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Research · Medication

Modafinil and armodafinil

In narcolepsy, sleep apnea and shift work disorder, modafinil and armodafinil kept people awake a few minutes longer on lab tests and lowered sleepiness scores against placebo. In rested healthy adults, pooled trials found a very small gain on cognitive tests, an effect size near 0.1. Headache, nausea and insomnia were more frequent, and serious rash is rare.

Add to Bio HackChecked 2026-11-13
Status
Prescription drugs in the US and Schedule IV controlled substances. Modafinil and armodafinil are FDA-approved to improve wakefulness in adults with excessive sleepiness from narcolepsy, obstructive sleep apnea or shift work disorder. In sleep apnea the label states they treat the sleepiness, not the blocked airway. Neither is approved for focus or alertness in people without a sleep disorder. Neither label carries a boxed warning.
Also called
modafinil, Provigil, armodafinil, Nuvigil, R-modafinil, eugeroic, wakefulness-promoting agent, smart drug
Taken for
narcolepsy sleepiness, ADHD, shift work sleepiness, sleep apnea sleepiness despite CPAP, focus, concentration, alertness, studying, working through sleep loss, fatigue, depression add-on, nootropic

Strong several reviews agree · Moderate one review or consistent trials · Limited one or a few small studies · Untested no study in people, listed with what it rests on

Shown to help6

Reported risks11

What people take it for, and what was found

Shown to help6

StrongVery common

Daytime sleepiness in narcolepsy

Shown to reduce daytime sleepiness in adults with narcolepsy, about 3 points on the Epworth scale and 3 minutes longer awake on a lab test, but not cataplexy.

Compared with placebo [1][2][3]; sodium oxybate in one comparison [1]

The numbers and sources
How common
Very common: more than 1 in 10 people.
Effect
Against placebo, modafinil lowered Epworth Sleepiness Scale scores by 2.73 points (95% CI 2.08 to 3.39) and lengthened time to fall asleep on the Maintenance of Wakefulness Test by 2.82 minutes (95% CI 2.40 to 3.24). It did not change the number of cataplexy attacks a day. Its effect on sleepiness was similar to sodium oxybate's [1]. An updated meta-analysis found 3.56 more minutes on the Maintenance of Wakefulness Test (95% CI 2.25 to 4.86) and a 3.34-point drop on the Epworth scale (95% CI 2.56 to 4.13) [2]. In the two label trials, 58% to 72% on modafinil were rated improved against 37% to 38% on placebo [3].
Population
1,054 patients in 9 randomized trials [1]; 997 adults in 5 trials pooled, out of 9 studies reviewed [2]; 558 adults in two 9-week US trials [3].
Sources
[1], [2], [3]
Caveats
The 2026 review notes the randomized trials date mostly from the 1990s and early 2000s, with no new eligible trials in the past decade, and that long-term efficacy is not established [2]. Patients on modafinil still averaged well below normal wakefulness on the lab test [3].
StrongVery common

Sleepiness in sleep apnea despite CPAP

Shown to reduce residual sleepiness in sleep apnea, about 2 to 3 points on the Epworth scale, with about three times the adverse events of placebo.

Compared with placebo, on top of CPAP [3][4][5]

The numbers and sources
How common
Very common: more than 1 in 10 people.
Effect
Modafinil or armodafinil improved Epworth Sleepiness Scale scores by 2.2 points (95% CI 1.5 to 2.9) and Maintenance of Wakefulness Test times by 3 minutes (95% CI 2.1 to 3.8) over placebo. Adverse events tripled and withdrawals for adverse events doubled, with no rise in hospitalizations or deaths [4]. A second meta-analysis found Epworth scores lower by 2.96 points with modafinil (95% CI 2.19 to 3.73) and 2.63 with armodafinil (95% CI 1.85 to 3.40) [5]. In the 12-week label trial, 61% on modafinil 200 mg and 68% on 400 mg were rated improved against 37% on placebo [3].
Population
1,466 patients in 10 trials of at least 2 weeks [4]; 723 patients in 11 modafinil trials and 1,009 in 5 armodafinil trials [5]; 327 adults with sleep apnea, 80% fully using CPAP [3].
Sources
[3], [4], [5]
Caveats
The European Medicines Agency removed this indication in 2011 over an unfavorable balance of benefit and risk, which the first review sought to re-examine [4]. The drug treats sleepiness, not the airway obstruction [3].
ModerateVery common

