Modafinil has potential for abuse, study says

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Modafinil, a stimulant medication used to treat narcolepsy, has characteristics that may trigger abuse and dependence in people who take the drug off-label to improve cognitive performance, according to a study published today in the Journal of the American Medical Assn.

The study is an early warning by federal health officials that modafinil may have unexpected and tragic consequences for people who use it simply for a brain boost. Besides treating narcolepsy, modafinil is prescribed for cognitive dysfunction in some psychiatric disorders, like schizophrenia. But ‘modafinil is increasingly being diverted for nonmedical use by healthy individuals with the expectation that it will improve cognitive performance,’ wrote the authors of the paper, from the National Institute on Drug Abuse.

The way modafinil works in the brain has been something of a mystery, however it was developed with the expectation that it would not affect the neurotransmitter dopamine while promoting wakefulness. The new study, however, shows it acts on dopamine, which opens the door for potential abuse. The researchers gave 10 healthy men either a placebo or modafinil in doses of either 200 milligrams (the dose recommended for narcolepsy) or 400 milligrams (a dose used to treat attention deficit hyperactive disorder). The men then underwent brain scans, which showed an increase of dopamine in the brain, especially a part of the brain central to drug dependence.

‘This is relevant because drugs that increase dopamine in the brain, particularly those that increase dopamine in the nucleus accumbens, a brain region critical for the rewarding effects of drugs of abuse, have the potential for being diverted, and repeated use by individuals who are vulnerable can result in addiction,’ the authors wrote.

While stimulants used to treat attention deficit hyperactivity disorder, such as methylphenidate (Ritalin) also increase dopamine, the therapeutic doses for modafinil are much higher -- 200 milligrams for modafinil compared with 20 milligrams for methylphenidate, the authors noted.

-- Shari Roan