Sunosi (solriamfetol) is a prescription medication that works as stimulant to reduce excessive daytime sleepiness in both sleep apnea and narcolepsy. It is a pill and its mechanism of action is through activity as a dopamine norepinephrine reuptake inhibitor (DNRI). What are the uses, potential side effects, available dosages, and recommended safety precautions related to this drug? Learn more about Sunosi and whether it might be the right treatment for you.
Sunosi (solriamfetol) is approved by the FDA for the treatment of excessive daytime sleepiness in adults with obstructive sleep apnea or narcolepsy. As a pill, it is taken once daily to improve wakefulness.
It does not treat the underlying obstruction of the airway associated with sleep apnea, affecting oxygen and carbon dioxide levels within the blood. This must be resolved with additional treatment, such as with continuous positive airway pressure (CPAP), for at least 1 month prior to the initiation of Sunosi. Moreover, optimal airway management must continue after starting the medication.
First, the diagnosis of obstructive sleep apnea or narcolepsy must be established. This may require evaluation by a board-certified sleep medicine healthcare provider and testing that may include:
- Home sleep apnea testing (HSAT)
- In-center diagnostic polysomnogram (PSG)
- Multiple sleep latency testing (MSLT)
Other causes of sleepiness must be excluded, including obtaining inadequate sleep to meet sleep needs, circadian disorders (such as delayed sleep phase syndrome), and other hypersomnias.
If obstructive sleep apnea is diagnosed, it must be effectively treated (such as with CPAP) for 1 month prior to starting Sunosi to address any residual sleepiness.
Prior to the initiation of Sunosi, blood pressure must be adequately controlled.
Precautions and Contraindications
If you have had a prior allergic reaction to the drug, it should be avoided. Do not take Sunosi if you are taking, or have stopped taking within the past 14 days, a medicine used to treat depression called a monoamine oxidase inhibitor (MAOI).
Discuss your medical conditions with your prescribing healthcare provider, including:
- Heart problems or heart attack
- High blood pressure
- Kidney problems
- High cholesterol
- Mental health problems (including psychosis or bipolar disorder)
- Drug or alcohol abuse or addiction
- Pregnancy (or planned pregnancy)
- Breastfeeding (or planned breastfeeding)
It may interact with other medications, and you should review your complete medication list with your prescribing healthcare provider.
As a new medication, insurance may require the trial and failure of other prescription stimulant medications prior to approving the use of Sunosi. These may include:
- Provigil (modafinil)
- Nuvigil (armodafinil)
- Concerta or Ritalin (methylphenidate)
- Adderall (dextroamphetamine/amphetamine)
- Vyvanse (lisdexamfetamine)
In addition, sodium oxybate (Xyrem) is used to improve sleepiness and cataplexy in narcolepsy.
All listed dosages are according to the drug manufacturer. Check your prescription and talk to your healthcare provider to make sure you are taking the right dose for you.
Dosage in Sleep Apnea
According to the manufacturer, Sunosi is started at 37.5 milligrams (mg) once daily in adults with persistent sleepiness due to sleep apnea. The recommended dosage range is 37.5 mg to 150 mg once daily. Based on the response to treatment, the dose may be doubled every three days as needed. The maximum recommended dosage is 150 mg once daily. Higher doses do not confer increased benefits to outweigh adverse reactions.
Dosage in Narcolepsy
According to the manufacturer, Sunosi is started at 75 milligrams (mg) once daily in adults with persistent sleepiness due to narcolepsy. The recommended dosage range is 75 mg to 150 mg once daily. Based on the response to treatment, the dose may be doubled every three days as needed. The maximum recommended dosage is 150 mg once daily. Higher doses do not confer increased benefits to outweigh adverse reactions.
The doses are reduced in the setting of impairment of the function of the kidneys. This depends on the severity, with a maximum dose of 75 mg in moderate and 37.5 mg in severe renal impairment. In end-stage renal disease, Sunosi is not recommended for use.
How to Take and Store
Sunosi is taken by mouth upon awakening with or without food. It should not be taken within nine hours of planned bedtime due to the risk of it causing insomnia. If a dose is missed, excessive daytime sleepiness may occur, and you may wait until the next day to take your regularly scheduled dose.
It should be stored at 68 to 77 degrees Fahrenheit (or 20 to 25 degrees Celsius).
Sunosi is a federally controlled substance (class IV medication) because it contains solriamfetol that can be a target for people who abuse prescription medicines or street drugs. Keep Sunosi in a safe place, such as a locked cabinet, to protect it from theft.
Never give your Sunosi to anyone else, because it may cause death or harm them. Selling or giving away Sunosi may harm others and is against the law. Tell your healthcare provider if you have ever abused or been dependent on alcohol, prescription medicines, or street drugs.
If you take too much Sunosi, call your healthcare provider or go to the nearest hospital emergency room right away.
As with any medication, there are potential side effects that may occur with the use of Sunosi (solriamfetol). Some side effects may occur more commonly, and others may severe but rare.
Some of the common side effects associated with the use of Sunosi (solriamfetol) include:
- High blood pressure (hypertension)
- High heart rate (tachycardia)
- Decreased appetite
- Insomnia (difficulty sleeping)
If these occur, discuss with your prescribing healthcare provider whether the medication should be continued.
The effects of Sunosi (solriamfetol) on blood pressure and heart rate may lead to serious cardiovascular consequences if left unchecked, such as:
- Heart attack
- Heart failure
To avoid these potential events, your healthcare provider should check your blood pressure before and during the use of Sunosi.
Warnings and Interactions
As noted previously, do not take Sunosi if you are taking, or have stopped taking within the past 14 days, a medicine used to treat depression called a monoamine oxidase inhibitor (MAOI) because of the risk of a hypertensive reaction causing a severe elevation in blood pressure.