Sleepiness in shift work disorder

Shown to reduce sleepiness on night shifts in people diagnosed with shift work disorder, about 1 point on a 10-point scale. No trials tested shift workers without the disorder.

Compared with placebo [6][7][8]

The numbers and sources
How common
Very common: more than 1 in 10 people.
Effect
Armodafinil taken before the night shift lowered Karolinska Sleepiness Scale scores by 0.99 points (95% CI 0.67 to 1.32, range 1 to 10) and sped simple reaction time by 50 milliseconds at 3 months. Modafinil lowered the same score by 0.90 points (95% CI 0.35 to 1.45) [7]. In the pivotal 3-month trial, modafinil 200 mg lengthened nighttime time to fall asleep by 1.7 minutes against 0.3 on placebo, and 74% against 36% were rated clinically improved [8]. The armodafinil label reports the same kind of trial results for 150 mg [6].
Population
2 armodafinil trials with 572 participants and 1 modafinil trial with 183, within a Cochrane review of 15 trials and 718 shift workers [7]; 209 patients with shift work disorder [8].
Sources
[6], [7], [8]
Caveats
The trial authors noted that treated patients remained very sleepy at night [8]. The Cochrane review found no trials in shift workers without a diagnosed disorder, and rated the evidence moderate quality [7].
Strong

Focus and memory in rested healthy adults

Shown to improve cognitive test scores in rested healthy adults by a very small amount, an effect size near 0.1, with no clear advantage in any one domain.

Compared with placebo [9][10][11]

The numbers and sources
Effect
Across 19 placebo-controlled trials of a single dose, modafinil improved cognitive performance over placebo by g = 0.10 (95% CI 0.05 to 0.15). Domains did not differ, and 200 mg did no better than 100 mg [9]. A second meta-analysis found an overall effect of SMD 0.12, driven by memory updating (SMD 0.28), and its authors wrote that the belief among users that these drugs are strong cognitive enhancers is not supported [10]. A systematic review found most basic tests showed better executive function, half showed better attention and memory, and a few showed worse divergent creative thinking. It found no excess of side effects or mood changes [11].
Population
19 trials and 67 effect sizes in adults who were not sleep deprived [9]; 14 modafinil studies with 64 effect sizes in healthy adults who were not sleep deprived [10]; primary studies in healthy adults from 1990 to 2014 [11].
Sources
[9], [10], [11]
Caveats
Most trials tested one dose in a lab, not repeated use as people take it [10]. An effect size of 0.1 is about a tenth of a standard deviation on a test score. [9] included some psychiatric samples and found no difference from nonpsychiatric ones.
Moderate

Alertness and performance during sleep deprivation

Shown to keep sleep-deprived healthy people awake and to hold memory and executive function better than placebo, though repeated doses did not prevent decline over longer deprivation.

Compared with placebo [12]

The numbers and sources
Effect
In sleep-deprived individuals, modafinil maintained wakefulness, memory and executive function to a significantly greater degree than placebo. Over longer sleep deprivation, repeated doses did not prevent cognitive performance from deteriorating, while wakefulness was maintained and people possibly became overconfident about their own performance [12].
Population
Healthy adults in single- or double-blind randomized trials [12].
Sources
[12]
Caveats
One meta-analysis, and the abstract does not give pooled effect sizes or head counts [12].
Moderate

Depression, as an add-on

Shown to improve depression scores and remission modestly when added to standard treatment, in unipolar and bipolar depression, an off-label use.

