Nuvigil for Multiple Sclerosis Fatigue

Studies not very supportive, but may be still worth a try

Is Nuvigil a Sensible Option for MS Fatigue?
Is Nuvigil a Sensible Option for MS Fatigue?. Heri Images/Getty Images

Nuvigil (armodafinil) is a derivative of Provigil (modafinil), which some people with MS take to combat MS-related fatigue.

Overview of Nuvigil

Nuvigil is used to improve wakefulness in adults with excessive sleepiness linked to the following three medical conditions:

  • obstructive sleep apnea
  • narcolepsy
  • shift work disorder

That being said, it is sometimes used off-label (meaning it is not FDA approved) to treat fatigue in people with MS.

Nuvigil is not a generic version of Provigil, but is a derivative of Provigil (the right-handed isomer, to be exact). Using just part of the molecule that makes up Provigil is thought to be a way to get more benefits with fewer side effects, which seem to correspond to the left-handed isomer.

That being said, Nuvigil may also cause the same sorts of side effects as Provigil, the most serious being a life-threatening skin rash or a serious allergic reaction. In fact, if a person develops any signs of a rash or allergic reaction, it's important they seek emergent help right away. Some of these symptoms include:

  • skin rash, hives, blistering and/or peeling of the skin, sores in the mouth
  • swelling of the face, eyes, lips, tongue, or throat
  • problems swallowing or breathing
  • fever
  • swelling of the legs
  • yellowing of the eyes and/or dark-colored urine

Other potentially serious side effects including psychiatric symptoms like feeling depressed, anxious, experiencing hallucinations, mania, or aggressive behavior, and/or having suicidal thinking.

Heart problems too may occur and warrant medical attention right away. Possible signs include chest pain, problems breathing, or an abnormal heart beat.

Aside from these serious side effects, Nuvigil commonly causes these side effects in people:

  • headache
  • nausea
  • dizziness
  • problems sleeping

It's important to contact your doctor if you experience any persistent or bothersome side effects, including the ones above or any additional ones.

Also, Nuvigil may interact with and/or lower the effectiveness of certain medications like hormonal birth control methods (pills, shots, implants, patches, rings and IUDs). This means that a woman may have an increased chance of becoming pregnant while taking Nuvigil and for one month after stopping Nuvigil.

Due to Nuvigil's potential to interact with other medications, be sure to inform your doctor of all your medical problems and all the medications you are taking including prescriptions, herbals, supplements, vitamins, and over-the-counter medications.

A couple of other points bear mentioning. Your Nuvigil dosage will be different than your Provigil dosage, so be careful here and take it only as instructed by your doctor. Also, your insurance may not cover Nuvigil at the same level as it covered Provigil—it may be an expensive medication for some.

Does Nuvigil Work?

The scientific evidence supporting the use of Nuvigil in effectively treating fatigue in MS is weak and inconclusive at this time. That being said, it may work for some individuals, so your doctor may recommend you try it, especially if other therapies are not working. In treating fatigue, it's often a delicate combination of interventions that work including exercise, proper sleep, addressing other health issues that may be impacting fatigue, and medication

A Word From Verywell

While Nuvigil may cause adverse effects like heart or mental problems, it is generally well tolerated and may be a reasonable option for some people with MS-related fatigue.

Sources:

Asano M, Finlayson ML. Meta-analysis of three different types of fatigue management interventions for people with multiple sclerosis: exercise, education, and medication. Mult Scler Int. 2014;2014:798285.

Braley TJ, Chervin RD. Fatigue in multiple sclerosis: Mechanisms, evaluation, and treatment. Sleep. 2010 Aug 1;33(8):1061-67.

Bruce J, Hancock L, Roberg B, Brown A, Henkelman E, Lynch S. Impact of armodafinil on cognition in multiple sclerosis: a randomized, double-blind crossover pilot study. Cogn Behav Neurol. 2012 Sep;25(3):107-14.

Medication Guide (April 2015). Nuvigil.

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