priority than sustenance. I was exhausted nearly every waking moment of my life. But I looked fine.
It was obvious this was a problem to me. So what did the many doctors have to say? Lead a less stressful life. Eat Better. Nothing’s wrong. You have an anxiety disorder. Take a B-Complex. You’re already taking a B-Complex? Take it for another month. You’re depressed. And finally, perhaps ironically the most helpful answer of all, “I don’t know.”
At the next doctor, I convinced him to give me a 2-week supply of modafinil. They allowed to me function, but that wasn’t long enough to get a true feel for the drug. He refused providing any more after that, telling me I’m depressed and I just need to accept it. Those words were nothing new by this point.
After a few months and hundreds of dollars in shipments lost to customs, I finally amassed enough to take the drug regularly. So what did it do? Without mincing words, it saved my life. It kept me awake. I was still completely exhausted all the time. I still had to lie down after doing anything. But instead of immediately falling asleep, I stayed awake. Within 10 minutes I could get up again and carry on. I could decide my next task while lying down, and then do it. I still remember the first day I was able to do 2 loads of laundry on the same day. That may seem like nothing, but it meant the difference between eating and not eating the next day. I had about 8 hours each day, but that no longer meant 4 tasks. I could have a shower, lay down for 10 minutes, and then carry on. 20 minutes, instead of 2 hours. I didn’t let that time go to waste, and immediately started improving my situation. It felt like it took a month to finish cleaning, but it was actually a week. Within about 2 weeks from starting the drug, my main block of sleep slowly began to decrease from ~14 hours. I regularly checked the date on my computer, often shocked that it was still the same day and yet I had completed a week’s worth of housework. Every time, it was a great boost to my willpower. I felt incredible. Every day I was catching up. Every day I had less stress.
Eventually, not only had I caught up, I actually had free time. I began to improve my life. I started exercising, and even took up Yoga for something different; something I once thought I would never have time to do. When I had to lay down, I used the time to research as much as I could about sleep. For so long my doctors focused on the sleep component of my situation, and then so did I. The efficacy of these pills seemed to confirm a sleep disorder. It took quite some time for me to finally step back, look at my life, and once again see fatigue as the cause of the sleep. On to studying fatigue-related illnesses...
Modafinil is not a miracle drug. All it does is provide you with more time in a day. The miracle is in what you choose to do with that time.