Compared with placebo added to standard treatment [15][16]

The numbers and sources
Effect
Added to first-line treatment, modafinil improved overall depression scores (point estimate -0.35, 95% CI -0.61 to -0.10) and remission (OR 1.61, 95% CI 1.04 to 2.49), with a positive effect on fatigue and adverse events no different from placebo [15]. In bipolar depression, added modafinil or armodafinil raised response (RR 1.18, 95% CI 1.01 to 1.37) and remission (RR 1.38, 95% CI 1.10 to 1.73), with no rise in mood switching or suicide attempts [16].
Population
910 adults with major depressive disorder or bipolar depression in 6 trials [15]; 795 on drug and 792 on placebo in 5 bipolar depression trials, 4 of them of armodafinil [16].
Sources
[15], [16]
Caveats
Few trials. Both reviews included bipolar trials, so they overlap. Not an FDA-approved use.

Mixed results2

Moderate

Fatigue in neurological conditions

Mixed results: one review found less fatigue in multiple sclerosis, and an earlier review found benefit only after brain injury and not in multiple sclerosis or Parkinson's.

Compared with placebo [13][14]

The numbers and sources
Effect
Across 10 trials, modafinil lowered fatigue after traumatic brain injury (MD -0.82, 95% CI -1.54 to -0.11) and sleepiness in Parkinson's disease (MD -2.45 on the Epworth scale), but fatigue did not differ from placebo in pooled Parkinson's or multiple sclerosis studies [13]. A later review of 7 studies in multiple sclerosis found lower Modified Fatigue Impact Scale scores (MD -4.42, 95% CI -8.01 to -0.84) and more adverse events (RR 1.30) [14].
Population
535 patients with Parkinson's disease, multiple sclerosis, brain injury or post-polio syndrome in 10 trials [13]; 7 controlled studies in multiple sclerosis [14].
Sources
[13], [14]
Caveats
Most trials were small [13]. The two reviews disagree on multiple sclerosis, and neither studied fatigue in people without a diagnosed condition.
Moderate

ADHD

Mixed results: in a network meta-analysis, modafinil reduced ADHD symptoms in children on clinician and teacher ratings but did not differ from placebo in adults.

Compared with placebo, and other ADHD drugs in a network analysis [17]

The numbers and sources
Effect
In children and adolescents, every drug in the analysis, modafinil included, beat placebo on clinician ratings, and modafinil was one of two drugs that beat placebo on teacher ratings (SMD -0.76, 95% CI -1.15 to -0.37). In adults, modafinil did not differ from placebo (SMD 0.16, 95% CI -0.28 to 0.59) and was less well tolerated than placebo (OR 4.01). Amphetamines outperformed modafinil head to head [17].
Population
133 double-blind trials in children, adolescents and adults with ADHD [17].
Sources
[17]
Caveats
Most comparisons were indirect and rated low or very low confidence [17]. Modafinil is not FDA-approved for ADHD.

Doses studied

The modafinil label gives 200 mg once in the morning for narcolepsy and sleep apnea, and 200 mg about one hour before the shift for shift work disorder. The label states 400 mg a day was tolerated but gave no consistent extra benefit over 200 mg [3]. The armodafinil label gives 150 to 250 mg in the morning for sleep apnea and narcolepsy, and 150 mg before the shift for shift work disorder [6]. The pooled trials in rested healthy adults gave single doses, mostly 100 or 200 mg, and found no difference between them [9]. The shift work trial gave 200 mg before each shift for 3 months [8].

Risks

Reported risks10

ModerateVery common

Headache

Shown to raise headache in placebo-controlled trials, 34% on modafinil against 23% on placebo, and more at higher doses.

