Comparing Modafinil vs. Adderall
Medically reviewed by Alex Yampolsky, PharmD
When looking to manage symptoms associated with narcolepsy or attention deficit hyperactivity syndrome (ADHD), finding a prescription medication that works effectively for yourself or a loved one is essential to living a more fulfilled, productive life.
As such, your healthcare provider may prescribe one of the following Food and Drug Administration (FDA)-approved medications, modafinil (also known by its brand name, Provigil) or Adderall.
While generally used to improve wakefulness and focus, modafinil and Adderall share critical differences regarding their primary uses, dosing regimens, prescription requirements, and active ingredients, amongst other differences.
Therefore, this article will compare modafinil and Adderall, examining their respective indications, dosing regimens, safety concerns, potential for drug-related interactions, and more.
Overview: Modafinil vs. Adderall
Modafinil and Adderall are classified as central nervous system (CNS) stimulants. CNS stimulants are a commonly used type of medication for the management of narcolepsy and ADHD.
Modafinil is administered orally (taken by mouth). More specifically, it is available in immediate-release (IR, a form of administration where the drug instantly disintegrates, quickening its impact) form. It is approved only for adults 18 and older.
In comparison, Adderall, also orally administered, is a combination of two active ingredients, amphetamine and dextroamphetamine. This drug is approved for use in children, typically for people 3 and older.
Adderall is available in IR form (as a tablet) and in an extended-release (ER, a form of administration where the drug's effects happen slowly inside the body) capsule form.
Uses: Modafinil vs. Adderall
Modafinil Uses
Modafinil is prescribed to improve wakefulness in adults with excessive sleepiness due to:
Narcolepsy
Obstructive sleep apnea (OSA)/hypopnea syndrome (OSAHS)
Shift work sleep disorder (a sleep disorder that affects people who work nontraditional hours)
ADHD (note that modafinil is not FDA-approved for ADHD and is therefore prescribed, at times, off-label)
Narcolepsy is a chronic (persistent or long-lasting) medical condition that affects the brain's ability to control sleep-wake cycles. Individuals with narcolepsy may feel excessively sleepy during most of the day.
Modafinil is also sometimes prescribed off-label (for a use that the FDA has not approved) for Parkinson's disease, chronic fatigue syndrome, depression, ADHD, and fatigue related to multiple sclerosis (MS).
Adderall Uses
Adderall is prescribed to treat:
ADHD in adults and children 3 and older
Narcolepsy in adults and children 6 and older
People with ADHD may experience various symptoms, including inattention to detail, hyperactivity, personal conduct disorders, or poor organizational skills.
Adderall is sometimes prescribed off-label for people with MS to improve alertness or those with cognitive fog, who have difficulty understanding and thinking.
How Do Modafinil and Adderall work?
CNS stimulants work by increasing levels of chemicals (dopamine and norepinephrine) in the brain.
Yet, the exact way modafinil promotes wakefulness has to be fully understood. Generally, however, it is thought to work similarly to amphetamine drugs like Adderall (and methylphenidate drugs, such as Ritalin).
Modafinil is believed to increase dopamine levels, which helps improve wakefulness. It also stimulates mood, thinking, and feelings.
Similarly, Adderall improves attention and focus while decreasing impulsivity and aggression, bringing the brain to calm stimulation.
Which Is More Effective?: Modafinil vs. Adderall
There is little data comparing modafinil vs. Adderall regarding which is more effective in treating narcolepsy. However, some studies on the subject do exist.
The American Academy of Sleep Medicine (AASM) issued a strong recommendation for the use of modafinil to treat narcolepsy in adults.
In one study, modafinil was effective, well-tolerated, and did not cause overly severe side effects.
The AASM issued a conditional recommendation for dextroamphetamine (a component of Adderall). A conditional offer means the healthcare provider must use clinical judgment to determine the appropriate drug.
For example, a person with a history of substance use disorder may not be a suitable candidate to take Adderall or Modafinil.
While either drug is approved to treat narcolepsy, only Adderall is FDA-approved to treat ADHD.
However, some healthcare providers prescribe modafinil off-label (for a non-FDA-approved use) for ADHD because studies have shown it can improve ADHD-related symptoms.
While no studies compare modafinil directly with Adderall for ADHD, one past study compared modafinil with dextroamphetamine and found both drugs to be effective and well-tolerated.
Your healthcare provider can determine which medication, if any, is best for you, considering individual factors, such as your age, diagnosis, symptoms, risk of substance abuse, other medical conditions, and other medications you take that may interact with modafinil or Adderall.
Who Should Avoid Modafinil or Adderall?
