Wakefulness-promoting agent

Wakefulness-promoting agent
Drug class
The chemical structure of modafinil, a widely used wakefulness-promoting agent
Class identifiers
Synonyms	Wakefulness-promoting agent; Wakefulness-promoting drug; Wakefulness promoting medication; Wake-promoting agent; Wake-promoting drug; Wake-promoting medication; WPA
Use	To increase wakefulness and arousal, to reduce sleepiness and sedation
Legal status
In Wikidata

A wakefulness-promoting agent (WPA), or wake-promoting agent, is a drug that increases wakefulness and arousal. ^{[1] [2] [3]} They are similar to but distinct from psychostimulants, which not only promote wakefulness but also produce other more overt central nervous system effects, such as improved attention span, executive functions, vigilance and motivation. ^{[1] [4]} Wakefulness-promoting agents are used to treat narcolepsy and hypersomnia as well as to promote wakefulness and increase performance in healthy people. ^{[5] [6] [7]}

A variety of different classes of drugs have shown wakefulness-promoting effects, including: ^{[8] [5] [3] [9]}

• Dopamine reuptake inhibitors like modafinil, armodafinil, mesocarb, phenylpiracetam, and vanoxerine ^{[8] [5] [9] [10] [11]}
• Norepinephrine–dopamine reuptake inhibitors like methylphenidate, solriamfetol, mazindol, bupropion, nomifensine, and amineptine ^{[8] [9]}
• Norepinephrine–dopamine releasing agents like amphetamine and methamphetamine ^{[8] [9]}
• Norepinephrine reuptake inhibitors like atomoxetine and reboxetine ^{[8] [9]}
• Norepinephrine releasing agents like ephedrine and selegiline (via its metabolites) ^{[8] [5]}
• Dopamine D₁ receptor positive allosteric modulators like mevidalen ^{[12] [13]}
• Adenosine receptor antagonists like caffeine, paraxanthine, and istradefylline ^{[8] [5] [14] [15]}
• Histamine H₃ receptor antagonists and inverse agonists like pitolisant and samelisant ^[9]
• Orexin receptor agonists like danavorexton and suntinorexton ^[5]
• Nicotinic acetylcholine receptor agonists like nicotine ^{[1] [16]}

Histamine and other histamine H₁ receptor agonists also have wakefulness-promoting effects. ^{[9] [17] [18]} However, H₁ receptor agonists as drugs are limited by their mediation of allergy-type symptoms. ^[18]

Serotonergic psychedelics, acting as serotonin 5-HT_2A receptor agonists, such as LSD, psilocybin, mescaline, and DOM, have wakefulness-promoting effects in animals in addition to their hallucinogenic effects. ^{[19] [20] [21]} Relatedly, some psychedelics are associated with mild stimulant-like effects in humans and psychedelics have often been associated with insomnia or sleep disturbances. ^{[22] [23] [24]} Similarly to serotonergic psychedelics, the iboga alkaloids and oneirogens ibogaine and noribogaine have been found to promote wakefulness in rodents. ^{[25] [26]} Relatedly, low doses of Tabernanthe spp. extracts containing ibogaine have been used pharmaceutically as stimulants in the past. ^{[27] [28]}

Certain other drugs are being studied as wakefulness-promoting agents as well, including GABA_A receptor antagonists and negative allosteric modulators like clarithromycin, flumazenil, and pentylenetetrazol (pentetrazol), among others. ^[29]

The GHB and GABA_B receptor agonist sodium oxybate or γ-hydroxybutyrate (GHB) has been used in the treatment of narcolepsy. ^{[30] [8] [5] [3]} Relatedly, some researchers have classified this drug as a stimulant-like agent. ^[30] However, GHB is taken at night and only results in improved wakefulness the next day following sleep. ^[30]

The related term "eugeroic" (or "eugregoric") means "vigilance-promoting". ^[5] It was introduced in 1987 in the French literature and has been used as an alternative term to refer to wakefulness-promoting drugs and to distinguish them from psychostimulants. ^[5] However, the term has usually been used to refer specifically to modafinil and its analogues, even to the exclusion of other wakefulness-promoting agents. ^{[5] [31] [32]} Moreover, the term has not been widely adopted in the scientific literature. ^[5] The discovery of wakefulness-promoting neurons and the orexin neuropeptides has prompted a terminological shift away from the concept of "vigilance-promoting" to "wakefulness-promoting". ^[5]