The numbers and sources
How common
Very common: more than 1 in 10 people.
Effect
In pooled placebo-controlled trials, headache occurred in 34% on modafinil against 23% on placebo, and was dose related across 200, 300 and 400 mg. Headache was the most frequent reason for stopping (2%) [3]. On armodafinil, headache occurred in 17% against 9% [6].
Population
934 adults on modafinil and 567 on placebo in narcolepsy, sleep apnea and shift work trials [3]; 645 on armodafinil and 445 on placebo [6].
Sources
[3], [6]
Caveats
Trials ran 4 to 12 weeks in people with sleep disorders.
ModerateVery common

Nausea and other common side effects

Shown to raise nausea, 11% on modafinil against 3% on placebo, along with smaller rises in appetite loss, dry mouth and diarrhea. 8% stopped for side effects.

The numbers and sources
How common
Very common: more than 1 in 10 people.
Effect
In pooled trials, nausea occurred in 11% vs 3% on placebo, anorexia in 4% vs 1%, dry mouth in 4% vs 2%, diarrhea in 6% vs 5% and dizziness in 5% vs 4%. 8% stopped modafinil for an adverse reaction against 3% on placebo [3]. On armodafinil, nausea occurred in 7% vs 3% and dizziness in 5% vs 2%, and 7% stopped against 4% [6].
Population
934 on modafinil and 567 on placebo [3]; 645 on armodafinil and 445 on placebo [6].
Sources
[3], [6]
Caveats
Short trials in people with sleep disorders.
ModerateCommon

Insomnia, nervousness and anxiety

Shown to raise insomnia and anxiety, each 5% on modafinil against 1% on placebo, and nervousness 7% against 3%. Anxiety rose with dose.

The numbers and sources
How common
Common: between 1 in 100 and 1 in 10 people.
Effect
In pooled trials, insomnia occurred in 5% vs 1% on placebo, anxiety in 5% vs 1% and nervousness in 7% vs 3%. Anxiety was dose related [3]. On armodafinil, insomnia occurred in 5% vs 1% [6]. A meta-analysis of neurological conditions found insomnia and nausea more frequent on modafinil than placebo [13].
Population
934 on modafinil and 567 on placebo [3]; 645 on armodafinil and 445 on placebo [6]; 535 patients in 10 trials [13].
Sources
[3], [6], [13]
Caveats
Doses in the label trials were taken in the morning or before a shift.
ModerateCommon

Blood pressure and heart rate

Shown to raise reports of high blood pressure, 3% against 1% on placebo, and fast heart rate and palpitations, 2% against 1%.

The numbers and sources
How common
Common: between 1 in 100 and 1 in 10 people.
Effect
In pooled trials, hypertension was reported in 3% on modafinil vs 1% on placebo, chest pain in 3% vs 1%, palpitations in 2% vs 1% and tachycardia in 2% vs 1%. The label reports chest pain, palpitations and ischemic ECG changes in three people with mitral valve prolapse or left ventricular hypertrophy, and one episode of asystole in a patient with prior fainting [3]. The Cochrane review of shift workers lists a rise in blood pressure among reported adverse effects [7].
Population
934 on modafinil and 567 on placebo [3]; shift workers in trials [7].
Sources
[3], [7]
Caveats
Short trials. The rates are reports of adverse reactions, not measured mean blood pressure change.
ModerateCommon

Liver enzyme changes

Shown to raise mean GGT and alkaline phosphatase in placebo-controlled trials, mostly within the normal range. ALT and AST did not differ.

The numbers and sources
How common
Common: between 1 in 100 and 1 in 10 people.
Effect
Mean GGT and alkaline phosphatase were higher after modafinil but not placebo, and rose over time, with few values outside the normal range. ALT, AST, albumin and total bilirubin did not differ. "Abnormal liver function" was reported as an adverse reaction in 2% vs 1% on placebo [3].
Population
Adults in placebo-controlled label trials [3].
Sources
[3]
Caveats
The label gives no size for the mean change. The band above is the adverse-reaction rate.
LimitedUncommon

Serious rash, including Stevens-Johnson syndrome

The label warns of serious rash, including Stevens-Johnson syndrome. In children's trials 0.8% stopped for rash, against none on placebo. Modafinil is not approved for children.

