Provigal (more correctly spelt Provigil) acts on the brain, presumably by increasing dopamine levels and causing a level of alertness to counteract the sleepiness felt by the person with sleep apena.  Provigal is modafinil 200mg, given daily or twice a day, has been approved by the FDA for the treatment of the daytime sleepiness of sleep apena.

One side effect of provigal is a mild sense of happiness and increased concentration, which gets people worried about the addictive potential of the drug.  However the general opinion of people is that this addictive potential is minimal.

The cause of narcalepsy is not well known.  It is felt that there may be a genetic factor involved where the cells of the sleep center in the hypothalamus malfunction, so that abnormal sleep patterns result.  This problem of narcalepsy may start from teenage years or young adulthood, and become progressively worse.

Provigal is indicated in this condition because it is known to prevent the excessive sleepiness associated with narcalepsy.  Provigal causes the buildup of dopamine in the brain and this results in wakefulness.

Features of shift work sleep disorder:

Insomnia
disrupted sleep schedule
Problems with interpersonal relationships
Reduced work performance with difficulty concentrating
sleepiness at work
irritability and depression, headaches, lack of energy

Ultimately, the consequences of SWSD are
-an increase in work time accidents and work-related errors
-an increase in off work accidents
-an increase in medical leave

Treatment of shift work sleep disorder

Sleep must be made a priority in treating this problem. That is, when one goes off duty, the priority must be to get sleep. Thus there must be a minimum of exposure to bright lights, loud noises, excitement, and social gatherings where the brain needs to keep awake. Family and friends must understand that it is essential to get good sleep to combat the feeling of fatigue and irritability that will come on without sufficient sleep.

However if there is no choice but to keep awake, then one will have to depend on caffeine, or take a brain stimulant such as Provigal (officially known as Provigil), which will reduce the feeling of sleepiness and help at least reduce the other symptoms of SWSD.

Provigil is manufactured by Cephalon Inc.  Also often known as Provigal, it has become very popular as a drug to remove sleepiness and keeping awake.  The actual drug is known as modafinil.

Mechanism of Action: Provigal is a cerebral stimulant.  However modafinil is structurally different from other cerebral stimulants.  The mechanism of action is not known, but it appears to differ from the usual stimulation of catecholamine or dopamine systems. Provigal does not appear to give rise to the withdrawal symptoms common in persons on long term cerebral stimulants. It is taken orally and is used to promote wakefulness in patients who have problems with excessive sleepiness.  This problem is seen in patients with Sleep Apnea, Narcolepsy and Shift Work Sleep Disorder, for which 3 problems the FDA has approved for usage.

Provigal is a prescription drug and comes in strengths of 100mg and 200mg modafinil.  Generic modafinil is not available at the present moment.

Provigil side effects are not common.  They are mostly nausea, headache and dry mouth.  Usage of provigal in pregnancy is not recommended as no studies have been or ever will be done in pregnant or nursing women, due to ethical issues.

What is interesting in Provigal is the off-label uses of the drug (off-label uses are uses not recommended or approved by the FDA, but recommended by doctors based on observation of clinical judgement of its effects).  Thus we see a lot of people taking Provigal to keep awake, and to improving their learning abilities.  Students use a lot of it to keep awake when cramming last minute for exams.  Wall Street and Silicon Valley executives use it to keep awake and maximise their waking hours.  Soldiers and helicopter pilots use it to keep awake when going on long missions.

The most common ones are headache, symptoms of upper respiratory tract infection such as runny nose, nausea, nervousness, insomnia, back pain, diarrhea, hearburn.  Other Provigil side effects which may occur are dry mouth, loss of appetite, flushing, diarrhea, tremors and sweating and shakiness.

Unusual Provigil side effects are anxiety and depression, confusion, hallucinations, fast pulse, palpitations, muscle spasms, blood in the urine, allergic reactions such as itching or rashes or difficulty breathing.

A rare but potentially life-threatening hypersensitivity phenomenon is the Stevens-Johnson syndrome (which can be seen in exposure to other drugs as well such as sulfonamides), which comes on with an initial rash, but which progresses to a situation affecting the skin and mucous membranes causing separation of large tracts of the upper layer of skin known as epidermis from the dermis, causing symptoms such as severe ulceration in the mouth.

It can be seen thus that this is a very popular drug to keep awake.  Sales of the original product Provigil has been estimated to reach USD 1 billion a year, a prize so attractive to Cephalon Inc., the manufacturers of the original product Provigil, that they have been charged with acting illegally to prevent competition due to sales of generic Provigal or modafinil.  This they are alleged to have done by offering up to USD200 million to 4 firms to refrain from selling generic versions till the year 2012.

Provigil cost is quoted variously at USD720 per 100tab of the 100mg and about USD1075 for the 200mg (100tab).

Generic Provigal (Modalert) has been advertised online at about USD72 per 100 tabs for the 100mg tablets and about USD112 per 100 tabs for the 200mg tablets.

As you can see, the price difference is amazing.