As you’ve been hunting for the best ways to take modafinil most effectively, we’ll give you the details on this subject in this in-depth guide. First, we’ll introduce you to modafinil, the world’s most popular nootropic, & its powerful effects and tell you how to circumvent its minor negative reactions. Then we’ll give top-notch tips on how to take it effectively for the best results and finally – our verdict. Generally, all the info you need to acquaint yourself with to succeed on modafinil safe use can be found here.
What Is Modafinil?
Modafinil is a type of med known as a eugeroic. It fosters wakefulness & prevents you from feeling tired. It was first discovered in France in the mid-1970s & became a pharmaceutical product there in 1994 under the original name Modiodal. In the USA, it has become available as Provigil since 1998 [1].
As a powerful med, modafinil is used to treat sleep-related disorders like narcolepsy, shift work sleep disorder (SWSD), and obstructive sleep apnea (OSA). It is also prescribed off-label to combat the symptoms of attention deficit hyperactivity disorder (ADHD), jet lag, depression, etc. [2]. The medicine is sometimes taken by individuals having exacting jobs who desire to stay awake & vigilant for extended periods, such as astronauts, commercial aviators, and military personnel [3]. While that’s all very intriguing, it’s probably not the cause why you’re fascinated by modafinil.
Since it’s quite popular, you’ve probably heard that it’s a “smart pill,” a “study med,” or a powerful “nootropic,” and you’d be right; it does offer many cognitive advantages. Administering modafinil as a “smart pill” can generally reward with the following benefits:
- ameliorated focus for 12+ hours [4];
- augmented cognitive function in highly exacting task performance [5];
- fostered memory retention [6];
- higher productivity;
- fostered mood.
Generally, researchers have found that this “smart pill” ameliorates higher-order cognitive function without triggering serious negative effects [7]. Because of this, modafinil is becoming extremely well-liked with Type-A (personality theory) high-achievers like business executives, entrepreneurs, CEOs, IT professionals, programmers, astronauts, and students, etc., who want to get the superhuman levels of mental acuity, focus & memory that this “smart pill” offers.
If you’re intrigued about how the drug offers these incredible benefits, the real answer is that it floods the brain with enormous amounts of histamine & dopamine [8]. This results in a stimulant effect in the body. Histamine keeps the brain wired & productive for literally hours [9]. After ingesting the nootropic, it’s almost impossible to experience fatigue, even if you are doing a complex, boring, or repetitive task.
Modafinil’s cognitive augmentations come from dopamine [10]. As a powerful neurotransmitter, it gives your memory & mood a remarkable boost, making it much easier to work & study successfully [11].
As a “study med,” one of its most beneficial effects is that it dulls a specific part of the brain — the amygdala, meaning it lowers individual sensitivity to fear stimuli & aids in doing work & studying efficaciously even if feeling stressed or under an enormous amount of pressure [12].
What About Side Effects and Safety?
Although modafinil is known as the safest pharmaceutical product, some side effects can transpire – just as with any health remedy. To minimize their onset, the nootropic should be taken after consulting a physician to determine if it’s good for you.
Headache, nervousness, nausea, difficulty sleeping, and dizziness are common adverse reactions correlated with modafinil use. They are usually mild & don’t require any treatment. However, if any of these symptoms persists or worsens, you should inform your physician promptly. In rare cases, serious negative effects may transpire. If you notice mental/mood changes, pounding/irregular/fast heartbeat, or chest pain, seek urgent help from a medical specialist to avoid complications.
Because modafinil affects people in different ways depending on their health response to medication, given side effects is not an absolute list. If you experience other symptoms not mentioned above while on modafinil, contact your physician for assistance.
Regarding modafinil safety and warnings, you should not use it if you have manic behavior, suicidal thoughts, aggressive behavior, psychotic disorder, depression, high blood pressure, a heart attack, severe liver disease or renal impairment, and other health conditions that a doctor should examine before taking the nootropic [13]. As a prescription med, modafinil is popularly considered non-addictive, but instances of withdrawal & dependence have been reported if it is taken at high doses[14][15]. Always take this medication as advised by a physician.
So, if you are contemplating taking modafinil off-label as a powerful nootropic, you should be prepared to experience some of the mentioned negative effects. Based on the statistical data, they shouldn’t be a crucial concern if you take the recommended dose of 100–200 mg.