The numbers and sources
How common
Uncommon: between 1 in 1,000 and 1 in 100 people.
Effect
In modafinil trials in patients under 17, rash leading to discontinuation occurred in about 0.8% (13 of 1,585), including 1 possible case of Stevens-Johnson syndrome and 1 multi-organ hypersensitivity reaction, against none of 380 on placebo. Median time to rash was 13 days. The label states the postmarketing reporting rate of toxic epidermal necrolysis and Stevens-Johnson syndrome exceeds the background rate of 1 to 2 cases per million person-years, and reports multi-organ hypersensitivity with at least one death [3]. Angioedema and allergic reactions were seen in armodafinil trials [3].
Population
1,585 pediatric patients in trials, and postmarketing reports in adults and children [3].
Sources
[3]
Caveats
The trial rate comes from children. The adult rate is not known, since postmarketing reports have no denominator.
LimitedHow often is not known

Psychiatric symptoms

Case reports: the label describes mania, delusions, hallucinations, suicidal thoughts and aggression after approval, many in people with prior psychiatric history.

The numbers and sources
How common
How often is not known: the sources give no rate.
Effect
Postmarketing reports include mania, delusions, hallucinations, suicidal ideation and aggression, some leading to hospitalization. A healthy male volunteer developed paranoid delusions and hallucinations on 600 mg a day, three times the usual dose, with sleep deprivation, which cleared 36 hours after stopping [3]. In the bipolar depression trials, mood switching did not differ from placebo (RR 0.99) [16].
Population
Postmarketing reports [3]; 1,587 patients in 5 bipolar trials [16].
Sources
[3], [16]
Caveats
Reports have no denominator and cannot prove cause.
LimitedHow often is not known

Abuse and dependence

The label states modafinil produces euphoric effects like other stimulants in experienced drug users, and found no withdrawal symptoms over 14 days after 9 weeks of use.

The numbers and sources
How common
How often is not known: the sources give no rate.
Effect
Both drugs are Schedule IV. In an inpatient study of people experienced with drugs of abuse, modafinil 200 to 800 mg produced psychoactive and euphoric effects consistent with methylphenidate. Monkeys trained on cocaine self-administered it. After 9 weeks of use in one placebo-controlled trial, no withdrawal symptoms were reported over 14 days, though sleepiness returned in people with narcolepsy [3].
Population
People with a history of drug use in an inpatient study, and patients in one 9-week trial [3].
Sources
[3]
Caveats
The label gives no rate of misuse in the general population.
LimitedHow often is not known

Hormonal birth control

The label warns that modafinil and armodafinil may reduce how well hormonal birth control prevents pregnancy, during use and for a month after stopping.

The numbers and sources
How common
How often is not known: the sources give no rate.
Effect
Modafinil induces the liver enzyme CYP3A4/5, which may lower blood levels of steroidal contraceptives such as ethinyl estradiol. The labels state their effectiveness may be reduced while taking the drug and for one month after stopping, including depot and implanted forms [3][6]. Armodafinil 250 mg lowered exposure to midazolam, another drug cleared by this enzyme, by 32% [6].
Population
Labeling statement based on drug interaction studies [3][6].
Sources
[3], [6]
Caveats
The labels give no rate of unplanned pregnancy.
LimitedHow often is not known

Other drug interactions

The label states modafinil can lower cyclosporine levels and raise levels of drugs cleared by CYP2C19, such as diazepam, propranolol, phenytoin and omeprazole.

