Almost all of the currently available stimulants used to treat excessive daytime sleepiness in clinical practice (amphetamines, amphetaminelike stimulants, and modafinil) increase dopaminergic transmission either by stimulating dopamine release and/or by blocking dopamine reuptake. These mechanisms are critically involved in the mediation of the wake-promoting effects of these compounds, yet are also primarily involved in the potential for abuse. Modafinil is an attractive alternative to amphetamine and amphetaminelike stimulants because of lower risk of dependence, fewer cardiovascular side effects, and less rebound sleepiness. Agents stimulating other wake-promoting systems (eg, hypocretinergic, histaminergic) may be promising future therapies. © 2010 Elsevier Inc. All rights reserved.
