Solriamfetol (Sunosi)

What it treats

Solriamfetol is approved by the U.S. Food and Drug Administration for excessive daytime sleepiness in adults with:

• Narcolepsy.
• Obstructive sleep apnea (as an adjunct to CPAP or other primary OSA treatment, not as a substitute).

It's not approved for ADHD, shift-work sleep disorder, or general fatigue.

How it works

Solriamfetol is a dopamine and norepinephrine reuptake inhibitor. It blocks the transporters that would normally reabsorb these two chemical messengers, which raises their signaling in wake-promoting brain circuits. That produces alertness through the day.

Unlike modafinil, whose mechanism is fuzzier, solriamfetol's action is straightforward: same class of transport inhibition as methylphenidate, but with different pharmacokinetics and (in practice) a wake-promoting rather than stimulant profile.

Receptor mechanism (detail)

Solriamfetol is a dopamine and norepinephrine reuptake inhibitor at DAT and NET. Its affinity is greater for NET than DAT. It doesn't cause substantial release of dopamine or norepinephrine on top of the reuptake block, which places it mechanistically closer to methylphenidate than to amphetamine. Metabolism is primarily renal, which matters for dosing in kidney disease.

Potency and typical dosing pattern

Ranges are typical framework only, not a prescription for any individual.

Narcolepsy: 75 mg once daily in the morning, titrated to 150 mg after 3 days if needed. Obstructive sleep apnea: 37.5 mg once daily in the morning, titrated in 3-day intervals to 75 mg or 150 mg. Maximum dose is 150 mg per day.

Half-life is about 7 hours. Renal impairment slows clearance and requires dose reduction; solriamfetol is not recommended in end-stage renal disease.

Safety monitoring

• Blood pressure and heart rate. Baseline and periodic. Solriamfetol raises both in a dose-dependent way, more consistently than modafinil.
• Psychiatric symptoms. Anxiety, agitation, mania, or suicidal thoughts can occur.
• Schedule IV controlled substance. Assess for misuse.
• Renal function. Dose reduction in moderate to severe impairment; avoid in end-stage renal disease.
• Do not combine with MAOIs or use within 14 days of stopping an MAOI.
• Cardiovascular history. Uncontrolled hypertension, recent cardiovascular events, or significant heart disease require careful evaluation.

What to expect

Common side effects

• Headache, common.
• Nausea.
• Reduced appetite.
• Trouble sleeping.
• Anxiety.
• Dry mouth.
• Elevated blood pressure and heart rate.

If a side effect is bothersome or persistent, or if blood pressure runs high, that's a conversation for the prescriber.

Serious side effects and warnings

• Blood pressure and heart rate elevation. Dose-dependent. Watch for signs of uncontrolled hypertension (headache, chest pain, vision changes).
• Psychiatric symptoms. New anxiety, mania, hallucinations, aggression, or suicidal thoughts need prescriber contact.
• Serotonin syndrome risk with concurrent serotonergic drugs, though solriamfetol itself is not primarily serotonergic.
• Cardiovascular events, rare.

Sexual side effects

Solriamfetol isn't a notable cause of sexual side effects. If a change occurs, mention it to a prescriber.

Weight, appetite, and sleep

Reduced appetite is common; some weight loss is possible. Sleep timing matters. Late-day dosing can interfere with nighttime sleep, so morning dosing is standard.

Starting and dosing basics

This section is general background, not a dosing instruction for any individual. The right dose is a decision for a prescriber.

Solriamfetol comes as tablets in 75 mg and 150 mg strengths (150 mg tablet is scored to allow 37.5 mg starting doses in OSA). Taken once each morning.

Missed doses and interactions

If a morning dose is missed and it's still early, take it. If it's late, skip and resume the next day.

Solriamfetol is primarily renally excreted, so its drug interactions through the liver enzyme system are limited. That is one advantage over modafinil.

Do not combine with MAOIs or use within 14 days of stopping an MAOI. Other stimulants and blood pressure medications need prescriber attention. Give every prescriber and pharmacist the full medication list.

Stopping and tapering

Solriamfetol doesn't require a formal taper. Sleepiness will likely return if the underlying disorder isn't otherwise treated.

Pregnancy and breastfeeding

Data on solriamfetol in pregnancy and breastfeeding are limited. Individual circumstances matter, and the decision belongs with a clinician. Anyone pregnant, planning a pregnancy, or breastfeeding should discuss it with their prescriber.

Cost and generic availability

Solriamfetol is a newer, branded medication. Generic isn't yet available. Cost is significant. Insurance coverage varies. The manufacturer offers copay assistance in some cases.

Common questions

How is solriamfetol different from modafinil? Solriamfetol has a clearer mechanism: it's a straight dopamine and norepinephrine reuptake inhibitor. Blood pressure rise is more consistent with solriamfetol. Modafinil interferes with oral contraceptives; solriamfetol doesn't. Duration is shorter with solriamfetol (7-hour half-life vs. 15 for armodafinil).

Can I take it for ADHD? No, it's not approved for ADHD, and evidence in ADHD is limited.

Does it interact with birth control pills? No significant interaction. That's a clinical difference from modafinil and armodafinil.

Is it addictive? Its misuse liability is lower than the Schedule II ADHD stimulants, which is why it's Schedule IV. Some potential exists.

Do I still need my CPAP? Yes. Solriamfetol treats residual daytime sleepiness in OSA; it doesn't treat the airway obstruction itself.

Questions to ask your prescriber

• Why solriamfetol over modafinil or armodafinil?
• What are we hoping this treats, and how will we know it's working?
• How often will we check my blood pressure?
• If I have kidney problems, does that change how it's dosed?
• If I need to stop it, is a taper needed?

Sources

This guide draws on current prescribing information and public health references and current as of June 8, 2026. It is reviewed for clinical accuracy and updated as guidance changes.

• U.S. Food and Drug Administration. Solriamfetol (Sunosi) prescribing information.
• MedlinePlus, U.S. National Library of Medicine. Solriamfetol.
• American Academy of Sleep Medicine. Clinical Practice Guideline for the Treatment of Central Disorders of Hypersomnolence.
• National Institute of Neurological Disorders and Stroke. Narcolepsy information page.