Solriamfetol (Sunosi) is a new wakefulness promoting medication that lasts for 9 hours. It is stimulating but not considered a “stimulant”. It is a norepinephrine and weak dopamine reuptake inhibitor. Sunosi could be conceptualized as an atypical antidepressant with a mechanism similar bupropion (Wellbutrin). However, solriamfetol is not approved for depression, and clinical trials did not include psychiatric patients. About 1 in 25 subjects treated for narcolepsy/sleep apnea had psychiatric side effects such as irritability and anxiety.
Solriamfetol is a Schedule IV controlled substance. By comparison, bupropion is non-controlled but does have potential for abuse at high doses.
Subjects who abused drugs reported “drug liking” similar to the appetite-suppressing stimulant phentermine (Adipex) when solriamfetol was taken at supratherapeutic dose. Phentermine is also Schedule IV.
Other effects include nausea and appetite suppression. It may increase blood pressure and heart rate.
An advantage over bupropion is that solriamfetol is free from significant kinetic drug/drug interactions.
The two other wakefulness promoters approved for narcolepsy/sleep apnea are modafinil (Provigil) and armodafinil (Nuvigil), which are also Schedule IV. For context, methylphenidate (Ritalin) and amphetamine (Adderall) are more strictly regulated as Schedule II controlled substances and are referred to as stimulants.
Dosing: Start 75 mg q AM. Dose may be increased to 150 mg after 3 days based on efficacy and tolerability. Maximum dose is 150 mg/day.