References

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2. Dell'Osso B, Dobrea C, Cremaschi L, Arici C, Altamura AC (December 2014). "Wake-promoting pharmacotherapy for psychiatric disorders". Curr Psychiatry Rep. 16 (12) 524. doi:10.1007/s11920-014-0524-2. PMID   25312027.
3. Zhan S, Ye H, Li N, Zhang Y, Cheng Y, Wang Y, Hu S, Hou Y (2023). "Comparative Efficacy and Safety of Multiple Wake-Promoting Agents for the Treatment of Excessive Daytime Sleepiness in Narcolepsy: A Network Meta-Analysis". Nat Sci Sleep. 15: 217–230. doi: 10.2147/NSS.S404113 . PMC   10112483 . PMID   37082610.
4. Chang, Shen-Chieh; Shen, Winston W. (2013). "Stimulants, Wakefulness-promoting Agents, and Nonstimulant Attention Deficit Hyperactivity Disorder Medications". Journal of Experimental & Clinical Medicine. 5 (6): 210–216. doi:10.1016/j.jecm.2013.10.010.
5. Konofal E (August 2024). "From past to future: 50 years of pharmacological interventions to treat narcolepsy". Pharmacol Biochem Behav. 241 173804. doi: 10.1016/j.pbb.2024.173804 . PMID   38852786.
6. Clark I, Landolt HP (February 2017). "Coffee, caffeine, and sleep: A systematic review of epidemiological studies and randomized controlled trials" (PDF). Sleep Med Rev. 31: 70–78. doi:10.1016/j.smrv.2016.01.006. PMID   26899133.
7. Plumber N, Majeed M, Ziff S, Thomas SE, Bolla SR, Gorantla VR (May 2021). "Stimulant Usage by Medical Students for Cognitive Enhancement: A Systematic Review". Cureus. 13 (5): e15163. doi: 10.7759/cureus.15163 . PMC   8216643 . PMID   34178492.
8. Nishino, Seiji; Kotorii, Nozomu (2016). "Modes of Action of Drugs Related to Narcolepsy: Pharmacology of Wake-Promoting Compounds and Anticataplectics". Narcolepsy. Cham: Springer International Publishing. pp. 307–329. doi:10.1007/978-3-319-23739-8_22. ISBN   978-3-319-23738-1.
9. Thorpy MJ, Bogan RK (April 2020). "Update on the pharmacologic management of narcolepsy: mechanisms of action and clinical implications". Sleep Med. 68: 97–109. doi:10.1016/j.sleep.2019.09.001. PMID   32032921.
10. Macolino-Kane, Christine M.; Ciallella, John R.; Lipinski, Christopher A.; Reaume, Andrew G. (14 July 2017). "Phenotypic Screening". Drug Repositioning. Frontiers in Neurotherapeutics. Boca Raton: CRC Press, [2017]: CRC Press. pp. 121–145. doi:10.4324/9781315373669-7. ISBN   978-1-315-37366-9.
11. Veinberg G, Vavers E, Orlova N, Kuznecovs J, Domracheva I, Vorona M, Zvejniece L, Dambrova M (2015). "Stereochemistry of phenylpiracetam and its methyl derivative: improvement of the pharmacological profile". Chemistry of Heterocyclic Compounds. 51 (7): 601–606. doi:10.1007/s10593-015-1747-9. ISSN   0009-3122. Phenylpiracetam was originally designed as a nootropic drug for the sustenance and improvement of the physical condition and cognition abilities of Soviet space crews.2 Later, especially during the last decade, phenylpiracetam was introduced into general clinical practice in Russia and in some Eastern European countries. The possible target receptors and mechanisms for the acute activity of this drug remained unclear, until very recently it was found that (R)-phenylpiracetam (5) (MRZ-9547) is a selective dopamine transporter inhibitor that moderately stimulates striatal dopamine release.19
12. Jones-Tabah J, Mohammad H, Paulus EG, Clarke PB, Hébert TE (2021). "The Signaling and Pharmacology of the Dopamine D1 Receptor". Frontiers in Cellular Neuroscience. 15 806618. doi: 10.3389/fncel.2021.806618 . PMC   8801442 . PMID   35110997.
13. McCarthy AP, Svensson KA, Shanks E, Brittain C, Eastwood BJ, Kielbasa W, et al. (March 2022). "The Dopamine D1 Receptor Positive Allosteric Modulator Mevidalen (LY3154207) Enhances Wakefulness in the Humanized D1 Mouse and in Sleep-Deprived Healthy Male Volunteers". The Journal of Pharmacology and Experimental Therapeutics. 380 (3): 143–152. doi: 10.1124/jpet.121.000719 . PMID   34893551. S2CID   247363215.
14. Jenner P, Mori A, Kanda T (November 2020). "Can adenosine A2A receptor antagonists be used to treat cognitive impairment, depression or excessive sleepiness in Parkinson's disease?". Parkinsonism Relat Disord. 80 Suppl 1: S28 –S36. doi: 10.1016/j.parkreldis.2020.09.022 . PMID   33349577.
