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Strattera vs Provigil
Introduction
For patients with attention-deficit/hyperactivity disorder (ADHD) or narcolepsy, certain drugs that modify the levels of specific compounds in the brain can help manage symptoms and improve focus. Strattera and Provigil are two such drugs often prescribed for these conditions. They each impact different neurotransmitters in the brain, but both have effects on alertness and concentration.
Strattera, also known as Atomoxetine, is a selective norepinephrine reuptake inhibitor (NRI), primarily influencing levels of norepinephrine to improve attention span and reduce impulsive behavior.
On the other hand, Provigil which is also referred to as Modafinil acts by stimulating wakefulness. Its exact mechanism isn't fully understood yet; however, it's believed to influence dopamine levels among other neurotransmitters. It's important for patients to discuss their individual needs with their healthcare provider when choosing between these medications.
Strattera vs Provigil Side By Side
| Attribute | Strattera | Provigil |
|---|---|---|
| Brand Name | Strattera | Provigil |
| Contraindications | Cannot be taken if you are taking or have recently taken monoamine oxidase (MAO) inhibitors. May exacerbate symptoms of anxiety or restlessness. | Cannot be taken if you are taking or have recently taken monoamine oxidase (MAO) inhibitors. May exacerbate symptoms of anxiety or restlessness. |
| Cost | The price for 30 capsules of Strattera (60 mg) averages around $420. Generic Atomoxetine costs significantly less, with daily costs ranging from about $0.87 to $2.75 based on typical dosages. | The price for 30 tablets of Provigil (200 mg) is approximately $850. Generic Modafinil offers significant savings, with costs starting as low as approximately $0.90/per day and typically not exceeding about $5/per day. |
| Generic Name | Atomoxetine | Modafinil |
| Most Serious Side Effect | Increased thoughts about suicide or self-harm, allergic reactions, liver problems, psychotic or manic symptoms. | Serious rash or allergic reaction affecting your liver or blood cells, difficulty breathing or swallowing, swelling of your face, eyes, lips, tongue, or throat, fever, shortness of breath, swelling of legs, yellowing of the skin or whites of eyes, dark urine. |
| Severe Drug Interactions | MAO inhibitors | MAO inhibitors |
| Typical Dose | For adults and adolescents weighing over 70 kg: start at 40 mg/day, potentially increasing to a target of 80 mg/day divided into two doses. Maximum recommended amount is 100 mg/day. For children and adolescents under 70kg: start on a dose such as half a milligram per kilogram (mg/kg), increasing to around 1.2 mg/kg per day if necessary. | Treatment typically begins with a dosage of 200 mg/day, taken orally once in the morning. The dose can be increased to 400 mg/day if needed for the management of narcolepsy or sleep apnea. |
What is Strattera?
Atomoxetine (the generic name for Strattera) is a non-stimulant medication primarily used to treat attention deficit hyperactivity disorder (ADHD). Unlike the first class of ADHD medications known as stimulants, Atomoxetine works by selectively inhibiting the reuptake of norepinephrine in your brain, effectively increasing its availability. It was first approved by the FDA in 2002. Strattera is prescribed for both children and adults diagnosed with ADHD and has little to no effect on dopamine, resulting in fewer side effects like jitteriness or restlessness often associated with traditional stimulants.
On the other hand, Modafinil (the generic name for Provigil) belongs to a newer class of drugs known as "wakefulness promoting agents." First approved by the FDA in 1998, it's typically used for treating excessive sleepiness caused due to narcolepsy or shift work sleep disorder. While it's not entirely understood how Modafinil promotes wakefulness, scientists believe that it may increase dopamine levels in your brain by reducing dopamine reabsorption into nerves.
What conditions is Strattera approved to treat?
Strattera is approved for the treatment of different conditions:
- Attention Deficit Hyperactivity Disorder (ADHD) in both children and adults
- As part of a comprehensive treatment program including educational, psychological or other therapies
Provigil on the other hand is used to treat:
- Narcolepsy, a condition causing excessive daytime sleepiness
- Obstructive Sleep Apnea/Hypopnea Syndrome (OSAHS)
- Shift Work Sleep Disorder (SWSD), which can occur with shift work schedules that rotate or change.
How does Strattera help with these illnesses?
