Solriamfetol
SUNOSI
What it isDopamine reuptake inhibitor; excessive sleepiness in narcolepsy and obstructive sleep apnea.
Why this oneUnlike modafinil, it has little CYP interaction and does not undermine hormonal contraception.
What limits itMonitor blood pressure and pulse. Renal clearance governs use, and stimulant-like anxiety or insomnia can end treatment.
FDA-approved for
- excessive sleepiness in narcolepsy/OSA (2019)
FDA label
Read the full label on DailyMed ↗
| FDA dosing | Population | Start | Target | Max |
|---|---|---|---|---|
| Narcolepsy (excessive daytime sleepiness) | Adults | 75 mg QD | 75–150 mg QD | 150 mg QD |
| Obstructive sleep apnea (excessive daytime sleepiness) | Adults | 37.5 mg QD | 37.5–150 mg QD | 150 mg QD |
Titration May double the dose at intervals of at least 3 days
Renal Moderate (eGFR 30–59): start 37.5 mg QD, max 75 mg QD after ≥7 days; severe (eGFR 15–29): 37.5 mg QD (start and max); ESRD: not recommended
Hepatic Undefined
Instructions
- Administer once daily upon awakening
- Avoid administration within 9 hours of planned bedtime
- May take with or without food
- Ensure blood pressure is adequately controlled before initiating
- 75 mg tablet may be split at the score line (37.5 mg)
Contraindications
- MAOIs (concurrently or within 14 days) due to risk of hypertensive crisis
Cautions
- Blood pressure and heart rate increases — control hypertension before/during treatment; avoid in unstable cardiovascular disease
- Psychiatric symptoms (anxiety, insomnia, irritability); caution in psychosis or bipolar disorder
Adverse reactions
- Headache
- Nausea
- Decreased appetite
- Insomnia
- Anxiety
Pregnancy Insufficient human data; animal maternal/fetal toxicity and teratogenicity at high doses; pregnancy exposure registry available
Lactation Present in human milk (RID ~5.5%); monitor infant for agitation, insomnia, and reduced weight gain
NO BOXED WARNINGS
Principal riskBlood pressure and heart rate rise
Cost, est. cash$300–$2,500/month
Generic entry2026
Classes and tags
Clinical profile
Legacy pregnancy categoryNot assigned — PLLR-era drug
Defining liabilityDose-related blood-pressure and heart-rate elevation with anxiety or insomnia.
Mechanism of action: Solriamfetol ballicule
Open Solriamfetol in the interactive console ↗
Memory aids: mascots and interaction avatars
wide eyes: stimulant-like