15. Lazarus M, Chen JF, Huang ZL, Urade Y, Fredholm BB (2019). "Adenosine and Sleep". Handb Exp Pharmacol. Handbook of Experimental Pharmacology. 253: 359–381. doi:10.1007/164_2017_36. ISBN   978-3-030-11270-7. PMID   28646346.
16. Singh N, Wanjari A, Sinha AH (November 2023). "Effects of Nicotine on the Central Nervous System and Sleep Quality in Relation to Other Stimulants: A Narrative Review". Cureus. 15 (11): e49162. doi: 10.7759/cureus.49162 . PMC   10733894 . PMID   38130519.
17. Thakkar MM (February 2011). "Histamine in the regulation of wakefulness". Sleep Med Rev. 15 (1): 65–74. doi:10.1016/j.smrv.2010.06.004. PMC   3016451 . PMID   20851648.
18. Panula P (2021). "Histamine receptors, agonists, and antagonists in health and disease". The Human Hypothalamus - Middle and Posterior Region. Handbook of Clinical Neurology. Vol. 180. pp. 377–387. doi:10.1016/B978-0-12-820107-7.00023-9. ISBN   978-0-12-820107-7. PMID   34225942.{{cite book}}: |journal= ignored (help)
19. Dudysová D, Janků K, Šmotek M, Saifutdinova E, Kopřivová J, Bušková J, Mander BA, Brunovský M, Zach P, Korčák J, Andrashko V, Viktorinová M, Tylš F, Bravermanová A, Froese T, Páleníček T, Horáček J (2020). "The Effects of Daytime Psilocybin Administration on Sleep: Implications for Antidepressant Action". Front Pharmacol. 11 602590. doi: 10.3389/fphar.2020.602590 . PMC   7744693 . PMID   33343372. Serotonergic psychedelics such as LSD, dimethyltryptamine (DMT), and mescaline show sleep alterations including an increase in wakefulness and inhibition of REM and NREM sleep (Colasanti and Khazan, 1975; Kay and Martin, 1978).
20. Monti JM (March 2010). "Serotonin 5-HT(2A) receptor antagonists in the treatment of insomnia: present status and future prospects". Drugs Today (Barc). 46 (3): 183–193. doi:10.1358/dot.2010.46.3.1437247. PMID   20467592. Systemic administration of the nonselective 5-HT2A receptor agonists DOI (1-[2,5-dimethoxy-4-iodophenyl]- 2-aminopropane) and DOM (1-[2,5-dimethoxy-4- methylphenyl]-2-aminopropane) has been shown to reduce SWS and REM sleep, and to augment wakefulness in the rat (47-49) (Table I). In addition, systemic or intrathalamic injection of DOI decreased the neocortical high-voltage spindle activity that occurs during relaxed wakefulness in the rat (50).
21. Thomas, Christopher W.; Blanco-Duque, Cristina; Bréant, Benjamin J.; Goodwin, Guy M.; Sharp, Trevor; Bannerman, David M.; Vyazovskiy, Vladyslav V. (23 February 2022). "Psilocin acutely alters sleep-wake architecture and cortical brain activity in laboratory mice" (PDF). Translational Psychiatry. 12 (1) 77. doi: 10.1038/s41398-022-01846-9 . ISSN   2158-3188. PMC   8866416 . PMID   35197453 . Retrieved 27 July 2025.
22. Kuypers, Kim P. C. (2024). "Microdosing Psychedelics as a Promising New Pharmacotherapeutic". Modern CNS Drug Discovery. Cham: Springer Nature Switzerland. pp. 407–436. doi:10.1007/978-3-031-61992-2_26. ISBN   978-3-031-61991-5 . Retrieved 28 May 2025. Interestingly, users sometimes attribute other effects to different psychedelics, in which LSD is more associated with cognitive and/or stimulant effects and psilocybin with emotional or well-being effects (Anderson et al. 2019b; Johnstad 2018). This stronger stimulant character of LSD compared to psilocybin was seen by some as an advantage while others experienced it as uncomfortable (Johnstad 2018). [...] Additionally, McGlothlin et al. (1967) showed that LSD (25 mcg) indeed induces stimulant effects, as the effects were similar to those of amphetamine (20 mg) (McGlothlin et al. 1967). Notwithstanding this does not confirm that psilocybin and LSD would have dissimilar effects; it rather supports the claims by users that LSD in low doses has stimulant effects (Johnstad 2018; Anderson et al. 2019a). [...] Decades earlier, Albert Hofmann, the "discoverer" of LSD and its hallucinogenic effects, mentioned that "very small doses, perhaps 25 micrograms," could be useful as an antidepressant (Ghose 2015; Horowitz 1976) or as a substitute for Ritalin (Fadiman 2017; Horowitz 1976).