Modafinil and Adderall are not appropriate for everyone.
Before taking modafinil or Adderall, tell your healthcare provider about your medical conditions, medical history, and family history.
When to Avoid Modafinil
You should not take modafinil if you:
Are allergic to modafinil or any ingredient in the medication
Have mitral valve prolapse (MVP, a type of heart valve disease) or a history of MVP
Have a history of left ventricular hypertrophy (LVH, thickening of the walls of the lower left heart chamber)
Modafinil may be prescribed with caution in some people only if the healthcare provider determines it is safe. This includes:
People with heart disease
People with angina (chest pain)
Anyone who has had a recent heart attack
People 65 or older
People with severe liver problems
People with a history of substance abuse
People with a history of depression or certain other mental health conditions
When to Avoid Adderall
You should not take Adderall if you:
Are allergic to amphetamine, dextroamphetamine, or any ingredient in the medication
Have taken medication in the monoamine oxidase inhibitor (MAO) inhibitor drug class in the past 14 days
Are currently pregnant or breastfeeding
Have severe heart disease, heart rhythm problems or a blood vessel-related condition
Adderall may be prescribed with caution in some people only if the healthcare provider determines it is safe. This includes:
Certain people with heart disease or a history of heart disease
People with hypertension (high blood pressure)
People with an overactive thyroid
People with glaucoma
People with or at risk for bipolar disorder
People with Tourette syndrome or tics
People with a history of seizures
People with a history of substance abuse
Dosage: Modafinil vs. Adderall
In dosing these medications, the healthcare provider will generally start on the lower end of the dosing and slowly increase the dose if needed.
Modafinil
Modafinil is available as an oral tablet.
It is available in 100-milligram (mg) and 200-mg-dosed tablets. The dosage for narcolepsy in adults is 200 mg daily in the morning.
Doses above 200 mg are not considered adequate, although the maximum amount listed is 400 mg daily. Older adults may need lower doses.
The maximum dosage for modafinil varies by age, weight, and condition.
Adderall
Adderall IR is available as an oral tablet, supplied as 5-mg, 7.5-mg, 10-mg, 12.5-mg, 15-mg, 20-mg, and 30-mg tablets.
The amount for narcolepsy is:
Narcolepsy (adults and children 6 and older): 5 mg to 60 mg per day, divided into one, two, or three doses
The amount for ADHD is:
ADHD (adults and children 6 and older): 5 mg to 40 mg per day, divided into one, two, or three doses
ADHD (children 3 to 5 years old): 2.5 mg to 40 mg per day, divided into one, two, or three doses
The maximum dosage for Adderall varies by age, weight, and condition.
Adderall XR
Adderall XR is available as an oral capsule, supplied in 5-mg, 10-mg, 15-mg, 20-mg, 25-mg, and 30-mg doses.
The amount for ADHD is:
Adults: 20 mg once daily in the morning (maximum 60 mg per day)
Children 6 to 12 years old: 10 mg once daily in the morning (maximum 30 mg per day)
Adolescents/teenagers 13 to 17 years old: 10 mg to 20 mg once daily in the morning (maximum 40 mg per day)
Side Effects and Safety
Modafinil is classified as a CNS stimulant unrelated to amphetamines such as Adderall. The Drug Enforcement Agency (DEA) classifies it as a Schedule IV Controlled Substance.
This means it has the potential for abuse and dependence, but the risk is lower than Schedule II and III drugs. For context, Schedule I Controlled Substances includes illegal, highly abused drugs, such as heroin.
Moreover, Adderall is classified as a CNS stimulant. The DEA classifies it as a Schedule II Controlled Substance. As a result, be aware that both drugs carry a high potential for abuse and dependence.
Modafinil
The most common side effects of modafinil include but are not limited to:
Headache
Stomach problems like nausea, diarrhea, and indigestion
Nervousness
Runny or stuffy nose
Back pain
Anxiety
Trouble sleeping
Dizziness
Call your healthcare provider right away if you have serious side effects. Call 911 if your symptoms feel life-threatening or if you think you have a medical emergency.
Serious side effects of modafinil and their symptoms can include the following:
Anaphylaxis (severe allergic reaction): Get emergency medical help if you have urticaria (hives), difficulty breathing, or swelling of the face, lips, tongue, or throat
Severe, life-threatening skin or systemic reactions: Get emergency medical help if you have a fever, sore throat, burning eyes, skin pain, mouth sores, difficulty swallowing, red or purple rash, blistering or peeling skin
Mania (significantly elevated and excitable mood)
Psychosis (a disconnection from reality)
Hallucinations (seeing or hearing things that are not there)
Suicidal thoughts
Abuse and dependency
Adderall
Adderall (IR and XR) each carry a black box warning, the most severe warning required by the FDA.