Also, modafinil can be stacked with other safe nootropic products such as choline. Many users report taking this substance to lower or eliminate most of its inconsequential negative effects. Staying hydrated also aids in combating headaches & a dry mouth and throat associated with the nootropic’s use.
Although it’s the “smart pill,” it shouldn’t be taken every day for a long period. Most nootropic enthusiasts take it off-label one or three times per week, or on days where they do not need to cram intensively or foster memory for an upcoming exam or crush their workload.
As a beginner looking to take modafinil off-label for the first time, you can start with a 100 mg dose by ingesting it in the morning to see how your body will respond before increasing it up to a 200 mg dose. That being said, in infrequent instances, & at exceedingly high doses (300 mg+), modafinil can trigger effects like chest pain, hypersexuality, fever, & hallucinations. Halt its usage immediately if you experience any of these reactions & seek help from a physician.
Tips on How to Take Modafinil Effectively
Curious about how to take modafinil effectively? The tips given in this guide are based on our experiences & those of other “smart pill” enthusiasts, and, of course, your experience may be different. Although modafinil is the absolute king of nootropics, it’s wise to note that individuals react differently to distinct things including health remedies. It’s important to experiment and find out which tip works best for you for optimal results. Our 20 quick tips below have invariably helped several people to get the most out of modafinil. By following them, you too can get the greatest benefits.
The Optimal Modafinil Dosage
Ever asked yourself the optimal modafinil dosage? The ultimate key to acquiring the most out of this nootropic is finding the ideal dose. For most users, their optimal dose is between 100 to 200 mg per day. Others find the doses of less than 100 mg are effective. The process of taking low doses and increasing them gradually is what is called microdosing. Some people need a higher dosage of 200 mg+ to feel the drug’s effects. Several “smart pill” enthusiasts have experimented with ingesting 300 mg+ of modafinil but reported few auxiliary benefits in terms of focus & productivity juxtaposed with taking a 200 mg dose of the drug. However, everybody’s different, so if interested in this nootropic, you’ll want to consider your biology, as there’s no “universal perfect medicine dose.”
Split Dosing
Is modafinil taken twice a day? To most users, taking a half of a pill (50–100 mg) in the morning immediately after breakfast powers the brain function for about 4 to 6+ hours. After lunch, it’s also safe to take another 50–100 mg of the “smart pill.” This allows you to work another 5 to 7+ hours without losing focus.
By splitting the modafinil dose, many users find its effects to be more stable & predictable. Besides, it’s generally cheaper to purchase modafinil 200 mg pills & then split them in half – if that’s how you desire to take the “smart drug.”
Time the Dosage Right
It’s unwise to take modafinil in the afternoon & look forward to getting the full benefits of it – unless you’re contemplating pulling an all-nighter. If intending to reap its benefits throughout the day, pop a pill as early as possible. Due to the nootropic’s half-life, the effects can last up to 13 hours or so. So if you wake up at 6 am and pop the “smart pill,” the positive effects should kick in by around 7–8 am.
This should let you work for the next 13–15 hours (probably until 9–10 pm) that evening. That’s a whole lot of cognitive as well as productive time.
The rule of thumb: Take the “smart pill” always in the morning if using it as a cognitive ameliorator.
Forget About Sleep
Sleeping & the nootropic don’t exactly have a harmonious relationship. Think about it. Modafinil was designed to foster wakefulness – to keep some patients with sleep disorders awake all day long (for 13+ hours). So if you are looking to take modafinil, keep in mind that it may interfere with your regular sleep schedule.
However, this depends on the “smart pill” dosage, tolerance, as well as what time you usually sleep. Some nootropic users have no difficulty falling asleep at 10 or 11 pm after ingesting the “smart tab” once in the morning, while others cannot fall asleep until 1–3 am. This is why it’s recommended to take a dose of 100 mg or less early in the morning.
Remember to Eat
Although you can administer modafinil with food or without it, it’s always advisable to eat after taking this drug. It can act as an appetite suppressant. As such, you infrequently feel the hunger while on the nootropic.
So make a conscious effort to recall to eat well when using this “smart pill.” This means you should stick to your quintessential meal schedule — even if you don’t feel hungry. Plan to have breakfast, lunch, & dinner as usual & try to eat analogous amounts. This helps you minimize certain negative effects of modafinil such as headaches & nausea.
