Solriamfetol
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Norepinephrine-dopamine reuptake inhibitor (NDRI), wake-promoting agent
Solriamfetol
Sunosi
Solriamfetol (brand name Sunosi) is a selective dopamine and norepinephrine reuptake inhibitor (NDRI) approved by the FDA in March 2019 for excessive daytime sleepiness (EDS) in narcolepsy and obstructive sleep apnea. Unlike traditional stimulants (amphetamine, methylphenidate), solriamfetol does not significantly release monoamines from vesicles, it is purely a reuptake inhibitor, which may produce a smoother subjective effect with lower abuse potential. Lower scheduled (CIV) than the traditional stimulants (CII). Not indicated to treat underlying OSA (use with primary OSA therapy such as CPAP).
Selective inhibitor of DAT and NET. Modest serotonin reuptake inhibition. Does not bind VMAT2 or cause significant monoamine release (contrast with amphetamine).
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Effects
Headache, nausea, decreased appetite, anxiety, insomnia, palpitations, blood pressure / heart rate elevation. Avoid in patients with significant cardiovascular disease.
Pharmacodynamics
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Summary
Classes
Norepinephrine-dopamine reuptake inhibitor (NDRI), wake-promoting agent
Common uses
Excessive daytime sleepiness in adults with narcolepsy or obstructive sleep apnea (OSA)
Pharmacy
Starting dose
Narcolepsy: 75 mg PO once daily upon awakening, titrate every 3 days. OSA: 37.5 mg PO once daily, titrate.
Preparations
75 mg, 150 mg tablets
US FDA Max
150 mg/d
Pharmacology
Routes
Oral
Onset
~30-60 min
Duration
~9 hours
Half-life
~7.1 hours
Bioavailability
~95%
Pregnancy
Limited data; pregnancy exposure registry available
Legal status
Rx, Schedule IV (US)
Purported mechanism
Selective dopamine and norepinephrine reuptake inhibitor (DAT and NET inhibition). Unlike amphetamine, does not significantly release monoamines, pure reuptake inhibition.