This article was first published on September 26, 2022.
Solriamfetol ( brand name Sunosi®) is a dopamine and norepinephrine reuptake inhibitor (DNRI) approved by the FDA in 2019 for the treatment of excessive daytime sleepiness associated with narcolepsy or obstructive sleep apnea (OSA).
On this page, we will provide basic information about this medication. Links to other articles on this website with more advanced information and tips related to this medication and related topics are provided below—under Related Pages below.
FDA indication
Solriamfetol is indicated to improve wakefulness in adult patients with excessive daytime sleepiness associated with narcolepsy or obstructive sleep apnea (OSA).
Mechanism of action/ Pharmacodynamics
Though exact mechanism is unclear, improvement in wakefulness in adult patients with excessive daytime sleepiness associated with narcolepsy or obstructive sleep apnea (OSA) may be mediated via its activity as a dopamine and norepinephrine reuptake inhibitor (DNRI).
Pharmacokinetics
The elimination half-life of solriamfetol is about 7.1 hours. It is minimally metabolized in the body and 95% of the dose is excreted unchanged in urine.
Side effects
The commonest side effects of solriamfetol (occurring in 5% or more of patients and greater than the rate of placebo) were headache, nausea, decreased appetite, anxiety, and insomnia.
Contraindications
Do not use solriamfetol in patients who are currently on treatment with monoamine oxidase inhibitor (MAOI) or were on MAOI within the preceding 14 days.
Warnings and Precautions
1. Solriamfetol may increase blood pressure and heart rate. It should be avoided in patients having unstable cardiovascular disease, serious heart arrhythmias, or other serious heart problems. Monitor blood pressure and heart rate before initiating and during the treatment. Any newly diagnosed or pre-existing hypertension should be treated promptly.
2. Anxiety, insomnia, and irritability may occur with solriamfetol. Caution is recommended during treatment in patients with a history of psychosis or bipolar disorders. Consider dose reduction or discontinuation of solriamfetol, if needed.
Dosage and Administration
Dosage in Narcolepsy
75 mg to 150 mg orally once daily upon awakening and at least 9 hours before the bed time.
Start at 75 mg and may be doubled to 150 mg after an interval of 3 days or more.
Dosage in Obstructive Sleep Apnea
37.5 mg to 150 mg orally once daily upon awakening and at least 9 hours before the bed time.
Start at 37.5 mg and dosage may be doubled after an interval of 3 days or more up to maximum of 150 mg.
Instructions
May be taken with or without food.
Special cases
a) Moderate renal impairment (eGFR 30-59 ml/min/1.73 m2): Start at 37.5 mg and may increase to a maximum of 75 mg after an interval of 7 days or more.
b) Severe renal impairment (eGFR 15-29 ml/min/1.73 m2): 37.5 mg daily (maximum recommended dose)
c) End stage renal disease (eGFR <15 ml/min/1.73 m2): Not recommended
Dosage forms and strengths
Tablets: 75 mg (scored) and 150 mg
Important! This page does not provide all the information needed to prescribe this medication. Please refer to the full Prescribing Information (see link below) before prescribing this medication.
Related Pages
Medications for excessive daytime sleepiness (due to sleep apnea, narcolepsy, or shift work disorder)
Which hypnotics to use or avoid in persons with sleep apnea
Clinical tips on excessive daytime sleepiness (hypersomnolence)
How to screen for sleep apnea
Excessive daytime sleepiness after remission of major depression
STOP-Bang Questionnaire (my summary and link to the questionnaire)
Epworth Sleepiness Scale (my brief summary and link to the scale itself)
How to know if your patient snores if s/he sleeps alone!
How to measure neck circumference
In a sleep study result, what is the Respiratory Disturbance (Distress) Index (RDI)?
Apnea-Hypopnea Index
References
Solriamfetol (Sunosi®) Prescribing Information
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