Many “smart pill” users experiencing nausea & stomach issues when taking this drug find that it’s due to one cause – not eating food while on modafinil.
Drink Plenty of Water
Most often, people forget to drink adequate amounts of water while on modafinil – just like food. Just because the effect the drug gives can make one bury in work & neglect the need to quench thirst.
Forgetting to drink sufficient water is commonplace for many “smart pill” users. They begin to be so focused on their planned task that they neglect to drink water during the day. Without water, the mouth becomes extremely dry, & by the time the users notice how dehydrated they are, the side effect like a headache has already developed. The most common cause of headaches is dehydration.
If taking the nootropic, try to have some Pedialyte (a rehydration solution) with a final meal of the day. This considerably aids with hydration. Pedialyte helps prevent or treat the loss of too much body water (dehydration). By being hydrated when using the cognitive enhancer, you can easily ward off most common negative effects of modafinil. So make it a routine to always consider drinking sufficient water throughout the nootropic’s effect.
Pay Attention to Tolerance
Some individuals prefer to pop modafinil every single day. Is it safe? Can you take a pill every day without building a tolerance? While this may reward users with some sustained cognitive effects, it is certainly not a habit you’d like to be in.
Although this nootropic doesn’t appear to be addictive, it is a powerful prescription med that needs to be considered with some perspectives. As such, it’s paramount to be aware that the body can build a tolerance to the “smart pill” if taken for extended periods. This is principally true when using modafinil to ameliorate cognitive function or for productivity.
Generally, nootropic enthusiasts find modafinil is ideal if taken 1–3 days per week. This is also the best dosing schedule most people follow (as discussed earlier), and it allows them to experience insanely great cognitive benefits while making sure that they don’t build up any type of “smart pill” tolerance.
Pay Attention to Withdrawal
Withdrawal symptoms can kick in if you no longer use modafinil. If you desire to quit this med, it’s best to taper off the dosage over time to give your body enough time to adjust to less of the medication. Tapering means that if you used to take a 200 mg tab or so, lower the dose gradually until you hit the lowest possible dosage, say, 25 mg, that still spans for some time to circumvent the development of withdrawal symptoms.
Most modafinil users notice reactions such as being more tired than usual after stopping it. Other possible but uncommon “smart tab” withdrawal symptoms are low energy, poorer concentration, sleepiness, depression, and shortness of breath. The intensity and duration of such reactions may vary depending on genetic factors, age, how long you have been using the “smart pill,” etc.
Don’t Hit the Gym
Some people rave about “smart pill” effects on their workouts. To be sure, they find that this med fosters their focus, mood, vigilance, energy, endurance, as well as a mind-body interrelationship while in the gym.
Indeed, studies have shown that the nootropic lowers the sensation of fatigue arousing in the muscle, among other effects [16]. However, a decrease in the sensation of fatigue in muscles can potentially lead to negative consequences such as exercising too intensely & injuring oneself. Joint pain fosters significantly when going to the gym after popping the “smart pill.” This may be due to one’s ability to feel extremely fatigued while lifting.
Aside from this caution against using modafinil in the gym, there is one more thing. If you’re in the gym having taken it, you’re not using various benefits of the nootropic wisely. As depicted, there are much better uses for the “smart pill” than solely pumping iron. So ensure to make the preeminent use of its cognitive benefits by sticking to career, academic, or work-related tasks that require massive brainpower.
Don’t Booze
Modafinil may sound perfect for dealing with a hangover & being productive, but combining it with booze is no-go. Prescription meds rarely combine well with booze, & modafinil is certainly no different.
Both the “smart pill” & alcohol place extra strain on the liver [17][18]. The liver breaks down (metabolizes) both of these substances after you ingest them. When using alcohol & modafinil at the same time, the liver is put under undue stress. Also, combining the two compounds can proliferate the chances of becoming dehydrated. Due to this, we don’t recommend mixing modafinil and alcohol.
Occasionally, combining small amounts of alcohol with modafinil may not pose a major risk to the body; nevertheless, long-term use certainly will. It’s paramount that if you choose to take the “smart pill” along with alcohol, circumvent doing it every day, or even every few days. Over long periods, an intolerable burden on the liver can cause health issues like high cholesterol, heart disease, hyperlipidemia, and diabetes.
