Sign-in to Ask A Doctor - 24x7
OR
Sign in with Google
What Causes Irritability While On Nuvigil?
Question: Hi Dr. XXXXXXX
You suggested I take provigil to help with the confusion, sedation, fogginess, that I was getting with Trileptal. I only have nuvigil (armodafinil) it has worked very well for this. I started at 25 mg for two days and then increased to 50 mgs for 2 days.
Monday I started to get somewhat irritable in the late afternoon, but that faded when I took my afternoon Trileptal. Tuesday I was slightly irritable in the morning but then in the late afternoon, I became overwhelmed with anger for no reason, and the trileptal did not help at all. What did seem to help was either prazosin or propranolol.
Wednesday I decided not to take Any nuvigil. Still by mid day I was full of rage and also cognitive problems. Knowing that prazosin has calmed by aggressiveness before I took some and I think it helped. I did not take any after trileptal but the anger came back. It dissipated after I took more prazosin.
Can armodafinil cause increased anger over time? I am still taking 100 mgs lamictal. sunday, mornday and tuesdayI have taken 450mg of trileptal instead of 300mg. Typically this medication has made me more calm and less angry.
I'm not sure if this coming from the Nuvigil or trileptal or as a withdrawal from Effexor. I stopped the effexor more than 2 weeks ago, and the irritation and dizziness has been there, but It got so much worse over the last three days.
I think I will discontinue the trileptal
Any help would be great, please. You should have access to my background in past emails.
Thank you.
You suggested I take provigil to help with the confusion, sedation, fogginess, that I was getting with Trileptal. I only have nuvigil (armodafinil) it has worked very well for this. I started at 25 mg for two days and then increased to 50 mgs for 2 days.
Monday I started to get somewhat irritable in the late afternoon, but that faded when I took my afternoon Trileptal. Tuesday I was slightly irritable in the morning but then in the late afternoon, I became overwhelmed with anger for no reason, and the trileptal did not help at all. What did seem to help was either prazosin or propranolol.
Wednesday I decided not to take Any nuvigil. Still by mid day I was full of rage and also cognitive problems. Knowing that prazosin has calmed by aggressiveness before I took some and I think it helped. I did not take any after trileptal but the anger came back. It dissipated after I took more prazosin.
Can armodafinil cause increased anger over time? I am still taking 100 mgs lamictal. sunday, mornday and tuesdayI have taken 450mg of trileptal instead of 300mg. Typically this medication has made me more calm and less angry.
I'm not sure if this coming from the Nuvigil or trileptal or as a withdrawal from Effexor. I stopped the effexor more than 2 weeks ago, and the irritation and dizziness has been there, but It got so much worse over the last three days.
I think I will discontinue the trileptal
Any help would be great, please. You should have access to my background in past emails.
Thank you.
Brief Answer:
Increased irritability is known side effect of nuvigil
Detailed Answer:
Dear XXXXXXX
Thanks for reverting back to me.
First of all I agree with irritability part following use of nuvigil as it is reported in around 10-15% of individuals as side effect. However I do not think it is the only cause for rage as the side effect disappears within five half lives of medication which is just two to three days following last use. In addition following discontinuation the irritability should go down which was not a case following discontinuation of nuvigil by you.
My understanding with increased rage in this week is that it was probably combination of two things if not three. We are well aware that irritability is very common following withdrawal of effexor and new prescription of nuvigil probably worsened the irritability leading to cognitive problems.
As of now we need to keep away the nuvigil for some more time till we complete at least four weeks free of effexor (time to complete withdrawal effects of effexor).
Although you stated your intention to stop trileptal but in my opinion we need to give it more time to calm down your reactivity and to observe definite positive effects.
I hope this helps you.
If you have more questions feel free to write back to me.
Thanks again.
Increased irritability is known side effect of nuvigil
Detailed Answer:
Dear XXXXXXX
Thanks for reverting back to me.
First of all I agree with irritability part following use of nuvigil as it is reported in around 10-15% of individuals as side effect. However I do not think it is the only cause for rage as the side effect disappears within five half lives of medication which is just two to three days following last use. In addition following discontinuation the irritability should go down which was not a case following discontinuation of nuvigil by you.
My understanding with increased rage in this week is that it was probably combination of two things if not three. We are well aware that irritability is very common following withdrawal of effexor and new prescription of nuvigil probably worsened the irritability leading to cognitive problems.
As of now we need to keep away the nuvigil for some more time till we complete at least four weeks free of effexor (time to complete withdrawal effects of effexor).
