Adrafinil, a compound the liver converts into modafinil (a prescription medication for excessive sleepiness), is sold unregulated online for alertness and focus. Nearly all human evidence comes from modafinil: it most consistently sustains alertness during sleep loss; gains in rested people are small. Concerns include poor sleep, headache, higher blood pressure, rare serious skin reactions and an unmeasured liver load. Long-term safety has never been directly studied in people. (Full Review)
| Marker | Target | Why |
|---|---|---|
| ALT | <25 U/L | Liver-cell injury |
| AST | <25 U/L | Liver and muscle injury |
| GGT | <25 U/L | Liver enzyme induction |
| Alkaline phosphatase | 40–100 U/L | Bile-flow and liver stress |
| Total bilirubin | 0.3–1.0 mg/dL | Liver clearance function |
| eGFR | >90 mL/min/1.73 m² | Kidney clearance of metabolites |
| Blood pressure | <120/80 mmHg | Stimulant blood-pressure rise |
| Resting heart rate | 50–70 bpm | Stimulant cardiac effect |
| Pregnancy test (where relevant) | Negative | Avoid fetal exposure |
Cadence: Baseline before starting; liver enzymes at 4–8 weeks, then every 3 months while use continues; blood pressure and resting heart rate weekly during the first month, then monthly; sleep, mood and focus at 2 weeks and at each later check