Use of modafinil for the treatment of attention deficit/hyperactivity disorder

OBJECTIVE: To review the evidence for the use of modafinil in the treatment of attention deficit/hyperactivity disorder (ADHD). DATA SOURCES: A MEDLINE search (January 1990-May 2006) was conducted using MeSH terms ADHD and modafinil. The search was limited to English-language articles on clinical trials in humans. The Cochrane Database was also searched. STUDY SELECTION AND DATA EXTRACTION: The literature search yielded 4 randomized clinical trials. DATA SYNTHESIS: The use of modafinil in the treatment of ADHD is associated with significant improvements in primary outcome measures used to assess the status of patients diagnosed with ADHD. Several aspects of cognitive function in ADHD patients also appear to improve following moclafinil treatment. Modafinil shows a favorable adverse effect profile. Insomnia and headache were the most common adverse effects, seen in approximately 20% of treated individuals. However, it has not been demonstrated that the beneficial effects of moclafinil are maintained with chronic administration. CONCLUSIONS: Modafinil may be a viable option for some patients in the treatment of ADHD, perhaps those for whom standard ADHD therapies have not been successful or tolerated. There remains a need for additional large, long-term studies using flexible titration methods to optimize the dose of moclafinil to establish safety and efficacy, as well as head-to-head comparisons between modafinil and both long- and short-acting stimulants to determine the role of moclafinil in the treatment of ADHD.