Solriamfetol for treating excessive daytime sleepiness caused by narcolepsy

Solriamfetol (SUNOSI, formerly JZP-110 and ADX-N05) is an FDA-approved dopamine and norepinephrine reuptake inhibitor indicated to improve wakefulness in adult patients with excessive daytime sleepiness associated with narcolepsy or OSA (obstructive sleep anpoea)

• solriamfetol has lower binding affinity to dopamine and norepinephrine transporters than traditional stimulants, and lacks the monoamine-releasing effects of amphetamines at therapeutic doses
• solriamfetol significantly increased wakefulness and reduced sleepiness in participants with obstructive sleep apnea and excessive sleepiness; most adverse events were mild or moderate in severity (1)

NICE state that:

• Solriamfetol is recommended as an option for treating excessive daytime sleepiness in adults with narcolepsy with or without cataplexy. This is only if modafinil and either dexamfetamine or methylphenidate have not worked well enough or are not suitable

Notes:

• NICE note that excessive daytime sleepiness caused by narcolepsy is usually first treated with modafinil, then dexamfetamine or methylphenidate. Availability of other treatments such as sodium oxybate and pitolisant varies in clinics across England. If available, they're normally used after modafinil and dexamfetamine or methylphenidate
  • clinical trial evidence shows that solriamfetol reduces excessive daytime sleepiness compared with placebo
  • does not show a difference in quality of life but this is not certain because of the way that quality of life was assessed in the trial
  • is no data comparing solriamfetol with dexamfetamine or methylphenidate
  • is no direct data comparing it with sodium oxybate or pitolisant

Reference:

• Schweitzer PK, Rosenberg R, Zammit GK, et al. Solriamfetol for Excessive Sleepiness in Obstructive Sleep Apnea (TONES 3). A Randomized Controlled Trial. Am J Respir Crit Care Med. 2019;199(11):1421-1431. doi:10.1164/rccm.201806-1100OC
• NICE (January 2022). Solriamfetol for treating excessive daytime sleepiness caused by narcolepsy