Fatigue in military aviation: an overview of
US military-approved pharmacological countermeasures

Caldwell JA, Caldwell JL.
Biosciences and Protection Division,
United States Air Force Research Laboratory,
Brooks City-Base, TX 78235, USA.
Aviat Space Environ Med. 2005 Jul;76(7 Suppl):C39-51.


Uncomfortable working and sleeping environments, high operational tempos, sustained operations, and insufficient staffing make fatigue a growing concern. In aviation, where a single mistake can cost millions of dollars, it is essential to optimize operator alertness. Although behavioral and administrative fatigue countermeasures should comprise the "first line" approach for sustaining aircrew performance, pharmacological fatigue countermeasures are often required. Various components of the U.S. military have authorized the use of specific compounds for this purpose. Hypnotics such as temazepam, zolpidem, or zaleplon can mitigate the fatigue associated with insufficient or disturbed sleep. Alertness-enhancing compounds such as caffeine, modafinil, or dextroamphetamine can temporarily bridge the gap between widely spaced sleep periods. Each of these medications has a role in sustaining the safety and effectiveness of military aircrews. The present paper provides a short overview of these compounds as well as factors to be considered before choosing one or more to help manage fatigue.

Military modafinil
Modafinil and the aviator
Modafinil as an antidepressant
Modafinil versus amphetamine
Modafinil versus methylphenidate
Modafinil, amphetamine and sleep
Modafinil (Provigil, Alertec, etc) for nightshift workers