Get Started Before the Effects Kick In
You don’t have to take the nootropic and then wait around for the expected effects to kick in. Just put yourself in the task before the active ingredient’s effect starts working to experience the best results.
It is prudent to avoid this trap of waiting. Otherwise, you’ll end up doing other things rather than the one you expected to engage in. Nobody desires to end up wasting 1 to 4 hours or so mindlessly doing unnecessary acts in lieu of being productive and getting stuff done.
Modafinil tends to take about 1 hour or so to kick in. Nonetheless, if you’re doing other tasks or researching some interesting things, you might realize that moving to productive tasks begins to be more tedious once the med kicks in.
Have a Plan
“Smart pill” enthusiasts ensure they plan out their day when using this nootropic. At night or early in the morning before popping a tablet, you may want to jot down what you want to fulfill throughout the day. After taking modafinil, you need to put together a full day plan that will take 9 to 12+ hours to complete. Ensure you keep this plan uninterrupted when working throughout the day and don’t omit to eat and drink a lot of water. Having accomplished the planned task, you can cross it off the list you wrote earlier. Planning on modafinil is key to a productive day.
Combine with Coffee
The combo of coffee and modafinil is popular and is a universal gift to productivity. According to various studies, caffeine pairs exceptionally well with the “smart pill.” Many individuals consider it to be a nootropic by itself because it is a powerful performance ameliorator. Additionally, caffeine is even forbidden by the National Collegiate Athletic Association (NCAA) as a performance-fostering med at high levels of use [19].
If considering this substance as a stack, keep in mind that an average cup of coffee contains roughly 100 mg of caffeine. It takes about 6 hours to pass through the system. It’s advisable to ingest a maximum of 200 mg of caffeine every 6 hours or 100 mg every 3 hours while on the “smart tab.” This means you can have about 1 cup of coffee every 3 hours.
Take note that a higher amount of caffeine & 200 mg of modafinil as a stack can be too stimulating – depending on your response to the mix. Due to this, consume a lower dose of the “smart pill” next time. Also, you may want to try the standard dose of the nootropic (200 mg) with 50 mg of caffeine instead.
Combining modafinil with coffee helps you stay awake for a long time. The “smart pill” ameliorates wakefulness & caffeine hinders the body’s natural inclination to sleep. Thus, you experience a double-whammy mix that leads to productivity nirvana & helps you power through complicated cognitive tasks [20]. A combination of the smart pill’s performance-ameliorating capability and caffeine’s fatigue-reducing effects rewards with insanely great cognitive benefits, possibly turning you into a superhuman machine. Read our other guide on how to mix the “smart pill” & caffeine effectively: Beginner’s Guide to Mixing Modafinil and Caffeine. You might want to try this combination to perform great throughout the day.
Don’t Mix “Smart Pills”
What happens if you mix modafinil with other nootropics? While combining coffee with “smart drugs” is ideal, don’t mix modafinil with other nootropics without any knowledge about the effect expected. Some stacks can be dangerous to your health. Usually, the safest nootropic is coffee. You can easily take the “smart pill” & drink some coffee as discussed earlier. That’s all nootropic enthusiasts need to succeed.
Also, combining modafinil with other health remedies that are known to cause interaction is not safe. Drug interactions may alter how your medications work or increase the risk of serious negative effects. So to take modafinil most effectively, keep a list of all the products you use (including prescription/non-prescription meds & herbal products) & share it with your physician to determine if any drug can cause an interaction [21].
Expect Good Mood with Occasional Euphoria
Because stimulants have a mood-ameliorating effect on most people, using modafinil can also make you be in a happy mood. Occasionally, some people get awash with a euphoric feeling after ingesting this nootropic. The fact is that because of the modafinil effect, you get a ton of high-quality work done, which contributes to this as well. The degree of mood enhancement and/or euphoria experienced will likely depend on the individual’s disposition. Some people tend to respond very well to stimulants. So if caffeine makes you feel insanely good, modafinil likely will too.
Know Your Health
Before deciding to use modafinil off-label for cognitive purposes, it’s best to know the status of your health. The medicine is known to interact with 9 health conditions leading to serious or minor disease interactions. Consult a physician to determine if you have the following conditions [22]:
- cardiac disease (major interaction);
- seizure disorders;
- bipolar disorders;
- liver disease (major interaction);
- psychotic disorders;
- hypertension (major interaction);
- psychiatric disorders;
- renal dysfunction;
- cardiovascular disease.
