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Modafinil

CAT NO AQ-M013609
CAS NO 68693-11-8
Mol.F C15H15NO2S
Mol.Wt 273.4
Availability Custom Synthesis
Chemical name 2-(benzhydrylsulfinyl)acetamide

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Modafinil, sold under the brand name Provigil among others, is a central nervous system (CNS) stimulant medication used to treat narcolepsysleep apnea, and shift work sleep disorder.[3][7][14] It is taken by mouth.[3][7] Modafinil is a first-line treatment for narcolepsy in the United States and Europe.[15][16]

The mechanism of action is not fully understood, but modafinil acts mainly as an atypical dopamine reuptake inhibitor, increasing dopamine levels without the rapid signaling seen with classical stimulants such as amphetamine or cocaine.[17][9] Unlike these drugs, modafinil has low addiction and dependence potential and does not produce strong euphoria, which contributes to its classification as a Schedule IV controlled substance in the United States.[2][7][18] It is a prescription medication in most countries.[3]

Modafinil is generally well-tolerated; common side effects include headachenauseaanxiety, and insomnia.[19][20] Rare but serious adverse effects include severe skin reactions such as Stevens-Johnson syndrome.[21] Modafinil is contraindicated during pregnancy due to increased risk of birth defects.[22]

Modafinil is used off-label as a cognitive enhancer or “smart drug” by students and professionals seeking improved focus.[23][24] Research on cognitive effects in non-sleep-deprived individuals has yielded mixed results.[25][18] The drug is banned in competitive sports by the World Anti-Doping Agency.[26]

Developed in France in the 1970s by neurophysiologist Michel Jouvet, modafinil was approved for medical use in France in 1994 and in the United States in 1998.[9][7][27] Generic versions became available in the US in 2012.[28]

Uses

Medical

Sleep disorders

Modafinil, a eugeroic or wakefulness-promoting drug, is used for treating narcolepsy, a sleep disorder characterized by excessive daytime sleepiness and sudden sleep attacks.[16] Being a central nervous system (CNS) stimulant itself,[29] modafinil has lower addictive potential than classical stimulants such as amphetaminecocaine, or methylphenidate,[12][30][31] but still produces psychoactive and subjective effects typical of classical stimulants.[3][7][20]

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 hallucinations. Narcolepsy is linked to a lack of the brain chemical hypocretin (orexin), primarily produced in the hypothalamus.[32][33] Modafinil is not a cure for narcolepsy, but it can help manage the symptoms. While modafinil is 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.[34][35]

Modafinil is also prescribed for shift work sleep disorder, a condition affecting people who work rotating or night shifts and experience excessive sleepiness during work hours and difficulty sleeping during the day.[7] Clinical trials have shown modafinil improves wakefulness and reduces accidents in shift workers, though it does not fully normalize alertness levels.[36]

Modafinil performs moderately (but better than armodafinil or solriamfetol)[37] as a drug to overcome excessive daytime sleepiness caused by obstructive sleep apnea,[38] 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.[7][18][39] When obstructive sleep apnea is comorbid with narcolepsy, modafinil is an effective drug to reduce the associated excessive daytime sleepiness.[40]

As of 2024, both the French and the American Academy of Sleep Medicine strongly recommend modafinil as the first-choice treatment for narcolepsy.[15] In Europe, modafinil is considered one of the primary drugs recommended for treating narcolepsy according to the guidelines.[41]

Fatigue is a common and often debilitating symptom experienced by people with MS.[42][43]

Reviews and meta-analyses of controlled trials have found that modafinil has modest effectiveness in managing MS-related fatigue, though improvements in fatigue severity scores have not consistently reached statistical significance.[44][45] Optimal dosing and treatment schedules are not well established.[45][46] Clinical assessments have found that adverse events were common.[44][47] The American National Multiple Sclerosis Society states that modafinil can be used off-label to alleviate fatigue associated with MS.[48]

Attention deficit hyperactivity disorder

Modafinil is occasionally prescribed off-label for individuals with attention deficit hyperactivity disorder (ADHD).[49][50][51] It has not consistently shown efficacy in treating adult ADHD,[52] especially when compared to other treatments such as lisdexamfetamine.[53][54] In children, modafinil shows efficacy for ADHD symptoms in clinical trials, though it is less effective than first-line treatments such as methylphenidate and amphetamines.[55][56]

Modafinil is considered a second-line treatment for comorbid ADHD and bipolar disorder, after psychostimulants and bupropion.[57]

Bipolar disorder

Modafinil is used off-label as an adjunctive treatment for the acute depressive phase of bipolar disorder.[58][59][60] Meta-analyses have found that add-on modafinil and armodafinil are more effective than placebo for treatment response and remission, with low rates of mood switching to mania, but the effect sizes are small and the quality of evidence is low.[61][62][63] Modafinil may also have cognitive benefits in people with bipolar disorder who are in remission.[52]

Occupational

Military forces in several countries, including France, the United States, and the United Kingdom, have used modafinil as an alternative to amphetamines for managing fatigue during combat operations and extended missions.[64][65][66][67] The US Air Force approved modafinil for specific missions as a fatigue countermeasure.[68] Modafinil is also available to astronauts aboard the International Space Station for fatigue management.[69]

