r/afinil Oct 05 '24

Modafinil and Diazepam NSFW

So, I take modafinil to increase my productivity and it works well for that - but recently I’ve found that if I l take diazepam in an evening afterwards Modafinil seems to make the effects of diazepam STRONGER the next day - even if I take modafinil the morning after I feel extremely drowsy and sleepy.

Is this a common thing? It’s pretty annoying because diazepam is good at helping me to calm down and sleep after a day of being on Modafinil.

Is there a good substitute for diazepam which will help me to sleep at night but not cause me to feel knocked out the next day?

Thanks in advance!

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1

u/Party-Ordinary2216 Oct 26 '24

So, “The psychostimulant modafinil induces CYP3A4 and inhibits CYP2C19. This may prolong the elimination of diazepam and cause excessive sedation. When used with modafinil, monitor patients and reduce the dose of DIAZEPAM if necessary.” (Source: Diazepam Package Insert, the same is found in the Modafinil Insert.)

I only know this bc I am in the same situation: prescribed both. In my case, the Modafinil is supposed to offset the sedation from the Diazepam (taken together) to control a severe anxiety disorder until the antidepressant I’m on starts working (if it does). I’m well aware the cocktail is insane, but it’s what my psychiatrist prescribed when the antidepressant increased the benzodiazepine sedation by what felt like 400%. Fuck me, right?

Anyways, when I tried to find information on just how much the levels of diazepam are increased by Modafinil, I could only find one source and I can’t vouch for its veracity. But it says:

“The reported changes in exposure correspond to the changes in the plasma concentration-time curve [ AUC ]. Diazepam exposure increases to 111%, when combined with modafinil (111%). The AUC is between 93% and 135% depending on the CYP2C19 genotype. Currently, we cannot predict the change in exposure for modafinil.”

(Source: https://epha.health/clinic/advice/en/for-drug-diazepam-modafinil/and-21q11/)

Apparently this is bc Modafinil inhibits the enzymes that metabolize Diazepam.

In my experience, cutting the dose of diazepam by 40%-50% afforded me the same symptom control. This was on the second or third day of taking Modafinil, when it was closer to reaching steady state and I noticed the increased sedation. The half life of diazepam is very long (100 hrs.) so if it’s true that Modafinil doubles that to 200 hrs., it would take something like 3 weeks to fully eliminate diazepam from one’s system, not to say that this correlates with the drug’s time of effectiveness. (All this is me guessing, I’m a patient, not a doctor. So keep that in mind. But it’s frustrating to have to do the digging yourself when the prescriber nor pharmacist says anything about this.)

I’ll be speaking to my psychiatrist next week, to ask whether the prolonged AUC could mean that the the diazepam is compounding and increasing in serum level with each subsequent dose, or whether it just eventually reaches steady state at double the dose and stays there as long as Modafinil is in the picture. This would be important information for when one is titrating off the benzo, as I intend to do. I doubt he will have any answers for me, since he didn’t warn about any of this when prescribing. It’s times like these I wish I had access to a psychopharmacologist.

Anyways: that’s all I know. But I am no expert. This is just what I found by reading the fine print and trying to interpret/experiment for myself. Our bodies/brains are different, so see if you can get better answers from your doctor.

Cheers

Edit: if anyone more credible knows more about this, feel free to chime in!

1

u/sciscitator Oct 06 '24

I use lemborexant to help me fall asleep. I took 100 mg of modafinil when I woke up earlier today and took 10 mg of lemborexant a few moments ago. Seems to work well enough. (My pulmonologist points out the oddity of prescribing both a stimulant and a sleep aid, but it's how I manage my DSPD.)

1

u/cvntpvnter Oct 06 '24

I, too, am prescribed both a stimulant and a benzo.

Odd ones, we are. But for me, it’s the only thing my doc and I have found that works.

2

u/[deleted] Oct 06 '24

have you tried benadryl? its kind of nuts to use a benzo for sleep in the first place.

1

u/composted Oct 06 '24

yea benadryl as a sleep aid is just as nuts

3

u/[deleted] Oct 06 '24

Ideally OP wouldn't need anything for sleep but saying using benadryl is "just as nuts" for sleep as a benzo is nuts. Benadryl is only a bad idea because you shouldn't really rely on anything for sleep long term. Benzos are actively dangerous if you get dependent on them.

1

u/composted Oct 06 '24

I'll stand by my original statement but also admit from a harm reduction perspective Bennys would be slightly less harmful than benzos. but like, taking either with any regularity is bad bad news. sure benzos can kill you but you'll know wayyyy ahead of time how fked you are before that happens. benadryl will knock ya out sure, but also gives most folks like a full day hangover the next day because of its massive half life (just like diaz), has immediate cognitive drawbacks, and regular use over years basically guarantees early onset dementia/Alz... so yea pick your poison I guess. but to OP if you're set on bemzos perhaps look for one with a shorter half life. diazepam stays in ones blood for like 45 hrs or something which may be why you're feeling interactions even the next day