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Nuvigil AM and another stimulant PM? Unheard of?


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So I take nuvigil 200 mg in the morning. But it wears off early to mid late afternoon, leaving me a lump and unable to do anything but crawl into bed and lay around until I go to bed at like 6 pm. Which is way too early. And I shouldn’t have to spend my days in bed either.

Nuvigil helps me greatly during the morning to the early afternoon. I was thinking of calling my sleep dr and asking her my options. One possibly being adding a small dose of a stimulant in the afternoon so I could combat this afternoon hump that I can’t seem to get over. This happens year round. I’ve just let myself get used to it. But recently I’ve wondered if things could be better for me. 

Does anyone have any suggestions on meds that I could take with nuvigil? Anyone on an afternoon stimulant dose? Is it unheard of to mix nuvigil with like a dose of adderal in the afternoons (or something like that)?

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No it's not unheard of to mix Nuvigil with stimulants. My pdoc used to do with for me. It worked amazingly, but I didn't know about copay cards and it was when Nuvigil was brand-name only, so I was paying full-copay for Nuvigil. But man, when I was on that combo, I felt amazing! I was on Nuvigil 250 mg though, and Adderall 40 mg. I don't know if adding that extra 50 mg of Nuvigil would benefit you any in your dosage.

I know that Provigil is often dosed twice daily. I don't know of Nuvigil is ever done that way, maybe you could ask your sleep doctor about taking Nuvigil twice daily? It would definitely need a prior authorization in your insurance's part, but it might be worth it. You could do like 150 mg twice daily or something like that... Or maybe 200-250 mg in the AM and 50 mg or 150 mg in the PM...

But there is certainly no reason why you couldn't add a small dose of Adderall (like 5-10 mg or so at first, just to see how you tolerate it) to your PM schedule, that is unless it would destabilize you.

Either way would be worth a try I think.

Edited by mikl_pls
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2 hours ago, Wonderful.Cheese said:

So I take nuvigil 200 mg in the morning. But it wears off early to mid late afternoon, leaving me a lump and unable to do anything but crawl into bed and lay around until I go to bed at like 6 pm. Which is way too early. And I shouldn’t have to spend my days in bed either. 

Maybe you could try taking 100mg of the nuvigil in morning, and 100mg at noon?

I have no experience with nuvigil, so you would need to ask pdoc or sleep doc about doing that....

Just a thought.......

Edited by CrazyRedhead
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6 hours ago, mikl_pls said:

No it's not unheard of to mix Nuvigil with stimulants. My pdoc used to do with for me. It worked amazingly, but I didn't know about copay cards and it was when Nuvigil was brand-name only, so I was paying full-copay for Nuvigil. But man, when I was on that combo, I felt amazing! I was on Nuvigil 250 mg though, and Adderall 40 mg. I don't know if adding that extra 50 mg of Nuvigil would benefit you any in your dosage.

I know that Provigil is often dosed twice daily. I don't know of Nuvigil is ever done that way, maybe you could ask your sleep doctor about taking Nuvigil twice daily? It would definitely need a prior authorization in your insurance's part, but it might be worth it. You could do like 150 mg twice daily or something like that... Or maybe 200-250 mg in the AM and 50 mg or 150 mg in the PM...

But there is certainly no reason why you couldn't add a small dose of Adderall (like 5-10 mg or so at first, just to see how you tolerate it) to your PM schedule, that is unless it would destabilize you.

Either way would be worth a try I think.

Thanks for your help! I will call my sleep doc tomorrow. Do you happen to know if nuvigil can be split in half? I’m thinking that is what she is going to want to try first. Although I’d prefer like a dose of 10 mg of adderall to try first. I can ask but I kinda see her heading that way already. And I don’t know if that would prove helpful anyway by just splitting the dose. Hmm 

5 hours ago, CrazyRedhead said:

Maybe you could try taking 100mg of the nuvigil in morning, and 100mg at noon?

I have no experience with nuvigil, so you would need to ask pdoc or sleep doc about doing that....

Just a thought.......

Your idea is sound. And I believe my sleep doc will probably go for this idea first. I don’t know if this will be beneficial or not but I guess I will have to try it and see. I just got a 90 day supply of the 200 mg tablets so I’m wondering if I can split them safely? I hate to waste. Plus I don’t think there is a 100 mg nuvigil tablet. I could be wrong but I don’t think so. 