Strattera helps to manage Attention Deficit Hyperactivity Disorder (ADHD) by increasing the amount of norepinephrine available in the synapses of the brain. Norepinephrine is a neurotransmitter, a chemical that acts as a messenger in the brain and throughout the body, playing an important role in mood regulation, attention, alertness and memory. Strattera works by blocking it from being reabsorbed by neurons so levels can be maintained higher for longer periods of time. It is thought that individuals with ADHD have relatively lower levels of norepinephrine. Therefore, by increasing norepinephrine, Strattera can limit negative effects associated with ADHD such as poor focus or impulsivity and help patients better manage their condition.
Meanwhile Provigil (modafinil), another medication used for different situations including sleep disorders like narcolepsy and also off-label uses like managing ADHD symptoms or enhancing cognitive functions does not increase specific neurotransmitters but instead seems to modulate activity within complex neuronal networks primarily through indirect actions on dopamine receptor sites where it inhibits dopamine reuptake which results in an increased extracellular concentration.
What is Provigil?
Provigil, also known as modafinil, is a medication that boosts levels of hypothalamic histamine while simultaneously reducing gamma-aminobutyric acid (GABA), which leads to increased wakefulness and alertness. It's not entirely understood how Provigil works, but it doesn't operate in the same way as many other stimulants like amphetamines do. Instead of stimulating all areas of the brain indiscriminately, Provigil appears to target specific regions responsible for sleep/wake cycles.
The FDA approved Provigil in 1998 primarily for treating narcolepsy; however, it has found additional use in managing shift work sleep disorder and obstructive sleep apnea. Compared to Strattera - a norepinephrine reuptake inhibitor used mainly for attention deficit hyperactivity disorder (ADHD) - Provigil does not directly manipulate dopamine or serotonin neurotransmitters and therefore does not cause weight gain or sexual dysfunction commonly seen with these types of drugs. This makes it an attractive option for patients who have had adverse reactions to traditional stimulant medications.
What conditions is Provigil approved to treat?
Provigil, also known as modafinil, has been approved for the treatment of:
- Narcolepsy, a neurological disorder that affects the control of sleep and wakefulness
- Shift work sleep disorder (SWSD) which is a circadian rhythm sleep disorder characterized by insomnia or excessive sleepiness affecting people whose work hours overlap with the typical "sleep period"
- Obstructive Sleep Apnea/Hypopnea Syndrome (OSAHS), used as an adjunct to standard treatments like continuous positive airway pressure.
How does Provigil help with these illnesses?
Dopamine is a neurotransmitter that influences several aspects of cognition, including motivation, pleasure and attention. Low levels of dopamine have been associated with conditions such as ADHD. Provigil works by increasing the availability of dopamine in the brain and thereby improving cognitive function and wakefulness. Its action on other neurotransmitters like histamine, orexin neurons, serotonin may also play roles in its effectiveness as a stimulant medication. Unlike Strattera which is an NRI (norepinephrine reuptake inhibitor) used to treat ADHD and not known to affect dopaminergic pathways significantly, Provigil does influence these pathways playing key role in vigilance promotion making it useful for narcolepsy patients or those working odd hours shifts needing sustained focus during waking periods.
How effective are both Strattera and Provigil?
Atomoxetine (Strattera) and modafinil (Provigil) are both effective medications used in the management of attention deficit hyperactivity disorder (ADHD), though they were approved by the FDA at different times, with Strattera receiving approval in 2002 and Provigil initially approved for narcolepsy in 1998. Since they act on different neurotransmitters, their usage can be tailored to individual patient needs. The effectiveness of atomoxetine and modafinil was directly compared in a double-blind clinical trial conducted in 2010; although this study found that both drugs reduced symptoms of ADHD, it concluded that atomoxetine exhibited superior efficacy.
A review published in 2006 reported that atomoxetine is effective from the first week of treatment onwards, has a side effect profile comparable to other ADHD treatments, and is well-tolerated across a wide demographic range including children, adolescents, and adults. Atomoxetine is unique as it's not classified as a stimulant medication which makes it an option for patients who cannot take stimulants due to health reasons or personal preference.
On the other hand, evidence from meta-analyses indicates that modafinil shows promise as an alternative treatment for ADHD but its use is typically considered off-label or secondary when front-line stimulant therapies don't work or aren't tolerated. While some people may find benefit from using modafinil alone or alongside another drug like Ritalin or Adderall if these primary treatments are ineffective or cause intolerable side effects. As such, while both medications have proven usefulness within their own niches based on distinct pharmacological properties.
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At what dose is Strattera typically prescribed?