Misusing Adderall can cause sudden death or severe heart problems like heart attacks. People who take Adderall will be closely monitored during treatment.
Common side effects of Adderall include but are not limited to:
Appetite and weight loss
Dry mouth
Trouble sleeping
Headache
Stomach problems including stomach pain, nausea, vomiting, diarrhea or constipation, indigestion
Changes in sex drive/sexual problems
Sleepiness
Speech problems
Worsening of tics
Shortness of breath
Excess sweating
Palpitations
Increased blood pressure
Vision changes
Call your healthcare provider right away if you have serious side effects. Call 911 if your symptoms feel life-threatening or if you think you have a medical emergency.
Serious side effects of Adderall and their symptoms, in addition to the black box warning above, can include the following:
Anaphylaxis (severe allergic reaction): Get emergency medical help if you have urticaria (hives), difficulty breathing, or swelling of the face, lips, tongue, or throat
Severe, life-threatening skin reactions: Get emergency medical help if you have a fever, sore throat, burning eyes, skin pain, red or purple rash, blistering or peeling skin
Abuse and dependency
Psychosis
Sudden death
Heart attack
Hypertension
Seizures
Priapism (prolonged, painful erection; this requires emergency treatment)
Circulation problems
Raynaud's syndrome (a condition where some areas of the body feel numb and cool)
Cardiomyopathy (abnormal thickening of the heart muscle; associated with long-term Adderall use)
Growth suppression (associated with long-term Adderall use in children; the healthcare provider will monitor growth during treatment)
Interactions: Modafinil vs. Adderall
Tell your healthcare provider about all your medicines, including prescription and over-the-counter (OTC) drugs and vitamins or supplements.
While taking modafinil or Adderall, do not start any new medications without approval from your healthcare provider.
Modafinil
Examples of drug interactions with modafinil include:
Modafinil interacts with birth control pills, making them less effective. Talk to your healthcare provider about using an alternative (or additional) method of birth control while taking modafinil and for one month after you stop taking modafinil.
Cyclosporine (modafinil may cause lower levels of cyclosporine, which will require monitoring and a possible dosage adjustment of cyclosporine)
Certain medications, like Prilosec (omeprazole) or Valium (diazepam), can build up to higher levels in the body when combined with modafinil, increasing the risk of side effects.
Adderall
Examples of drug interactions with Adderall include:
Tricyclic antidepressants such as Elavil (amitriptyline)
Prozac (fluoxetine)
MAOIs, such as selegiline
Phenobarbital
Medications used for hypertension
Also, drugs that increase serotonin levels can cause a build-up of serotonin which can be life-threatening or cause death if not treated. This is called serotonin syndrome.
Symptoms range from mild to severe, including agitation, confusion, diarrhea, shivering, sweating, chills, fever, stiff muscles, and seizures.
Drugs that may contribute to serotonin syndrome, when combined with Adderall, include:
Selective serotonin reuptake inhibitors (SSRIs) (a type of antidepressant), such as Lexapro (escitalopram)
Serotonin-norepinephrine reuptake inhibitors (SNRIs) antidepressants, such as Cymbalta (duloxetine)
Opioid pain medications, such as Duragesic (fentanyl) or dextromethorphan (found in many cough and cold medications)
Summary
Finding safe and effective treatment options for managing narcolepsy or ADHD can be a challenging process to navigate. Fortunately, a variety of pharmaceutical options for these conditions are available.
Adderall is widely prescribed for ADHD and narcolepsy, and modafinil, used primarily for narcolepsy, is sometimes prescribed off-label for ADHD.
While similarly classified as CNS stimulants, both are administered orally and used to achieve focus and wakefulness.
Nonetheless, differences in primary, active ingredients, age requirements, and potential adverse effects ensure that you consult your healthcare provider before beginning either of these medications.
However, besides prescribed medications, the management of narcolepsy and ADHD often involves a combination of prescription medication and lifestyle changes.
Review the information above and talk to your healthcare provider to determine which medication would be appropriate for you.
Frequently Asked Questions
How do I store modafinil vs. Adderall?
Modafinil and Adderall should be stored at room temperature (between 68 and 77 degrees F). Moreover, do not store either of these drugs in an area susceptible to high moisture levels, such as a bathroom.
Because of their potential for adverse effects, keep them out of the reach of children and pets. And like all medications you use, keep close track of your prescription to determine if any pills are missing.