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1 hour ago, Wonderful.Cheese said:

 Your idea is sound. And I believe my sleep doc will probably go for this idea first. I don’t know if this will be beneficial or not but I guess I will have to try it and see. I just got a 90 day supply of the 200 mg tablets so I’m wondering if I can split them safely? I hate to waste. Plus I don’t think there is a 100 mg nuvigil tablet. I could be wrong but I don’t think so. 

I looked it up and there is no 100mg Nuvigil tablet available.......I don't know if you can split the 200mg tablet equally, though.

I would say discuss this with sleep doc/pdoc.......Do they know about the Nuvigil wearing off so quickly for you?

Edited by CrazyRedhead
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6 hours ago, Wonderful.Cheese said:

Thanks for your help! I will call my sleep doc tomorrow. Do you happen to know if nuvigil can be split in half? I’m thinking that is what she is going to want to try first. Although I’d prefer like a dose of 10 mg of adderall to try first. I can ask but I kinda see her heading that way already. And I don’t know if that would prove helpful anyway by just splitting the dose. Hmm

Yes, it can be split. My pdoc wanted me to split Nuvigil if I felt I didn't need the whole 250 mg I was taking.

6 hours ago, CrazyRedhead said:

I looked it up and there is no 100mg Nuvigil tablet available.......I don't know if you can split the 200mg tablet equally, though.

I would say discuss this with sleep doc/pdoc.......Do they know about the Nuvigil wearing off so quickly for you?

There is a 150 mg tablet though!

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16 hours ago, CrazyRedhead said:

I looked it up and there is no 100mg Nuvigil tablet available.......I don't know if you can split the 200mg tablet equally, though.

I would say discuss this with sleep doc/pdoc.......Do they know about the Nuvigil wearing off so quickly for you?

Yes. I recently saw my sleep doc and she said that I’m so young she doesn’t want to increase the nuvigil. She wants to save that as an absolute last resort. Which I can see her point. 

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10 hours ago, Gatorgirl said:

Hey Cheese! I think I remember reading where you posted that you take 4 APs right? What about reducing those first to see if that helps with wakefulness? Just a thought. Plus I’ve never heard of anyone on 4 APs! It seems so counterproductive... if you can’t do that though I don’t see why they wouldn’t try you on a small dose of Adderall. I tried it once at 10 mg and it only gave me energy and anxiety for a couple hours..

Hi! Yes, unfortunately I’m on 4 AAP’s still. My Tdoc just read a note to me that was written by my pdoc. In pdoc’s note, she wrote that she was not going to reduce any of my other AAP’s (the abilify or the Invega, with the Invega being tossed away first). I am apparently going to remain on seroquel XR and I’m in the process of titrating up on clozapine. So someday way down the line I’ll just be on two AAP’s, seroquel XR and clozapine. But pdoc won’t remove abilify or Invega until I show a good amount of improvement in psychosis, mood, and anxiety. My mood is good but the damn anxiety and what they see as psychosis is not good.

Your theory makes absolute sense to me. Remove the two other AAP’s and see if that helps with the sedation. I know abilify and Invega aren’t specifically known for lots of sedation but removing them might help. You never know. I think that should be the route to go instead of adding pills. You are correct. The only other option I see is to spilt the nuvigil in half if my sleep doc says it’s ok and see if that helps the late afternoon and evening tiredness/unable to do anything, etc.

Thanks for the perspective!

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10 hours ago, mikl_pls said:

Yes, it can be split. My pdoc wanted me to split Nuvigil if I felt I didn't need the whole 250 mg I was taking.

There is a 150 mg tablet though!

Ah ok! It’s good to know that the nuvigil can be split! Thanks! So maybe this splitting tablets business to take 100 mg AM and 100 mg afternoon is the way to go.

I just got a 90 day supply plus I still have a whole bottle of 30 days to go through of 200 mg tablets of the nuvigil. So I’m hoping sleep doc says I can just split them. I hate to waste all that.

I have 5 questions:

1. Did you ever try splitting them @mikl_pls?

2. Were they difficult to split (did they turn into crumbs everywhere)?

3. Did you find it helpful to split them?

4.Did you get any more side effects by splitting them, or was it just the same (any increased irritability or increased anxiety or trouble sleeping)?

5.What times did you take your split doses (like one in the AM but what time did you take the afternoon one?)

Sorry to bombard you with questions! I just what to be prepared when I call my sleep doc! I get nervous on the phone so I like to have a game plan!

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I took a quarter of a pill. Or 25 mg of nuvigil around an hour ago or so. I feel more awake and alert.

I feel lazy still, like I have not much motivation, but maybe I can get my butt to crochet a bit.

I hope I can stay up til 8 or 9 pm even! That's really late for me! I get up at 6 AM or so. 

