Can Modafinil Cause Heart Palpitations?

Yes. Heart palpitations are a recognised adverse effect of modafinil. The drug can also affect heart rate and blood pressure, although feeling your heart race, pound, flutter, or skip does not by itself mean that an abnormal heart rhythm is present. (DailyMed)

How Common Are Heart Palpitations With Modafinil?

The PROVIGIL prescribing information includes pooled placebo-controlled trials involving 934 patients who received modafinil and 567 who received placebo for narcolepsy, obstructive sleep apnea, or shift work disorder.

Palpitations were reported by 2% of patients taking modafinil compared with 1% receiving placebo. Tachycardia was also reported in 2% versus 1%, while chest pain occurred in 3% versus 1%. The modafinil doses used in these trials were 200, 300, or 400 mg once daily. (DailyMed)

These percentages come from controlled trials and do not equal an individual’s exact probability of developing palpitations, since adverse-event rates observed in trials may differ from those seen in practice. (DailyMed)

Why Can Modafinil Cause a Racing or Pounding Heart?

Taneja et al. (2005) compared a single 400 mg dose of modafinil with placebo in 12 healthy participants. Modafinil increased resting heart rate by an average of 9.2 beats per minute, systolic blood pressure by 7.3 mmHg, and diastolic blood pressure by 5.3 mmHg. It also increased measures of norepinephrine and epinephrine activity. (PubMed)

These cardiovascular and catecholamine changes provide a plausible explanation for why modafinil can make the heartbeat feel faster or more forceful. The study used 400 mg in only 12 healthy participants, so the magnitude of these effects should not automatically be extrapolated to lower doses or to everyone who takes modafinil. (PubMed)

Do Modafinil Palpitations Mean You Have an Arrhythmia?

Not necessarily. Palpitations are sensations of a fast, pounding, fluttering, or skipped heartbeat. They can occur without a serious heart problem, although an arrhythmia is one possible cause. (Mayo Clinic)

Morgan and Malison (2008) reported a 40-year-old man who received 400 mg of modafinil on two consecutive mornings. Thirty to 60 minutes after each dose, he experienced mild anxiety, nausea, and a strong but not fast heartbeat. His measured pulse ranged from 68 to 82 beats per minute.

Later on the second day, after eating a meal estimated to contain a large amount of free glutamate, he developed chest tightness, anxiety, nausea, and a pounding heartbeat. Despite the pounding sensation, his pulse was 84 beats per minute, and emergency evaluation found no ECG changes or elevation in cardiac enzymes. His symptoms resolved within two hours. He was later restarted on 200 mg of modafinil and increased to 400 mg without another reported episode.

The authors proposed that an interaction between modafinil and the unusually high free-glutamate intake might have contributed to the more severe episode, so the report does not establish that modafinil alone caused those symptoms.

Can Modafinil Cause an Abnormal Heart Rhythm?

Premature Ventricular Contractions

Oskooilar (2005) reported a 54-year-old man who developed symptomatic premature ventricular contractions, or PVCs, while taking modafinil. A 24-hour Holter monitor recorded 1,695 PVCs. (PsychiatryOnline)

The PVCs subsided after modafinil was discontinued. Following a one-week PVC-free interval, the patient restarted the same dose, and the PVCs returned within 10 days. They again subsided after modafinil was stopped. (PsychiatryOnline)

PVCs are premature heartbeats that originate in the lower chambers of the heart and may be felt as skipped beats or thumps in the chest.

Ventricular Tachycardia

Mutlu et al. (2022) reported a 23-year-old woman who developed recurrent palpitations after taking modafinil 100 mg twice daily for approximately one month. Her evaluation found no structural heart disease or metabolic abnormality.

A 24-hour Holter monitor recorded 12,868 monomorphic PVCs and 11 episodes of non-sustained ventricular tachycardia, with the longest episode lasting eight beats. Modafinil was discontinued. Two weeks later, she was symptom-free and her ECG showed normal sinus rhythm. At one-month follow-up, Holter monitoring recorded 86 PVCs and no non-sustained ventricular tachycardia.

After investigating other common causes of PVCs and non-sustained ventricular tachycardia and observing substantial improvement after the drug was withdrawn, the authors considered modafinil-induced arrhythmia their final diagnosis.

How Serious Are Modafinil-Related Heart Palpitations?

Roth et al. (2007) pooled safety data from six randomized, double-blind, placebo-controlled studies involving 1,529 patients. A clinically significant increase in heart rate occurred in one patient receiving modafinil and one receiving placebo. New clinically meaningful ECG abnormalities occurred in two modafinil-treated patients and four placebo-treated patients. Clinically significant increases in blood pressure were also uncommon. (PubMed Central (PMC))

Those controlled data reflect how cardiovascular abnormalities appeared across larger groups, while the case reports of PVCs and ventricular tachycardia show that more significant rhythm disturbances have occurred in particular patients. Case reports cannot determine how often these events occur in people taking modafinil.

When Should Heart Palpitations Be Checked?

The PROVIGIL prescribing information states that increased monitoring of heart rate and blood pressure may be appropriate during treatment and advises caution in people with known cardiovascular disease. It also recommends considering cardiac evaluation if new findings such as chest pain, ischemic ECG changes, or arrhythmia develop. (DailyMed)

Mayo Clinic recommends emergency medical attention when heart palpitations occur with chest pain or discomfort, fainting, severe shortness of breath, or severe dizziness. (Mayo Clinic)

Palpitations that recur, become more frequent, or worsen can also warrant medical assessment. Heart-monitoring tests may be used to determine whether the symptoms correspond to an abnormal rhythm. (Mayo Clinic)

Bottom Line

Palpitations while taking modafinil do not by themselves establish that an arrhythmia is present. Persistent or recurring symptoms, particularly those accompanied by other cardiac symptoms, should be medically evaluated.

FAQs

Can modafinil increase your heart rate?

Yes. Increased heart rate has been demonstrated experimentally after modafinil administration. (PubMed)

Are heart palpitations a known side effect of modafinil?

Yes. Palpitations are listed among adverse reactions in the PROVIGIL prescribing information. (DailyMed)

Can modafinil cause PVCs?

PVCs have been reported during modafinil treatment, including a case in which they returned after the drug was restarted. (PsychiatryOnline)

Can modafinil cause ventricular tachycardia?

Yes. Non-sustained ventricular tachycardia has been documented in individual case reports involving modafinil.