Although you stated your intention to stop trileptal but in my opinion we need to give it more time to calm down your reactivity and to observe definite positive effects.
I hope this helps you.
If you have more questions feel free to write back to me.
Thanks again.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
maybe I wasn't clear; I am well within 5 half-lives of stopping the Nuvigil. I took for four days and stopped Wednesday, the day I wrote this. I didn't take the nuvigil Wednesday but I still had the anger throughout most of the day.
I found armodafinil EXTREMELY helpful in reducing the fog from Trileptal, and restoring my motivation without making me "speedy" or overstimulated. Two questions:
-Is there something else I can take to offset the sedating and cognitive side effects of trileptal? regular modafinil?
-Is this anger coming from indirect dopamine agonism? I have HAD IN THE PAST similar ANGER effects after several days on the following drugs: Sertraline; buspirione.
-Both beta- and alpha-blockers decreased irritability in the last few days while taking the armodafinil? Is this a solution or will the anger get worse with continued armodafinil useage?
Thank you
I found armodafinil EXTREMELY helpful in reducing the fog from Trileptal, and restoring my motivation without making me "speedy" or overstimulated. Two questions:
-Is there something else I can take to offset the sedating and cognitive side effects of trileptal? regular modafinil?
-Is this anger coming from indirect dopamine agonism? I have HAD IN THE PAST similar ANGER effects after several days on the following drugs: Sertraline; buspirione.
-Both beta- and alpha-blockers decreased irritability in the last few days while taking the armodafinil? Is this a solution or will the anger get worse with continued armodafinil useage?
Thank you
Brief Answer:
Follow up
Detailed Answer:
Dear XXXXXXX
Thanks for follow up.
In case we are within five half life following use of Nuvigil it is possible that by Friday evening any irritability contributed by nuvigil should go away. In case it was contributed by multiple factors (as assumed above ) you may continue to see some part of irritability for few more days.
I must inform you that nuvigil is just purified form of povigil and have more nervousness, feeling edgy leading to irritability. I mean to state that the chances of irritability is much less with modafinil (provigil) than armodafinil (nuvigil). So we can consider provigil over nuvigil as it helped you immensely. In other words the answer to your first question is provigil in place of nuvigil.
Regarding the mechanism of anger and irritability not much known in true sense. However the hypothesis is more with dopamine specially in pre limbic areas of brain which control our emotions and expressions.
Regarding management I will request you to go very slowly with provigil when you try it in future. Most of my patients just need a short break or lowering of medication to control their irritability and anger. I expect same in your case and I think over a period of time the things should settle down and chances of worsening are very low if any (atleast as per my experience).
I hope this clarifies further.
Thanks and regards.
Follow up
Detailed Answer:
Dear XXXXXXX
Thanks for follow up.
In case we are within five half life following use of Nuvigil it is possible that by Friday evening any irritability contributed by nuvigil should go away. In case it was contributed by multiple factors (as assumed above ) you may continue to see some part of irritability for few more days.
I must inform you that nuvigil is just purified form of povigil and have more nervousness, feeling edgy leading to irritability. I mean to state that the chances of irritability is much less with modafinil (provigil) than armodafinil (nuvigil). So we can consider provigil over nuvigil as it helped you immensely. In other words the answer to your first question is provigil in place of nuvigil.
Regarding the mechanism of anger and irritability not much known in true sense. However the hypothesis is more with dopamine specially in pre limbic areas of brain which control our emotions and expressions.
Regarding management I will request you to go very slowly with provigil when you try it in future. Most of my patients just need a short break or lowering of medication to control their irritability and anger. I expect same in your case and I think over a period of time the things should settle down and chances of worsening are very low if any (atleast as per my experience).
I hope this clarifies further.
Thanks and regards.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Brief Answer:
You are always welcome
Detailed Answer:
Dear XXXXXXX
Thanks for positive feedback.
I am glad to know that my response to your problems helping you a lot at a time when local help is not available or inadequate.
Thanks for your feedback.
Regards.
You are always welcome
Detailed Answer:
Dear XXXXXXX
Thanks for positive feedback.
I am glad to know that my response to your problems helping you a lot at a time when local help is not available or inadequate.
Thanks for your feedback.
Regards.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Yesterday I continued to be very irritable (I smashed a few objects). Also some of my suspicion and confusion increased. This has been 3-4 days after nuvigil.
Some of this confusion, fear, suspicion, etc., feels similar to when I let my lamictal drop too low in the past. I took some lamictal in the afternoon and found some of the confusion and abated. I also took an afternoon dose of trileptal and found that some irritability returned in addition to the typical trileptal sedation.