Oral dosages of Strattera for adults and adolescents weighing over 70 kg typically start at 40 mg/day, with the potential to be increased after a minimum of three days to a target total daily dose of approximately 80 mg divided into two doses in the morning and late afternoon/early evening. After two to four additional weeks, the dosage may be increased up to maximum recommended amount of 100 mg/day if needed. For children and adolescents weighing under 70kg, they might start on a lower dose such as half a milligram per kilogram (mg/kg). This can increase after three days to around 1.2 mg/kg per day if necessary. On the other hand, oral dosages for Provigil are typically set at 200mg/day taken once in the morning. For certain conditions such as narcolepsy or sleep apnea, this may increase up to maximaum recommended amount of 400mg/day based on physician's discretion.
At what dose is Provigil typically prescribed?
Provigil treatment typically begins with a dosage of 200 mg/day, taken orally once in the morning. The dose can then be increased to 400 mg/day if needed for the management of narcolepsy or sleep apnea. However, there is no consistent evidence that this higher dose provides additional benefit beyond that of the 200 mg/day dose. The maximum safe dosage has not been established, but high doses may increase risk of serious side effects. Therefore, it's important to follow your doctor's instructions closely and monitor for any changes in response to treatment after a few weeks.
What are the most common side effects for Strattera?
Some of the most common side effects associated with Strattera include:
- Upset stomach, nausea or vomiting
- Decreased appetite
- Dizziness
- Tiredness or fatigue
- Changes in mood (irritability, anxiety)
- Dry mouth
- Urinary retention and urinary tract infection
- Sweating
- Insomnia (difficulty sleeping)
- Somnolence (sleepiness/drowsiness)
On the other hand, Provigil may cause:
- Headache
- Nausea
- Nervousness/anxiety.
- Back pain.
- Diarrhea.
- Stuffy nose.
Although these medications are used to treat different conditions they both have potential side effects that should be considered carefully.
Are there any potential serious side effects for Strattera?
Strattera and Provigil are both stimulant medications, but they have different side effects. Here's what you need to know:
With Strattera, some people report serious side effects such as:
- Increased thoughts about suicide or self-harm
- Allergic reactions that include symptoms like hives, difficulty breathing, swelling in the face or throat
- Liver problems with symptoms including upper right abdominal pain, dark urine and jaundiced skin
- Psychotic or manic symptoms like hallucinations, delusional thinking or mania
Provigil on the other hand can cause:
- Serious rash or allergic reaction affecting your liver or blood cells
- Difficulty breathing or swallowing
- Swelling of your face, eyes,lips,tongueor throat
- Fever; shortness of breath; swelling of legs; yellowing of the skin or whites of eyes; Dark urine
Always remember to consult a healthcare provider if any bothersome side effects occur when taking these medications.
What are the most common side effects for Provigil?
The potential side effects of Provigil may include:
- Headache or dizziness
- Nausea, upset stomach
- Dry mouth, sore throat
- Sleep problems (insomnia)
- Anxiety or nervousness
- Rapid heart beat
- Blurred vision or other changes in eyesight
- An unusual rash that can be severe and require hospitalization. This is especially likely if associated with fever and discomfort. -Stuffy nose due to inflammation of the nasal lining. -Uncontrolled movements or shaking (tremors). -Increased urination frequency. -The feeling of agitation or hostility. -Possible weight loss over extended use.
Remember, every individual's response to medication varies. Not all users will experience these symptoms, but it's important to consult your healthcare provider immediately should any emerge.
Are there any potential serious side effects for Provigil?
Although Provigil is typically well-tolerated, it can occasionally lead to severe side effects. Be vigilant for the following symptoms:
- An allergic reaction that may manifest as hives, itching or a rash
- Fever and swollen glands, possibly indicating an infection
- Difficulty breathing or swelling in your face or throat - this might suggest a serious allergic reaction
- Mental health changes such as confusion, unusual mood shifts or behavior alterations
- Cardiovascular issues like chest pain and fast/irregular heartbeats – these could indicate heart problems
- Signs of liver problems including nausea, stomach pain (particularly on the upper right side), dark urine coloration and jaundice (yellowing of skin and eyes) If you notice any of these signs while taking Provigil, seek medical attention promptly.
Contraindications for Strattera and Provigil?
Both Strattera and Provigil, along with most other cognitive enhancer medications, may exacerbate symptoms of anxiety or restlessness in some people. If you notice your anxiety worsening, or an increase in jitteriness, agitation or hyperactivity, please seek immediate medical attention.