Non-medical

Modafinil has been used non-medically as a “smart drug”[23][24] by various groups, including students,[70][71][72] office workers, and transhumanists.[73][74]

Some studies suggest significant increases in cognitive abilities, while others indicate mild to nonexistent cognitive improvements.[58][75] In some cases, it has been associated with impairments in certain cognitive functions.[25][18][76] It has been shown that a positive impact on cognitive abilities is more noticeable on sleep-deprived individuals.[77] Therefore, in people who are not sleep-deprived, the potential of modafinil as a cognitive enhancer may be limited.[78]

Sports

The regulation of modafinil as a doping agent has been controversial in the sporting world, with high-profile cases attracting press coverage since several prominent American athletes tested positive for the substance. Some athletes who used modafinil protested that the drug was not on the prohibited list at the time of their offenses.[79] However, the World Anti-Doping Agency (WADA) maintains that modafinil was related to already-banned substances. The Agency added modafinil to its list of prohibited substances on August 3, 2004, ten days before the start of the 2004 Summer Olympics.[26]

Several athletes across track and field, cycling, basketball, and rowing have tested positive for modafinil and faced sanctions, with some cases resulting in stripped medals and bans.[80][81][82]

The BALCO scandal brought to light an unsubstantiated (but widely published) account of Major League Baseball’s all-time leading home-run hitter Barry Bonds‘ supplemental chemical regimen that included modafinil in addition to anabolic steroids and human growth hormone.[83]

Available forms

Modafinil tablets – Modalert 200 (Sun Pharma)

Modafinil is commercially available in 100 mg and 200 mg oral tablet forms.[7] Additionally, it is offered as the (R)-enantiomer, known as armodafinil, and as a prodrug named adrafinil.[84]

Pharmacology

Pharmacodynamics

Modafinil activity profile
Site Potency Type Species Refs
DATTooltip Dopamine transporter 1.8–2.6 μM
4.8 μM
6.4 μM
4.0 μM
Ki
Ki
IC50a
IC50a
Human
Rat
Human
Rat
[85][86]
[85]
[87][88]
[85]
NETTooltip Norepinephrine transporter >10 μM
>92 μM
35.6 μM
136 μM
Ki
Ki
IC50a
IC50a
Human
Rat
Human
Rat
[85][86]
[85]
[87][88]
[85]
SERTTooltip Serotonin transporter >10 μM
46.6 μM
>500 μM
>50 μM
Ki
Ki
IC50a
IC50a
Human
Rat
Human
Rat
[85][86]
[85]
[87][88]
[85]
D2 >10 μM
16 μMb
120 μMb
Ki
Ki
EC50a
Human
Rat
Rat
[85]
[89]
[89]
Footnotes: a = Functional activity, not binding inhibition. b = Armodafinil at D2HighNotes: No activity at a variety of other assessed targets.[85]

Modafinil’s precise mechanism of action in narcolepsy and other sleep disorders remains incompletely understood.[3][90][91] Nevertheless, evidence from animal and human studies indicates that modafinil acts primarily as an atypical dopamine transporter (DAT) inhibitor or dopamine reuptake inhibitor (DRI), producing a modest increase in extracellular dopamine in cortical and striatal brain regions without inducing the rapid dopamine signaling characteristic of classical stimulants such as amphetamine or cocaine.[17]

This modest dopaminergic effect is accompanied by broader downstream activation of arousal-related neurotransmitter systems. Modafinil increases noradrenergic tone in wakefulness-promoting nuclei and indirectly engages hypothalamic orexin and histamine pathways, which together help stabilize the sleep–wake regulatory network and support sustained alertness.[92][90] Although modafinil interacts with multiple neurotransmitter systems, its exact mode of action at the molecular level remains uncertain

Modafinil

Item No. 15417

Product Relationships
Synonyms
Synonyms
  • CEP-1538
  • CRL 40476
  • (±)-Modafinil
Technical Information
Formal Name
2-[(diphenylmethyl)sulfinyl]-acetamide
CAS Number
68693-11-8
Molecular Formula
C15H15NO2S
Formula Weight
Purity
≥98%
Formulation
A crystalline solid
DMF: 20 mg/mlDMSO: 20 mg/mlDMSO:PBS(pH7.2) (1:1): 0.5 mg/mlEthanol: 0.25 mg/mlMethanol: 1 mg/ml
SMILES
O=S(CC(N)=O)C(C1=CC=CC=C1)C2=CC=CC=C2
InChi Code
InChI=1S/C15H15NO2S/c16-14(17)11-19(18)15(12-7-3-1-4-8-12)13-9-5-2-6-10-13/h1-10,15H,11H2,(H2,16,17)
InChi Key
YFGHCGITMMYXAQ-UHFFFAOYSA-N
Regulatory Information
DEA Schedule
IV
Shipping & Storage Information
Storage
-20°C
Shipping
Room temperature in continental US; may vary elsewhere
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