23. Baggott MJ (1 October 2023). "Learning about STP: A Forgotten Psychedelic from the Summer of Love" (PDF). History of Pharmacy and Pharmaceuticals. 65 (1): 93–116. doi: 10.3368/hopp.65.1.93 . ISSN   2694-3034 . Retrieved 26 January 2025. The Grateful Dead learned they could use small amounts as a stimulant, an effect they used extensively during the recording of the album Aoxomoxoa in 1968 and 1969.143 The use of lower doses of DOM echoed DOET's "psychic energizer" effects and may be the first documented use of subpsychedelic doses of a psychedelic for cognitive enhancement, a practice that is now called microdosing.144
24. Alexander T. Shulgin; Ann Shulgin (1991). PiHKAL: A Chemical Love Story (1st ed.). Berkeley, CA: Transform Press. ISBN   978-0-9630096-0-9. OCLC   25627628.
25. González, Joaquín; Prieto, José P.; Rodríguez, Paola; Cavelli, Matías; Benedetto, Luciana; Mondino, Alejandra; Pazos, Mariana; Seoane, Gustavo; Carrera, Ignacio; Scorza, Cecilia; Torterolo, Pablo (27 April 2018). "Ibogaine Acute Administration in Rats Promotes Wakefulness, Long-Lasting REM Sleep Suppression, and a Distinctive Motor Profile". Frontiers in Pharmacology. 9 374. doi: 10.3389/fphar.2018.00374 . ISSN   1663-9812. PMC   5934978 . PMID   29755349.
26. Castro-Nin, Juan Pedro; Serantes, Diego; Rodriguez, Paola; Gonzalez, Bruno; Carrera, Ignacio; Torterolo, Pablo; González, Joaquín (2024). "Noribogaine acute administration in rats promotes wakefulness and suppresses REM sleep" . Psychopharmacology. 241 (7): 1417–1426. doi:10.1007/s00213-024-06572-2. ISSN   0033-3158. PMID   38467891 . Retrieved 27 July 2025.
27. Maciulaitis R, Kontrimaviciute V, Bressolle FM, Briedis V (March 2008). "Ibogaine, an anti-addictive drug: pharmacology and time to go further in development. A narrative review". Hum Exp Toxicol. 27 (3): 181–194. Bibcode:2008HETox..27..181M. doi:10.1177/0960327107087802. PMID   18650249. In traditional use, ibogaine was consumed by chewing the root bark of T. iboga. Commercially available formulations include plant extracts and crystalline ibogaine hydrochloride salt. From 1901 to 1905, ibogaine was recommended as a treatment for "asthenia" at a dosage range of 10–30 mg/day. Tablets from extracts of the roots of Tabernanthe manii, containing about 200 mg of extract or 8 mg of ibogaine per tablet, were sold in France as a neuromuscular stimulant between 1939 and 1970 under the trade name of Lambarene®. This marketed formulation was recommended in the treatment of fatigue, depression, and recovery from infectious disease.9 Another ibogaine containing preparation was Iperton®, used as a tonic or stimulant, delivering 40 mg of the total T. iboga extract.39 The ibogaine hydrochloride salt (98% purity) was favored for research. Capsules containing 100 or 200 mg of ibogaine were available.40
28. Mash DC (April 2023). "IUPHAR - invited review - Ibogaine - A legacy within the current renaissance of psychedelic therapy". Pharmacol Res. 190 106620. doi: 10.1016/j.phrs.2022.106620 . PMID   36907284. Ibogaine is an indole alkaloid that has been used as a botanical preparation for over 100 years both as a crude preparation and as semisynthetic ibogaine. Ibogaine was marketed in France under the tradename Lambarene as a mental and physical stimulant in 8 mg tablets until 1970 [1].
29. Takahashi, Tatsunori; Noriaki, Sakai; Matsumura, Mari; Li, Chenyu; Takahashi, Kayo; Nishino, Seiji (3 October 2018). "Advances in pharmaceutical treatment options for narcolepsy". Expert Opinion on Orphan Drugs. 6 (10): 597–610. doi:10.1080/21678707.2018.1521267. ISSN   2167-8707.
30. Ono T, Takenoshita S, Nishino S (September 2022). "Pharmacologic Management of Excessive Daytime Sleepiness". Sleep Med Clin. 17 (3): 485–503. doi: 10.1016/j.jsmc.2022.06.012 . PMID   36150809.
31. Urban AE, Cubała WJ (February 2020). "The role of eugeroics in the treatment of affective disorders". Psychiatr Pol. 54 (1): 21–33. doi: 10.12740/PP/OnlineFirst/90687 . PMID   32447354.
32. Lagarde D, Batejat D (1995). "Some measures to reduce effects of prolonged sleep deprivation". Neurophysiol Clin. 25 (6): 376–385. doi:10.1016/0987-7053(96)84911-2. PMID   8904200.