Is it possible that that rage was NOT from the nuvigil (I don't remember this happening in the past) but is rather from the trileptal and the withdrawal of effexor?
I wake up in the mornings feeling good. The bad feelings start after I take my meds!
Some of this confusion, fear, suspicion, etc., feels similar to when I let my lamictal drop too low in the past. I took some lamictal in the afternoon and found some of the confusion and abated. I also took an afternoon dose of trileptal and found that some irritability returned in addition to the typical trileptal sedation.
Is it possible that that rage was NOT from the nuvigil (I don't remember this happening in the past) but is rather from the trileptal and the withdrawal of effexor?
I wake up in the mornings feeling good. The bad feelings start after I take my meds!
Brief Answer:
Follow up
Detailed Answer:
Dear XXXXXXX
Thanks for follow up.
As communicated earlier if the rage is still persisting the contribution from nuvigil is less likely than we discussed in the past. I have never seen a patient who continued to have irritability following discontinuation of Nuvigil. However I must acknowledge that I never encountered current prescription for my patient and adding of nuvigil during effexor withdrawal time.
I feel that waking up normal in the morning and increased irritability and rage in later part of day speaks a lot about contribution from current prescription and we need to change the prescription pattern. In my opinion an attempt should be made to prescribe trileptal (all dose together) during night/evening hours to avoid the foggy feelings and other side effects.
I hope this helps you further.
Thanks and regards.
Follow up
Detailed Answer:
Dear XXXXXXX
Thanks for follow up.
As communicated earlier if the rage is still persisting the contribution from nuvigil is less likely than we discussed in the past. I have never seen a patient who continued to have irritability following discontinuation of Nuvigil. However I must acknowledge that I never encountered current prescription for my patient and adding of nuvigil during effexor withdrawal time.
I feel that waking up normal in the morning and increased irritability and rage in later part of day speaks a lot about contribution from current prescription and we need to change the prescription pattern. In my opinion an attempt should be made to prescribe trileptal (all dose together) during night/evening hours to avoid the foggy feelings and other side effects.
I hope this helps you further.
Thanks and regards.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Took your advice...
Yesterday I avoided taking any trileptal until mid-day. I did take Nuvigil with just Lamictal. No irritability until about 8pm. it was brief but intense.
At bedtime I took 450mgs to see if I take the entire dose at night. Made me feel kind and open-hearted, but with a headache and not super tired. Woke up irritable and stayed that way for a couple of hours; I took lamictal with no relief. After .25 mgs klonopin I settled into a non-angry calm, somewhat sedated. Mood is a little better. Unsure what is really going on, but this seems significant.
My cat urinated on my remaining nuvigil bottle last night. Good thing I wasn't irritable or he would be gone! I'll probably take some ritalin if the sedation doesn't lift.
Yesterday I avoided taking any trileptal until mid-day. I did take Nuvigil with just Lamictal. No irritability until about 8pm. it was brief but intense.
At bedtime I took 450mgs to see if I take the entire dose at night. Made me feel kind and open-hearted, but with a headache and not super tired. Woke up irritable and stayed that way for a couple of hours; I took lamictal with no relief. After .25 mgs klonopin I settled into a non-angry calm, somewhat sedated. Mood is a little better. Unsure what is really going on, but this seems significant.
My cat urinated on my remaining nuvigil bottle last night. Good thing I wasn't irritable or he would be gone! I'll probably take some ritalin if the sedation doesn't lift.
Brief Answer:
Follow up
Detailed Answer:
Dear XXXXXXX
Thanks for follow up.
I am glad to know that things are working in positive direction despite some setbacks.
However I will request you to do following
1. Continue same schedule for nest two days
2. Do not have a trial with ritalin
3. Engage yourself in one or another activity leaving no room for excessive self analysis
4. Report back to me after 24-48 hours/on need basis with complete details.
I hope this helps you further.
Thanks again.
Follow up
Detailed Answer:
Dear XXXXXXX
Thanks for follow up.
I am glad to know that things are working in positive direction despite some setbacks.
However I will request you to do following
1. Continue same schedule for nest two days
2. Do not have a trial with ritalin
3. Engage yourself in one or another activity leaving no room for excessive self analysis
4. Report back to me after 24-48 hours/on need basis with complete details.
I hope this helps you further.
Thanks again.
Note: For further follow up on related General & Family Physician Click here.
Above answer was peer-reviewed by :
Dr. Prasad
Answered by
Get personalised answers from verified doctor in minutes across 80+ specialties
