Wakefulness-promoting agent
Similar to modafinil; thought to enhance wakefulness by inhibiting dopamine transporter and modulating glutamate and GABA neurotransmission
Narcolepsy, shift work sleep disorder, obstructive sleep apnea (OSA)-related sleepiness
Augmentation in major depressive disorder and bipolar disorder; fatigue in neurological conditions
Oral tablets
Start at 150 mg p.o. in the morning; titrate between 150–250 mg/day as clinically indicated
150–250 mg/day
Longer half-life than modafinil (~15 hours); metabolized primarily by CYP3A4
Headache, insomnia, nausea, anxiety, dry mouth
Severe rash (including Stevens-Johnson syndrome), mood destabilization in bipolar disorder
Monitor for rash and mood changes; assess cardiovascular status including baseline ECG and periodic blood pressure monitoring in patients with cardiac risk factors or older adults; monitor contraceptive efficacy in women using hormonal birth control
None
Armodafinil is supported for treating excessive daytime sleepiness in traumatic brain injury (TBI). Evidence for benefit in multiple sclerosis (MS), Parkinson’s disease (PD), dementia, and post-stroke fatigue is limited or lacking. Use cautiously in bipolar disorder due to risk of mood switching. In patients with cardiovascular disease, consider baseline ECG and periodic blood pressure monitoring, especially in older adults or those with cardiac risk factors.