solriamfetol

General Information

Solriamfetol (Sunosi) is a wakefulness-promoting medication indicated to improve wakefulness in adults with excessive sleepiness associated with narcolepsy or obstructive sleep apnea (OSA) (label).

It is a dopamine and norepinephrine reuptake inhibitor and is a Schedule IV controlled substance. Practical monitoring focuses on blood pressure/heart rate effects, anxiety/insomnia, and misuse risk in vulnerable populations (label/clinical).

Solriamfetol is not a substitute for primary OSA therapy; evaluation of PAP adherence, sleep restriction, sedating medications, and circadian factors remains clinically central when sleepiness persists (label/clinical).

Patients with moderate or severe renal impairment may be at higher risk for cardiovascular and psychiatric adverse reactions due to prolonged half-life; renal dosing is a routine prescribing checkpoint (label).

The solriamfetol compare view, evidence feed, and print page support review of activation and monitoring considerations.

Solriamfetol is a once-daily wake-promoting option with relatively low CYP-mediated interaction burden, but careful selection is important due to dose-dependent blood pressure/heart rate effects, insomnia/anxiety risk, and strict renal dose adjustments (label/clinical).

Mechanism of Action

Refer to the Glossary entry on Neurotransmitters for background on receptor systems involved in serious mental illness.

Dopamine and norepinephrine reuptake inhibition is considered central to wake-promoting effects; the clinical phenotype often resembles other activating agents, with attention to insomnia and anxiety as practical tolerability constraints (label/clinical).

Because of noradrenergic effects, cardiovascular monitoring is emphasized, particularly in patients with uncontrolled hypertension or when combined with other pressor agents (label/clinical).

• Dopamine and norepinephrine reuptake inhibition (wake-promoting mechanism).

Metabolism and Pharmacokinetics

• Oral bioavailability is ~95% and peak plasma concentration occurs at a median T_max of ~2 hours under fasted conditions; food has minimal effect on exposure but can delay T_max (label).
• Solriamfetol is largely excreted unchanged in urine (~95% recovered as unchanged drug) with minimal metabolism; apparent mean elimination half-life is ~7.1 hours (label).
• Renal impairment increases half-life and exposure in a graded manner; dose adjustments and avoidance in ESRD are safety-critical (label).

Dosing and Administration

• Administer once daily upon awakening; avoid dosing within 9 hours of planned bedtime (label).
• Narcolepsy: initiate 75 mg once daily; may increase to 150 mg once daily based on efficacy/tolerability (label).
• OSA: initiate 37.5 mg once daily; may titrate in stepwise fashion up to 150 mg once daily based on efficacy/tolerability (label).
• Dose adjustments are required for renal impairment; clinicians often document renal function at initiation and reassess with clinical changes or when labs update (label/clinical).

Monitoring & Labs

• Blood pressure and heart rate monitoring at baseline and periodically (label/clinical).
• Sleep disruption monitoring (insomnia, timing effects) (label/clinical).
• Mood and psychiatric symptom monitoring (anxiety, irritability, mania/psychosis) (label/clinical).
• Renal function review for dosing decisions and ongoing safety (label).
• Misuse/diversion risk monitoring consistent with Schedule IV status (clinical).

Adverse Effects

Interactions

• Monoamine oxidase inhibitors (MAOIs) are contraindicated and require a washout period due to risk of hypertensive reactions (label).
• Concomitant use with other agents that raise blood pressure/heart rate may amplify cardiovascular effects; monitoring is common in combination regimens (label/clinical).
• Because solriamfetol is largely excreted unchanged, CYP-based interaction burden is relatively low, but renal dosing and adherence to contraindications remain central safety steps (label/clinical).

Other Useful Information

• Evidence syntheses and guidelines support wake-promoting agents for excessive daytime sleepiness in central hypersomnolence disorders, but medication choice is individualized based on comorbidities, adverse-effect profiles, and implementation constraints (AASM/clinical).
• In serious mental illness, clinicians often monitor for activation, anxiety, and sleep disruption when adding wake-promoting agents, and may prioritize nonpharmacologic contributors to sleepiness first (clinical).

References

1. SUNOSI (solriamfetol) tablets prescribing information — DailyMed (2026)
2. Treatment of central disorders of hypersomnolence: an American Academy of Sleep Medicine clinical practice guideline — Journal of Clinical Sleep Medicine (2021)
3. Treatment OF Central Disorders OF Hypersomnolence: AN American Academy OF Sleep Medicine Systematic Review, Meta Analysis, AND Grade Assessment — Journal of Clinical Sleep Medicine (2021)
4. A randomized study of solriamfetol for excessive sleepiness in narcolepsy — Annals of Neurology (2019)
5. Solriamfetol for Excessive Sleepiness in Obstructive Sleep Apnea (TONES 3). A Randomized Controlled Trial — American Journal of Respiratory and Critical Care Medicine (2019)