Editing Modafinil (section)

====Sleep disorders====
{{See also|Sleep disorder}}
Modafinil, a [[eugeroic]] or [[wakefulness-promoting drug]], is primarily used for treating narcolepsy, a sleep disorder characterized by excessive daytime sleepiness and sudden sleep attacks.<ref name="pmid34743789">{{cite journal | vauthors = Maski K, Trotti LM, Kotagal S, Robert Auger R, Rowley JA, Hashmi SD, Watson NF | title = Treatment of central disorders of hypersomnolence: an American Academy of Sleep Medicine clinical practice guideline | journal = Journal of Clinical Sleep Medicine | volume = 17 | issue = 9 | pages = 1881–1893 | date = September 2021 | pmid = 34743789 | pmc = 8636351 | doi = 10.5664/jcsm.9328 }}</ref> Being a [[central nervous system]] (CNS) [[stimulant]] itself,<ref name="pmid38725665">{{cite journal |vauthors=Cid-Jofré V, Bahamondes T, Zúñiga Correa A, Ahumada Arias I, Reyes-Parada M, Renard GM |title=Psychostimulants and social behaviors |journal=Front Pharmacol |volume=15 |pages=1364630 |date=2024 |pmid=38725665 |pmc=11079219 |doi=10.3389/fphar.2024.1364630|doi-access=free }}</ref> modafinil has lower addictive potential than classical stimulants such as [[amphetamine]], [[cocaine]], or [[methylphenidate]],<ref name="pmid22375280">{{cite journal | vauthors = Kim D | title = Practical use and risk of modafinil, a novel waking drug | journal = Environmental Health and Toxicology | volume = 27 | pages = e2012007 | date = 2012 | pmid = 22375280 | pmc = 3286657 | doi = 10.5620/eht.2012.27.e2012007 }}</ref><ref name="pmid32927246">{{cite journal | vauthors = Tanda G, Hersey M, Hempel B, Xi ZX, Newman AH | title = Modafinil and its structural analogs as atypical dopamine uptake inhibitors and potential medications for psychostimulant use disorder | journal = Current Opinion in Pharmacology | volume = 56 | pages = 13–21 | date = February 2021 | pmid = 32927246 | pmc = 8247144 | doi = 10.1016/j.coph.2020.07.007 }}</ref><ref name="pmid33435717">{{cite journal |vauthors= Kakehi S, Tompkins DM |title=A Review of Pharmacologic Neurostimulant Use During Rehabilitation and Recovery After Brain Injury |journal=Ann Pharmacother |volume=55 |issue=10 |pages=1254–1266 |date=October 2021 |pmid=33435717 |doi=10.1177/1060028020983607 |s2cid=231593912 }}</ref> but still produces [[Psychoactive drug|psychoactive]] and subjective effects typical of classical stimulants.<ref name="Drugs.com-Monograph-2023" /><ref name="Provigil FDA label"/><ref name="pmid30285371"/>

Narcolepsy causes a strong urge to sleep during the day and can include symptoms like [[cataplexy]] (sudden muscle weakness), [[sleep paralysis]] (inability to move or speak while falling asleep or waking up), and [[hallucination]]s. Narcolepsy is linked to a lack of the brain chemical [[hypocretin]] ([[orexin]]), primarily produced in the [[hypothalamus]].<ref name="pmid35624073">{{cite journal | vauthors = Barateau L, Pizza F, Plazzi G, Dauvilliers Y | title = Narcolepsy | journal = Journal of Sleep Research | volume = 31 | issue = 4 | pages = e13631 | date = August 2022 | pmid = 35624073 | doi = 10.1111/jsr.13631 | s2cid = 251107306 }}</ref><ref name="pmid34031309">{{cite journal | vauthors = Anderson D | title = Narcolepsy: A clinical review | journal = JAAPA | volume = 34 | issue = 6 | pages = 20–25 | date = June 2021 | pmid = 34031309 | doi = 10.1097/01.JAA.0000750944.46705.36 | s2cid = 241205299 | doi-access = free | title-link = doi }}</ref> Modafinil is not a cure for narcolepsy, but it can help manage the symptoms. While modafinil is primarily used to treat excessive sleepiness, it may also help reduce the frequency and severity of cataplexy attacks in some people. Modafinil is approved for management of narcolepsy with or without cataplexy. However, it is not specifically approved for the treatment of cataplexy.<ref name="govuk-Modafinil Now restricted to narcolepsy"/><ref name="pmid28443381">{{cite journal |vauthors=Kallweit U, Bassetti CL |title=Pharmacological management of narcolepsy with and without cataplexy |journal=Expert Opin Pharmacother |volume=18 |issue=8 |pages=809–817 |date=June 2017 |pmid=28443381 |doi=10.1080/14656566.2017.1323877 |s2cid=1906751 }}</ref>

Modafinil is also prescribed for [[shift work sleep disorder]].<ref name="Provigil FDA label" />