The numbers and sources
How common
How often is not known: the sources give no rate.
Effect
By inducing CYP3A4/5, modafinil may lower levels of cyclosporine, midazolam and triazolam. By inhibiting CYP2C19, it may raise levels of phenytoin, diazepam, propranolol, omeprazole and clomipramine, and, in people lacking CYP2D6, tricyclic antidepressants and SSRIs. The label advises more frequent INR checks with warfarin and caution with MAO inhibitors [3].
Population
Labeling statement based on drug interaction studies [3].
Sources
[3]
Caveats
The label describes changes in drug levels and gives no rate of harm.

Mixed results1

LimitedStudied in pregnancyVery common

Pregnancy

Mixed results: a pregnancy registry found major birth defects in 13% of exposed live births against a 3% population rate, while a French national cohort found no clear rise.

The numbers and sources
How common
Very common: more than 1 in 10 people.
Effect
In the 14-year manufacturer pregnancy registry, major congenital malformations occurred in 13.1% of prospectively enrolled live births (18 of 137, 95% CI 8.0 to 20.0) against a population rate of 3%. Spontaneous abortion occurred in 10.9% [18]. In French national data, first-trimester modafinil exposure was linked to more major anomalies than methylphenidate (aRR 1.77, 95% CI 1.01 to 3.07), but not clearly more than matched unexposed children (aRR 1.23, 95% CI 0.76 to 1.99), with no rise in neurodevelopmental disorders [19]. The labels report fetal growth restriction and miscarriage cases and developmental toxicity in rats and rabbits [3][6].
Population
191 pregnancies, 137 prospective live births [18]; 865 children exposed to modafinil among 10,955,766 births [19].
Sources
[18], [19], [3], [6]
Caveats
The registry compared with an outside population rate, not a matched group, and was small [18]. The cohort's intervals were wide [19]. The band above is the registry rate. Two 2020 Scandinavian studies were not readable from an open source and are left out.

Claims tested and not found

  1. That modafinil is a strong cognitive enhancer for rested healthy people. Two meta-analyses found overall effects of g = 0.10 and SMD 0.12, with no difference between domains in one and gains limited to memory updating in the other [9][10].
  2. That a higher dose sharpens thinking more. In pooled single-dose trials in rested adults, 200 mg did not differ from 100 mg [9]. In narcolepsy and sleep apnea, 400 mg gave no consistent extra benefit over 200 mg [3].
  3. That repeated doses protect performance through long sleep deprivation. Repeated doses kept people awake but did not prevent cognitive performance from declining [12].
  4. That modafinil reduces cataplexy in narcolepsy. Cataplexy attacks did not differ from placebo [1].