Neither Strattera nor Provigil can be taken if you are taking or have been recently taking monoamine oxidase (MAO) inhibitors. Always inform your physician about the medications you are currently on; MAOIs will require a period of about 2 weeks to clear from the system to prevent dangerous interactions with Strattera and Provigil.
Just like many other medicines that affect brain chemistry, both drugs should not be discontinued suddenly — doing so could lead to withdrawal symptoms such as mood swings or fatigue. It is critical that changes to dosage amounts and schedules should only be made under the guidance of a healthcare professional.
How much do Strattera and Provigil cost?
For the brand name versions of these drugs:
- The price for 30 capsules of Strattera (60 mg) averages around $420, which works out to about $14/day.
- Conversely, the price for 30 tablets of Provigil (200 mg) is approximately $850, equating to roughly $28/day.
Therefore, if you are prescribed a higher dosage range for Strattera (e.g., 80 or even 100 mg per day), then brand-name Provigil could be less expensive on a daily treatment basis. However, it's crucial to remember that cost should not be your primary consideration when deciding between these two medications.
As for their generic counterparts:
-
Atomoxetine - the generic version of Strattera - costs significantly less than its branded counterpart and is available in packs starting from 30 capsules upward. Costs vary but generally fall within the range of about $0.87 to$2.75 per day based on dosages ranging from 20mg up to typical dosages of around 80mg per day.
-
Modafinil - the generic version of Provigil - also provides significant savings compared with the branded medication: A pack containing anywhere from fifteen up to thousands can start as low as approximately $0.90/per day and typically doesn't exceed about $5/per day depending upon dosage requirements which usually do not surpass 400mg daily.
Popularity of Strattera and Provigil
Strattera and Provigil are both medications used to treat different conditions related to focus, attention, and wakefulness.
Atomoxetine (sold under the brand name Strattera), is a non-stimulant medication primarily used for the treatment of Attention Deficit Hyperactivity Disorder (ADHD). In 2020, it was estimated that around 1.6 million prescriptions were filled in the U.S., accounting for roughly 9% of all non-stimulant ADHD prescription drugs. The use of Atomoxetine has been relatively steady over recent years with no significant increases or decreases observed.
Modafinil, marketed as Provigil among others, is a wakefulness-promoting agent approved for treatment of disorders such as narcolepsy, shift work sleep disorder and excessive daytime sleepiness associated with obstructive sleep apnea. It was prescribed to approximately 900 thousand people in the USA in 2020. Over time Modafinil's prevalence has generally remained stable; however it should be noted that off-label usage (for instance as a cognitive enhancer) may not be reflected accurately within these figures.
Conclusion
Both Strattera (atomoxetine) and Provigil (modafinil) have established records of use in patients with attention deficit hyperactivity disorder (ADHD), narcolepsy, and other sleep disorders. They are both supported by numerous clinical trials demonstrating effectiveness above placebo treatments. Occasionally, the drugs may be used together, but this requires careful consideration due to potential drug interactions.
Strattera acts primarily on norepinephrine whereas Provigil is believed to act on dopamine as well as other neurotransmitters, leading them to be prescribed under different conditions. Strattera is approved for ADHD treatment in children aged 6 years or older, teenagers, and adults while Provigil is typically reserved for adult use mainly for narcolepsy or shift work sleep disorder.
Both medications are also available in generic form which can provide cost savings especially for those paying out-of-pocket. Both Strattera and Provigil might need an adjustment period where effects may not be instantly noticeable.
The side effect profile between the two drugs varies; both generally being well-tolerated but with distinct sets of common side effects: dry mouth, insomnia and decreased appetite with Strattera versus headache, nausea and nervousness with Provigil. Patients should closely monitor their symptoms when starting treatment; if any adverse reactions occur such as heart problems or mental health issues including suicidal thoughts they should immediately seek medical help.
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Refrences
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- Turner, D. (2006, April). A review of the use of modafinil for attention-deficit hyperactivity disorder. Expert Review of Neurotherapeutics. Informa UK Limited.http://doi.org/10.1586/14737175.6.4.455
- Kratochvil, C. J., Vaughan, B. S., Harrington, M. J., & Burke, W. J. (2003, July). Atomoxetine: a selective noradrenaline reuptake inhibitor for the treatment of attention-deficit/hyperactivity disorder. Expert Opinion on Pharmacotherapy. Informa Healthcare.http://doi.org/10.1517/14656566.4.7.1165
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