Modafinil for the Pharmacological Stimulation of Wakefulness in Critically Ill Patients

Objective: Because of a number of factors critically ill patients are prone to develop cognitive problems, excessive daytime sleepiness (EDS) and fatigue during their intensive care unit (ICU) stay. Modafinil has potential advantages when used in patients to improve wakefulness, cognitive function and activity. The present article reviewed literature to describe modafinil use for the treatment of EDS and fatigue in ICU. Methods: For the present narrative review, an online search was conducted for studies referring to modafinil administration to improve wakefulness in the ICU. The search was performed on Embase, MEDLINE, Web of Science, and Google Scholar until May 20, 2025. Results: Nine relevant studies were identified. These included 2 RCTs, 2 case series and 5 retrospective studies. Four of these studies included TBI or post-stroke patients, while the rest comprised mixed ICU populations. Conclusion: Some data showing that modafinil may improve the wakefulness of selected critically ill patients and encourage their participation in physical therapy. Larger RCTs are essential to determine the role modafinil in the treatment of EDS and hypoactiveness in the ICU.