Solriamfetol

How it works

It is a dopamine and noradrenaline reuptake inhibitor, increasing synaptic levels of these neurotransmitters to promote wakefulness.

Prescribing in practice

• It can raise blood pressure and heart rate, so it is contraindicated with concurrent monoamine oxidase inhibitors and used with caution in those with cardiovascular disease, with blood pressure reviewed before and during treatment.
• In obstructive sleep apnoea it treats residual sleepiness only and does not replace primary therapies such as continuous positive airway pressure.
• The dose should be reduced in renal impairment and it is not recommended in end-stage renal disease.

Monitoring

Monitor blood pressure and heart rate before and periodically during treatment, and review the degree of daytime sleepiness.

Counselling the patient

• Take the dose on waking and avoid taking it within several hours of bedtime to prevent difficulty sleeping.
• Continue your underlying sleep apnoea therapy, such as CPAP, as this medicine does not replace it.
• Report palpitations, chest pain or breathlessness, and attend blood pressure checks.

Evidence & guidelines

Solriamfetol improved wakefulness in narcolepsy and obstructive sleep apnoea in the randomised TONES trials and is licensed for these indications.