Increase Alertness
Situations
-Stroke (mainly thalamic)
-PD/ MS
-Consciousness disorder (TBI)
-Narcolepsy/ OSA residual sleepiness
Medications
Base on safety
In-hospital
1st: caffeine, amantadine
2nd: methylphenidate
3rd: levodopa
Outpatient:
-modafinil/ armodafinil, bupropion, atomoxetine
-dextroamphetamine, lisdexamfetamine
Unclear:
-solriamfetol, pitolisant
Safety pearls
-Avoid late‑day dosing → insomnia, agitation
-Monitor BP/HR with methylphenidate, amphetamines, solriamfetol
-Renal adjust amantadine
-Modafinil induces CYP3A4 → ↓ OCP effectiveness
-Start low and titrate weekly