AdrafinilvsNicotine

Adrafinil is a prodrug—it is pharmacologically inactive until metabolized by hepatic cytochrome P450 enzymes (primarily CYP3A4) and possibly esterases into modafinil (the active metabolite) and modafinilic acid (inactive byproduct). The conversion involves oxidation of the sulfinyl group. Once converted, adrafinil acts identically to modafinil: inhibition of the dopamine transporter (DAT), activation of orexin/hypocretin neurons in the lateral hypothalamus, increased histamine release from tuberomammillary nuclei, and elevation of norepinephrine and serotonin in cortical regions. The hepatic first-pass conversion step explains the delayed onset (45-60 minutes vs 20-30 for modafinil) and the concern about liver enzyme elevation and oxidative stress with chronic daily use.

Nicotine binds to nicotinic acetylcholine receptors (nAChRs), particularly the high-affinity alpha-4-beta-2 subtype predominant in the brain, causing conformational changes that open the cation channel and allow Na+ and Ca2+ influx, depolarizing the neuron. This triggers vesicular release of dopamine (VTA to nucleus accumbens and prefrontal cortex), norepinephrine (locus coeruleus), acetylcholine (basal forebrain), serotonin, and glutamate. Cognitive enhancement comes from increased acetylcholine in the prefrontal cortex and hippocampus (attention, working memory) and dopamine in mesocortical pathways (motivation, executive function). Nicotine upregulates BDNF through nAChR-mediated Ca2+ signaling and CREB activation, and has anti-inflammatory effects via microglial alpha-7 nAChRs. Neuroprotection may involve reduced excitotoxicity and enhanced neuronal survival pathways.