Stimulants wake-promoting agents

Prior to the use of wakefulness-promoting agents, and in some pediatric patients, maintenance of wakefulness is dependent on stimulant medications and antidepressants. The safety of such medications during reproductive years and the risk of driving accidents without medication are typically handled during discussions between the prescribing practitioner and the patient. Irritability, anxiety, and erectile or ejaculatory dysfunction have been reported with these medications (78). The costs of newly approved medications for the treatment of narcolepsy,... 

Wake-promoting Agents (Stimulants) (See Also Chap. 20)... 

Modafinil is a wake-promoting agent whose specific biochemical mechanism of action is obscure. It increases brain concentrations of dopamine after chronic administration in animals but has no overtly stimulant effect like amphetamines. It appears to have a slow onset and its action lasts 8-12 h abuse potential is very low. Modafinil is used in narcolepsy and other hypersomnias and has also been studied in normal people who need to stay awake for long periods and fimction well. 

Modafanil, a racemic compound unrelated to psychostimulants, is the current standard for the treatment of EDS. Modafinil selectively targets neuronal pathways in the hypothalamus that regulate the normal sleep-wake cycle. The precise mechanism by which modafinil promotes wakefulness is unknown. Modafinil is readily absorbed, reaches peak plasma concentrations in 2 to 4 hours, and has a half-life of 15 hours. The dose is between 200 and 400 mg/day. The efficacy of modahnil in treating EDS has been demonstrated in several randomized studies. EDS may also be treated with stimulants to improve alertness and to increase daytime performance. Cataplexy is not signihcantly treated with modafinil and must be treated with anticataplectic agents." ... 

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