Modafinil performs moderately (but better than [[armodafinil]] or [[solriamfetol]])<ref name="pmid39243682">{{cite journal |vauthors=Wang Y, Zhang W, Ye H, Xiao Y |title=Excessive daytime sleepiness in obstructive sleep apnea: Indirect treatment comparison of wake-promoting agents in patients adherent/nonadherent to primary OSA therapy |journal=Sleep Med Rev |volume=78 |issue= |pages=101997 |date=August 2024 |pmid=39243682 |doi=10.1016/j.smrv.2024.101997 |url=|doi-access=free }}</ref> as a drug to overcome [[excessive daytime sleepiness]] caused by [[obstructive sleep apnea]],<ref name="pmid38754208">{{cite journal |vauthors=Neshat SS, Heidari A, Henriquez-Beltran M, Patel K, Colaco B, Arunthari V, Lee Mateus AY, Cheung J, Labarca G |title=Evaluating pharmacological treatments for excessive daytime sleepiness in obstructive sleep apnea: A comprehensive network meta-analysis and systematic review |journal=Sleep Med Rev |volume=76 |issue= |pages=101934 |date=August 2024 |pmid=38754208 |doi=10.1016/j.smrv.2024.101934}}</ref> though it is recommended that people with apnea use [[continuous positive airway pressure]] (CPAP) therapy, that is a sleep breathing apparatus to prevent apnea, before starting modafinil.<ref name="Provigil FDA label" /><ref name="pmid32341841">{{cite journal | vauthors = Hashemian SM, Farhadi T | title = A review on modafinil: the characteristics, function, and use in critical care | journal = Journal of Drug Assessment | volume = 9 | issue = 1 | pages = 82–86 | date = 2020 | pmid = 32341841 | pmc = 7170336 | doi = 10.1080/21556660.2020.1745209 }}</ref><ref name="pmid18041479">{{cite journal | vauthors = Morgenthaler TI, Lee-Chiong T, Alessi C, Friedman L, Aurora RN, Boehlecke B, Brown T, Chesson AL, Kapur V, Maganti R, Owens J, Pancer J, Swick TJ, Zak R | title = Practice parameters for the clinical evaluation and treatment of circadian rhythm sleep disorders. An American Academy of Sleep Medicine report | journal = Sleep | volume = 30 | issue = 11 | pages = 1445–1459 | date = November 2007 | pmid = 18041479 | pmc = 2082098 | doi = 10.1093/sleep/30.11.1445 }}</ref> When obstructive sleep apnea is comorbid with narcolepsy, modafinil is an effective drug to reduce the associated excessive daytime sleepiness.<ref name="pmid39386319">{{cite journal |vauthors=Miano S, Kheirandish-Gozal L, De Pieri M |title=Comorbidity of obstructive sleep apnea and narcolepsy: A challenging diagnosis and complex management |journal=Sleep Med X |volume=8 |issue= |pages=100126 |date=December 2024 |pmid=39386319 |doi=10.1016/j.sleepx.2024.100126|pmc=11462365 }}</ref>

Modafinil's use varies by region. In the US, it is approved for adult narcolepsy, shift work sleep disorder, and obstructive sleep apnea, but not for children.<ref name="pmid30285371"/> In the UK and the EU, since 2014, it is approved solely for narcolepsy, including in children ([[pediatric narcolepsy]]), with its use for other conditions restricted by the European Medicines Agency.<ref name="govuk-Modafinil Now restricted to narcolepsy">{{cite web | url=https://www.gov.uk/drug-safety-update/modafinil-provigil-now-restricted-to-narcolepsy | title=Modafinil (Provigil): Now restricted to narcolepsy | work=[[Medicines and Healthcare products Regulatory Agency]] | access-date=December 2, 2023 | archive-date=December 15, 2023 | archive-url=https://web.archive.org/web/20231215212604/https://www.gov.uk/drug-safety-update/modafinil-provigil-now-restricted-to-narcolepsy | url-status=live }}</ref><ref name="Modafinil: Restricted use recommended">{{cite web | url=https://www.gov.uk/drug-safety-update/modafinil-restricted-use-recommended | title=Modafinil: Restricted use recommended | publisher=[[Medicines and Healthcare products Regulatory Agency]] | access-date=December 2, 2023 | archive-date=December 2, 2023 | archive-url=https://web.archive.org/web/20231202141511/https://www.gov.uk/drug-safety-update/modafinil-restricted-use-recommended | url-status=live }}</ref>

{{As of|2024|post=,}} both the French and the American Academy of Sleep Medicine strongly recommend modafinil as the first-choice treatment for narcolepsy.<ref name="pmid36921459">{{cite journal | vauthors = Arnulf I, Thomas R, Roy A, Dauvilliers Y | title = Update on the treatment of idiopathic hypersomnia: Progress, challenges, and expert opinion | journal = Sleep Medicine Reviews | volume = 69 | pages = 101766 | date = June 2023 | pmid = 36921459 | doi = 10.1016/j.smrv.2023.101766 | s2cid = 257214950 | doi-access = free | title-link = doi | url = https://hal.science/hal-04588723/document | access-date = July 13, 2024 | archive-date = August 6, 2024 | archive-url = https://web.archive.org/web/20240806000406/https://hal.science/hal-04588723/document | url-status = live }}</ref> In Europe, modafinil is considered one of the primary drugs recommended for treating narcolepsy according to the guidelines.<ref name="pmid37839272">{{cite journal |vauthors=Winter Y, Lang C, Kallweit U, Apel D, Fleischer V, Ellwardt E, Groppa S |title=Pitolisant-supported bridging during drug holidays to deal with tolerance to modafinil in patients with narcolepsy |journal=Sleep Med |volume=112 |pages=116–121 |date=December 2023 |pmid=37839272 |doi=10.1016/j.sleep.2023.10.005 |doi-access=free }}</ref>