Take note that disease interaction can be life-threatening or can worsen the condition. The best thing to do is to determine with a physician if it’s possible to take modafinil in lower doses while being monitored if you desire to use it, especially where there’s a moderate interaction.
Plan to Sleep In
Planning to sleep later than you usually do is necessary while on modafinil. It is quite likely that the “smart pill” is going to mess up your usual sleep schedule. That’s precisely how a pharmaceutical med that was created for sleep disorders like SWSD and OSA works. Fortunately, you can reduce the possibility of sleep negative effects triggered by the nootropic with a few tips & tricks.
If you’re endeavoring to sleep after using modafinil, a supplement stack formulated to aid you in falling asleep can be advantageous. From time to time, you can add in supplements such as ashwagandha and cherry juice to make sure that you get a good nights’ sleep.
Another tip on modafinil and sleep is to vigorously exercise (a minimum of 3 hours before bed). This activity can help you fall asleep faster & ameliorate your sleep quality [23]. Also, take a lukewarm shower or bath about 1–1.5 hours before bed & avoid some eatables such as grapefruit juice. Such fruit can prolong the modafinil’s effects (due to inhibiting the enzyme that metabolizes the “smart pill” active ingredient) [24].
Additionally, to experience good sleep, circumvent the use of other stimulants, especially after 4 pm on the day you ingest modafinil. If you take the drug with other stimulants such as caffeine, you may consider it even more challenging to fall asleep at a reasonable hour. As a tip, we would exhort you not to consume any caffeine or similar products after 2 pm for the best results. Ensure to make the appropriate adjustments for any stimulants you plump for to take alongside the ‘‘smart pill.”
Creativity Crushed
According to various studies, modafinil does not seem to foster creativity. It may impede the creative process a bit. The “smart pill” might lower divergent thinking of creativity in healthy highly creative people. Rather than being a more general cognitive ameliorator, modafinil might have negative & subtle effects on creativity [25].
While you might have the power to crush work & stay focused for several hours on end when using the “smart pill,” you may not experience much creative inspiration. You may want to pop the medicine when you aspire to be productive. Accordingly, you may want to circumvent its use when you need to be creative.
Be Careful If You Drive
In a study done by researchers, the “smart pill” fostered driving performance in patients with idiopathic hypersomnia & narcolepsy who received 400 mg of the drug for 5 days before the driving test [26]. However, modafinil may impair your thinking or reactions if you pop it and instantly drive or do anything that requires your attention and extra caution. So to get the most out of this nootropic and not to harm your health, it’s advisable to circumvent dangerous activities you might want to engage in like driving until you know how this medicine will affect your level of wakefulness and cognition.
Set a Place Where You Won’t Be Disturbed
This tip is a personal preference. Most people pop this pill & work all day, and they do not want to be disturbed at all. Students prefer going to a coffee shop or a library that opens early & where they’re unlikely to be disturbed by the surroundings or anyone they know. Also, most of the “smart pill” enthusiasts perfectly feel OK without speaking to any person & while opting to sit in a corner with headphones in for extended hours or the whole day. Indeed, that’s how to be most productive. However, you might have your plan. Make sure it’s free from disturbances to be productive and focused on what you intend to achieve while on modafinil.
In Summary About Taking Modafinil Properly
Using modafinil most effectively doesn’t need to be extremely complicated or unhealthy. This drug is safe if taken properly, and it rewards users with great positive effects. Consider our quick actionable tips & tricks given above, especially if you want to get the best out of it. The proper ways to take this nootropic most effectively is something we’ve explored above. So take delight and apply any tip that suits your modafinil usage needs.
References
- Modafinil. Retrieved: February 2, 2021. Wikipedia.org.
- Modafinil reduces depression’s severity when taken with antidepressants. Published: November 27, 2013. Sciencedaily.com.
- Modafinil as a Stimulant for Military Aviators. By Timotheus Ooi, Sheau Hwa Wong, and Brian See. Published: May 2019. Pubmed.ncbi.nlm.nih.gov.
- Mechanisms of modafinil: A review of current research. By Paul Gerrard and Robert Malcolm. Published: June 2007. Ncbi.nlm.nih.gov.
