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Sleepiness and fatigue are common in the aviation environment even during peacetime, but during combat, fatigue can reach critical levels due to the necessity for sustained operations and the consequent requirement for lengthy duty schedules. Effective nonpharmacological countermeasures are often difficult to implement in these settings due to the situational demands and the unpredictable nature of war. Thus, during combat, pharmacological countermeasures (stimulants or Go Pills) may represent the only feasible alternative for the maintenance of aviator performance when sleep deprivation is inevitable. Caffeine is a first line choice, but might not be sufficiently effective for long durations or for those who are heavy caffeine users. Modafinil is a new alertness-promoting compound that appears to hold promise for use in military aviation, but is not yet recommended because of a lack of field- oriented aviation research. Dextroamphetamine has been successfully used by the military in past conflicts, and its effectiveness and safety are well established. Commanders, flight surgeons, and individual aviators may wish to examine what has been determined from past research in order to make the best possible decision concerning the appropriateness of Go Pills for future aviation sustained operations.