Modafinil (Provigil; Cephalon, Inc.) is a novel agent that is indicated to improve wakefulness in patients with excessive sleepiness, narcolepsy, and other conditions related to sleep disorders. A study suggests that the drug inhibits the sleep-promoting neurons by blocking norepinephrine reuptake. Some medications for narcolepsy has been useful in ADHD when the following conditions are prevalent:

- An unsatisfactory response to stimulant or antidepressants after trials of two or three different agents

- Inability to tolerate treatment-emergent side effects such as insomnia or loss of appetite

- Presence of risk because of moderate-to-severe side effects or a history of cardiac problems

- Development of tolerance to the benefits of stimulants or antidepressants

- ADHD symptoms in populations with special problems such as psychoses, schizophrenia, or other developmental disorders

- Presence of severe mental retardation

- Inadequate response to monotherapy

- Use in combination with a stimulant or antidepressant to treat a comorbid diagnostic condition

Modafinil is labeled for use in patients 16 years or older with sleep disorders and is not presently labeled by the FDA for use in ADHD. It is generally well tolerated, with common side effects including insomnia, abdominal pain, depression, headache, nervousness, and nausea.

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