Related

ADHD stimulants

Sources

  1. Golicki D, Bala MM, Niewada M, et al. Modafinil for narcolepsy: systematic review and meta-analysis. Medical Science Monitor. 2010. https://pubmed.ncbi.nlm.nih.gov/20671626/
  2. Mann GS, Ramakrishnan M, Pakkam ML, et al. An updated systematic review and meta-analysis of modafinil for excessive daytime sleepiness in narcolepsy. Sleep Medicine: X. 2026. https://doi.org/10.1016/j.sleepx.2026.100185
  3. U.S. Food and Drug Administration. PROVIGIL (modafinil) tablets, prescribing information. 2025. DailyMed. https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=e16c26ad-7bc2-d155-3a5d-da83ad6492c8
  4. Chapman JL, Vakulin A, Hedner J, et al. Modafinil/armodafinil in obstructive sleep apnoea: a systematic review and meta-analysis. European Respiratory Journal. 2016. https://doi.org/10.1183/13993003.01509-2015
  5. Kuan YC, Wu D, Huang KW, et al. Effects of Modafinil and Armodafinil in Patients With Obstructive Sleep Apnea: A Meta-analysis of Randomized Controlled Trials. Clinical Therapeutics. 2016. https://doi.org/10.1016/j.clinthera.2016.02.004
  6. U.S. Food and Drug Administration. NUVIGIL (armodafinil) tablets, prescribing information. 2025. DailyMed. https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=d878aed0-ddbf-8fa1-abf7-d3e480260845
  7. Liira J, Verbeek JH, Costa G, et al. Pharmacological interventions for sleepiness and sleep disturbances caused by shift work. Cochrane Database of Systematic Reviews. 2014. https://doi.org/10.1002/14651858.CD009776.pub2
  8. Czeisler CA, Walsh JK, Roth T, et al. Modafinil for Excessive Sleepiness Associated with Shift-Work Sleep Disorder. New England Journal of Medicine. 2005. https://doi.org/10.1056/NEJMoa041292
  9. Kredlow MA, Keshishian A, Oppenheimer S, et al. The Efficacy of Modafinil as a Cognitive Enhancer: A Systematic Review and Meta-Analysis. Journal of Clinical Psychopharmacology. 2019. https://doi.org/10.1097/JCP.0000000000001085
  10. Roberts CA, Jones A, Sumnall H, et al. How effective are pharmaceuticals for cognitive enhancement in healthy adults? A series of meta-analyses of cognitive performance during acute administration of modafinil, methylphenidate and D-amphetamine. European Neuropsychopharmacology. 2020. https://doi.org/10.1016/j.euroneuro.2020.07.002
  11. Battleday RM, Brem AK. Modafinil for cognitive neuroenhancement in healthy non-sleep-deprived subjects: A systematic review. European Neuropsychopharmacology. 2015. https://doi.org/10.1016/j.euroneuro.2015.07.028
  12. Repantis D, Schlattmann P, Laisney O, et al. Modafinil and methylphenidate for neuroenhancement in healthy individuals: A systematic review. Pharmacological Research. 2010. https://doi.org/10.1016/j.phrs.2010.04.002
  13. Sheng P, Hou L, Wang X, et al. Efficacy of Modafinil on Fatigue and Excessive Daytime Sleepiness Associated with Neurological Disorders: A Systematic Review and Meta-Analysis. PLoS ONE. 2013. https://doi.org/10.1371/journal.pone.0081802
  14. Ghazanfar S, Farooq M, Qazi SU, et al. The use of modafinil for the treatment of fatigue in multiple sclerosis: A systematic review and meta-analysis of controlled clinical trials. Brain and Behavior. 2024. https://doi.org/10.1002/brb3.3623
  15. Goss AJ, Kaser M, Costafreda SG, et al. Modafinil augmentation therapy in unipolar and bipolar depression: a systematic review and meta-analysis of randomized controlled trials. The Journal of Clinical Psychiatry. 2013. https://doi.org/10.4088/JCP.13r08560
  16. Nunez NA, Singh B, Romo-Nava F, et al. Efficacy and tolerability of adjunctive modafinil/armodafinil in bipolar depression: A meta-analysis of randomized controlled trials. Bipolar Disorders. 2020. https://doi.org/10.1111/bdi.12859
  17. Cortese S, Adamo N, Del Giovane C, et al. Comparative efficacy and tolerability of medications for attention-deficit hyperactivity disorder in children, adolescents, and adults: a systematic review and network meta-analysis. The Lancet Psychiatry. 2018. https://doi.org/10.1016/S2215-0366(18)30269-4
  18. Kaplan S, Carneal-Frazer N, Braverman DL, et al. Pregnancy and Fetal Outcomes Following Prenatal Exposure to Modafinil and/or Armodafinil: A 14-Year Registry Study. Neurology Clinical Practice. 2025. https://doi.org/10.1212/CPJ.0000000000200551
  19. Kanoun M, Bouazza N, Treluyer JM, et al. Prenatal Exposure to Modafinil and the Risk of Major Congenital Anomalies and Other Adverse Neonatal and Pediatric Outcomes. Pharmacoepidemiology and Drug Safety. 2026. https://doi.org/10.1002/pds.70448

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