- Effects of modafinil on non-verbal cognition, task enjoyment and creative thinking in healthy volunteers. By U. Müller, J. B. Rowe, T. Rittman, et al. Published: January 2013. Sciencedirect.com.
- Modafinil for cognitive neuroenhancement in healthy non-sleep-deprived subjects: A systematic review. By R. M. Battleday and A-K Brem. Published: November 2015. Pubmed.ncbi.nlm.nih.gov.
- A Safe Drug to Boost Brainpower. By Melinda Wenner Moyer. Retrieved: February 2, 2021. Scientificamerican.com.
- Modafinil increases histamine release in the anterior hypothalamus of rats. By Tomoko Ishizuka, Yasuhiko Sakamoto, Toshimi Sakurai, and Atsushi Yamatodani. Published: March 2003. Pubmed.ncbi.nlm.nih.gov.
- The physiology of brain histamine. By R. E. Brown, D. R. Stevens, and H. L. Haas. Published: April 2001. Pubmed.ncbi.nlm.nih.gov.
- Evidence for the involvement of dopamine transporters in behavioral stimulant effects of modafinil. By Dorota Zolkowska, Raka Jain, Richard B. Rothman, et al. Published: May 2009. Pubmed.ncbi.nlm.nih.gov.
- Modafinil: a review of neurochemical actions and effects on cognition. By Michael J. Minzenberg and Cameron S. Carter. Published: June 2008. Pubmed.ncbi.nlm.nih.gov.
- Modulatory Effects of Modafinil on Neural Circuits Regulating Emotion and Cognition. By Roberta Rasetti, Venkata S. Mattay, Beth Stankevich, et al. Published: June 16, 2010. Ncbi.nlm.nih.gov.
- Who should not take Modafinil? Retrieved: February 2, 2021. Webmd.com.
- Modafinil Dependence: A Case with Attention-Deficit/Hyperactivity Disorder. By Huseyin Alacam, Omer Basay, Selim Tumkaya, et al. Published: March 30, 2018. Ncbi.nlm.nih.gov.
- Could modafinil be a drug of dependence? By Rohan Dhillon, Xiaowen Wu, Tarun Bastiampillai, and Prashant Tibrewal. Published: May 2015. Pubmed.ncbi.nlm.nih.gov.
- Effects of acute modafinil ingestion on exercise time to exhaustion. By Ira Jacobs and Douglas G. Bell. Published: June 2004. Pubmed.ncbi.nlm.nih.gov.
- In vitro inhibition and induction of human hepatic cytochrome P450 enzymes by modafinil. By P. Robertson, H. H. DeCory, A. Madan, and A. Parkinson. Published: June 2000. Pubmed.ncbi.nlm.nih.gov.
- Effect of alcohol on cytochrome p450 arachidonic acid metabolism and blood pressure in rats and its modulation by red wine polyphenolics. By Christine Cowpland, Gloria M. Su, et al. Published: March 2006. Pubmed.ncbi.nlm.nih.gov.
- 2020-21 NCAA Banned Substances. Retrieved: February 2, 2021. Ncaa.org.
- Methylphenidate, modafinil, and caffeine for cognitive enhancement in chess: A double-blind, randomized controlled trial. By Andreas G. Franke, Patrik Gränsmark, Alexandra Agricola, et al. Published: March 2017. Sciencedirect.com.
- Modafinil – oral, Provigil. Retrieved: February 2, 2021. Medicinenet.com.
- Modafinil Disease Interactions. Retrieved: February 2, 2021. Drugs.com.
- Exercising for Better Sleep. Retrieved: February 2, 2021. Hopkinsmedicine.org.
- Grapefruit juice–drug interactions. By David G. Bailey, J. Malcolm, O. Arnold, and J. David Spence. Published: August 1998. Ncbi.nlm.nih.gov.
- The Effects of Modafinil on Convergent and Divergent Thinking of Creativity: A Randomized Controlled Trial. By Ahmed Dahir Mohamed. Published: September 15, 2014. Onlinelibrary.wiley.com.
- Modafinil Improves Real Driving Performance in Patients with Hypersomnia: A Randomized Double-Blind Placebo-Controlled Crossover Clinical Trial. By Pierre Philip, Cyril Chaufton, Jacques Taillard, et al. Published: March 1, 2014. Ncbi.nlm.nih.gov.