Solriamfetol
Generic Name: Solriamfetol
Brand Names: Sunosi
Solriamfetol is used to treat excessive daytime sleepiness in narcolepsy and obstructive sleep apnea.
Drug Class
Dopamine and Norepinephrine Reuptake Inhibitor (DNRI) — Wake-Promoting Agent
DEA Schedule
Schedule Schedule IV
Pregnancy
Not recommended during pregnancy. Animal studies showed adverse developmental effects at clinically relevant doses. No adequate human studies available.
Available Forms
Tablet
What It's Used For
Dosage Quick Reference
These are general dosage guidelines. Your doctor will determine the appropriate dose for your specific situation.
| Condition | Starting Dose | Maintenance Dose |
|---|---|---|
| Excessive Daytime Sleepiness due to Narcolepsy | 75 mg once daily upon awakening | 75–150 mg once daily (max 150 mg/day) |
| Excessive Daytime Sleepiness due to Obstructive Sleep Apnea | 37.5 mg once daily upon awakening | 75–150 mg once daily (max 150 mg/day) |
| Renal Impairment (eGFR 30–59) | Dose should not exceed 75 mg/day | 75 mg once daily maximum |
Side Effects
Common Side Effects:
- Headache
- Nausea
- Decreased appetite
- Anxiety
- Insomnia
- Dry mouth
- Dizziness
Serious Side Effects:
- Increased blood pressure
- Increased heart rate
- Psychiatric symptoms (anxiety, agitation, irritability)
- Dependence potential
Drug Interactions
Major Interactions:
- MAO inhibitors (e.g., selegiline, phenelzine, tranylcypromine) — Concurrent use is contraindicated due to increased risk of hypertensive crisis; allow at least 14 days washout after discontinuing an MAOI before starting solriamfetol
- Dopaminergic drugs (e.g., levodopa, amphetamines, methylphenidate) — Additive effects on dopamine may increase cardiovascular risks including elevated blood pressure and heart rate
- Sympathomimetic agents (e.g., pseudoephedrine, phenylephrine) — May potentiate increases in blood pressure and heart rate; use with caution and monitor vitals
- Antihypertensive medications — Solriamfetol can raise blood pressure, potentially reducing the effectiveness of antihypertensive therapy; blood pressure monitoring is essential
Additional Information
Solriamfetol is a dopamine and norepinephrine reuptake inhibitor (DNRI) used to treat excessive daytime sleepiness (EDS) in adults with narcolepsy or obstructive sleep apnea (OSA). Unlike traditional stimulants, it has a unique pharmacological profile.
Mechanism of Action
Solriamfetol enhances dopaminergic and noradrenergic transmission:
- Dopamine reuptake inhibition: Blocks dopamine transporter (DAT)
- Norepinephrine reuptake inhibition: Blocks norepinephrine transporter (NET)
- No direct catecholamine release: Unlike amphetamines, does not cause monoamine release
- Promotes wakefulness: Through enhanced dopamine and norepinephrine signaling in wake-promoting brain regions
This mechanism provides alertness without the abuse potential associated with amphetamine-like release mechanisms.
Available Formulations
Solriamfetol is available as tablets:
- 75 mg tablets
- 150 mg tablets
Also available as a 37.5 mg tablet (for titration).
Medical Uses
FDA-Approved Indications:
- Excessive daytime sleepiness (EDS) in adult patients with narcolepsy
- Excessive daytime sleepiness in adult patients with obstructive sleep apnea (OSA)
For OSA, solriamfetol does not treat the underlying airway obstruction; primary OSA therapy (e.g., CPAP) should be continued.
Dosing Guidelines
Narcolepsy:
- Starting dose: 75 mg once daily upon awakening
- May increase to 150 mg after at least 3 days
- Maximum: 150 mg daily
Obstructive Sleep Apnea:
- Starting dose: 37.5 mg once daily upon awakening
- May double dose weekly to 75 mg, then 150 mg
- Maximum: 150 mg daily
Renal Impairment:
- eGFR 30-59: Max 75 mg daily
- eGFR 15-29: Max 37.5 mg daily
- eGFR <15: Avoid use
Important Safety Information
Controlled Substance:
- Schedule IV controlled substance
Contraindications:
- Concomitant use with MAOIs or within 14 days of MAOI discontinuation
Warnings and Precautions:
- Blood pressure and heart rate increases: May elevate BP and HR; assess before starting and monitor during treatment
- Psychiatric symptoms: Anxiety, insomnia, and irritability may occur
- Abuse potential: Schedule IV; assess for history of substance abuse
- Not for use in severe OSA as sole therapy: Continue CPAP or other OSA treatment
Drug Interactions
- MAOIs: Contraindicated (hypertensive crisis risk)
- Dopaminergic drugs: Potential for additive effects; use with caution
- Other CNS stimulants: Use with caution; additive cardiovascular and CNS effects
- CYP450: No significant interactions (minimal CYP metabolism)
Special Populations
- Hepatic Impairment: No adjustment for mild to moderate; not studied in severe
- Renal Impairment: Dose adjustment required (see above)
- Pregnancy: Limited data; use only if benefit outweighs risk
- Lactation: Unknown if excreted in milk
- Elderly: No adjustment; consider renal function
- Pediatric: Safety and efficacy not established
Frequently Asked Questions
Related Health Conditions
This medication is commonly used to treat or manage the following conditions:
Medical Disclaimer: This information is for educational purposes only and should not be considered medical advice. Always consult with your healthcare provider before starting, stopping, or changing any medication. Your doctor can provide personalized recommendations based on your specific health condition and medical history.
Related Medications
Other medications in the same category
Questions About This Medication?
Talk to your doctor or pharmacist about whether Solriamfetol is right for you.
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