I am definitely calling sleep Dr tomorrow. I want to get her opinion if I can just split my current dose of if I need to add an afternoon dose of something. 

Edited by Wonderful.Cheese
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8 hours ago, Wonderful.Cheese said:

Ah ok! It’s good to know that the nuvigil can be split! Thanks! So maybe this splitting tablets business to take 100 mg AM and 100 mg afternoon is the way to go.

I just got a 90 day supply plus I still have a whole bottle of 30 days to go through of 200 mg tablets of the nuvigil. So I’m hoping sleep doc says I can just split them. I hate to waste all that.

I have 5 questions:

1. Did you ever try splitting them @mikl_pls?

2. Were they difficult to split (did they turn into crumbs everywhere)?

3. Did you find it helpful to split them?

4.Did you get any more side effects by splitting them, or was it just the same (any increased irritability or increased anxiety or trouble sleeping)?

5.What times did you take your split doses (like one in the AM but what time did you take the afternoon one?)

Sorry to bombard you with questions! I just what to be prepared when I call my sleep doc! I get nervous on the phone so I like to have a game plan!

  1. I never really did split them that often.
  2. They weren't difficult to split with a pill splitter (no crumbs or anything, didn't explode, etc.)
  3. I didn't personally find it helpful to split them, as I was only told to split them if I didn't need the whole dose.
  4. No increased side effects from splitting them.
  5. I only took one split dose in the AM. However, when I was on Provigil taking split doses, I would take them 4 hours apart (like 9 AM and 1 PM). I suppose if you take your first dose earlier, that you could probably take your second dose a little later (up to 6 hours later?).

 

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20 hours ago, mikl_pls said:
  1. I never really did split them that often.
  2. They weren't difficult to split with a pill splitter (no crumbs or anything, didn't explode, etc.)
  3. I didn't personally find it helpful to split them, as I was only told to split them if I didn't need the whole dose.
  4. No increased side effects from splitting them.
  5. I only took one split dose in the AM. However, when I was on Provigil taking split doses, I would take them 4 hours apart (like 9 AM and 1 PM). I suppose if you take your first dose earlier, that you could probably take your second dose a little later (up to 6 hours later?).

 

My sleep Dr said, nuvigil is supposed to be taken once daily and I should not split it. If I want to split a med I have to go back to provigil which made me an irritable crazy just insane ramped up lady.

She was going to increase nuvigil to 250 mg but that is not going to help! I asked and she said that would make it last longer. BS. 

I then asked if I could try taking it later like 8 AM. I don't want to increase it necessarily. Since this dose is working still, just not long enough. 

So I'll being defiant and I'm going to try splitting it. I don't give a crap. She doesn't care or know anything. 

I obviously sleep fine with the number of meds I'm on. I can go back to the morning only dose maybe once I'm off some other meds. 

Edited by Wonderful.Cheese
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Does anyone think my plan is reasonable (to continue to split the nuvigil into two daily doses)? I mean it's better than tossing more meds or an increase in meds at me, am I correct? Because once I'm at 250 mg that's as high as she will go. And I kinda think that that dose might be too much for me to handle mentally. 

There are no physical harm or other concerns I should know about, correct? It's not an extended release med that shouldn't be split, right? I see no harm in trying this. I don't understand why she is being so stubborn when this obviously is a good option. 

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Call your pharmacy and ask if it can be cut.  

Otherwise, If it were me I would do what i have to do till I can see the doc and figure out a better plan of action.

Edited by gb84
I'm terrible at advice
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16 hours ago, gb84 said:

Call your pharmacy and ask if it can be cut.  

Otherwise, If it were me I would do what i have to do till I can see the doc and figure out a better plan of action.

I am going to not cut it in half without dr approval I’ve decided. I am just going to take it as is in the morning.

But I am going to call back sleep dr and ask her if I could try a small dose of something like adderall in the afternoon, as that would be a compromise. I wouldn’t be increasing the nuvigil and I wouldn’t be splitting it and I would not have to go back to Provigil which made me absolutely crazy. I hope she goes for this. Otherwise she has basically given me zero workable options.  I have a bad feeling she will leave me stuck.

The dose increase won’t magically make nuvigil last longer.  

The provigil makes me crazy. 

I can’t take it later in the morning because how am I supposed to wake up and get up and go?

Or maybe what I need is an AD to help give me some oomph. And to steer me away from the darkness. I hoping pdoc listens to my trintellix request.  If not I’ll really be stuck. I’ll wait to hear from pdoc before I call Sleep doc

Edited by Wonderful.Cheese
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