Sunosi is available in tablet form.
What Is Sunosi Used For?
The Food and Drug Administration (FDA) approved Sunosi to help improve wakefulness in people with OSA or narcolepsy.
Brand Name(s): Sunosi
Drug Availability: Prescription
Therapeutic Classification: Dopamine and norepinephrine reuptake inhibitor (DNRI)
Available Generically: No
Controlled Substance: Schedule IV
Administration Route: Oral
Active Ingredient: Solriamfetol
Dosage Form(s): Tablet
However, Sunosi is not the first-choice treatment for OSA. The FDA recommends treatment with continuous positive airway pressure (CPAP) for at least a month. Then, if people with OSA still have severe daytime sleepiness, they may start taking Sunosi in addition to using CPAP therapy.
Obstructive Sleep Apnea
There are different types of sleep apnea. In OSA, individuals struggle to breathe because of relaxing soft tissue in the back of the throat that blocks the movement of air. So, people with OSA tend to experience the following symptoms:
Trouble breathingRestless sleepLoud snoring with periods of silence followed by gaspsDaytime sleepinessTrouble concentrating
Narcolepsy
Like OSA, there are also different types of narcolepsy—type 1 and type 2. In both types, daytime sleepiness is a common symptom. Sunosi is indicated for use to reduce excessive daytime sleepiness (EDS) in people with narcolepsy.
Since Sunosi only improves wakefulness, however, some people with narcolepsy might take additional medications for other symptoms.
In addition to EDS, other symptoms of narcolepsy include:
Hypnagogic hallucinations (experiencing a vivid dreamlike state between wakefulness and sleep) Sleep paralysis (inability to move or speak while falling asleep or when waking) Sudden muscle weakness and inability to move
How to Take Sunosi
Take Sunosi once a day first thing in the morning by mouth with or without food. Do not take Sunosi within nine hours of scheduled bedtime.
Sunosi is categorized as a schedule IV controlled substance. The active ingredient, solriamfetol, has the potential for abuse. Sunosi’s likelihood of causing substance use disorder (SUD) is less than schedule I through III controlled substances. However, its SUD potential is higher than a schedule V controlled substance.
If you have the following SUD-like symptoms, please notify your healthcare provider for help:
Agitation Anxiety Appetite changes Changes in behavior Decline in home, school, or work performance Irritability Lack of personal hygiene Mood swings Relationship troubles Sleeping troubles Weight changes
Storage
Like many medications, Sunosi can be stored at room temperature—68–77 degrees Fahrenheit—with a safe storage range of 59–86 degrees. Since Sunosi is a controlled substance, however, you should store the medication in a locked cabinet or a similar safe place.
If you are traveling with Sunosi, please consider talking with your healthcare provider. In order to bring Sunosi into and out of certain countries, you might need the healthcare provider to document the medical necessity of this medication in a letter with an official letterhead. Also, consider making a copy of your Sunosi prescription to take with you. If possible, keep Sunosi in its original container with your name on it from the pharmacy.
What Are the Side Effects of Sunosi?
Similar to most medications, there are potential side effects with Sunosi.
This is not a complete list of side effects and others may occur. A medical professional can advise you on side effects. If you experience other effects, contact your pharmacist or a medical professional. You may report side effects to the FDA at www.fda.gov/medwatch or 800-FDA-1088.
Common Side Effects
Some common side effects include:
Agitation Anxiety Decreased appetite Faster heart rate Headache Higher blood pressure Irritability Nausea Trouble sleeping
Severe Side Effects
Please seek medical attention if you experience the following serious side effects:
Heart attack Heart failure Stroke Worrisome dependence on medication Worsening of mood condition
Your healthcare provider will regularly check your blood pressure and heart rate before and during Sunosi therapy to prevent serious heart-related side effects. Also, if you experience agitation, anxiety, appetite changes, irritability, and sleeping troubles, please notify your healthcare provider to prevent worrisome medication dependence or worsening mood conditions.
Furthermore, if you have the following current or past medical history, please inform your healthcare provider:
Alcohol or other substance use disorder (SUD) Heart attack High blood pressure High cholesterol Kidney condition Mental health disorder Nursing Pregnancy
Dosage: How Much Sunosi Should I Take?
Modifications
Sunosi is available as 75 milligram and 150 milligram tablets. However, only the 75 milligram tablets are scored. So, if necessary, you can only break the 75 milligram tablets in half.
The amount of medicine that you take depends on the strength of the medicine. Also, the number of doses you take each day, the time allowed between doses, and the length of time you take the medicine depend on the medical problem for which you are using the medicine.
For oral dosage form (tablets): For wakefulness in patients with narcolepsy: Adults—At first, 75 milligrams (mg) once a day. Your doctor may adjust your dose as needed and tolerated. However, the dose is usually not more than 150 mg per day. Children—Use and dose must be determined by your doctor. For wakefulness in patients with sleep apnea: Adults—At first, 37. 5 milligrams (mg) once a day. Your doctor may adjust your dose as needed and tolerated. However, the dose is usually not more than 150 mg per day. Children—Use and dose must be determined by your doctor.
Sunosi has little data about its safety and effectiveness when taken during pregnancy or breastfeeding. If you were already taking Sunosi during pregnancy or no other treatment selections are effective for your symptoms, there is no current reason to stop the medication while nursing.
However, if you are taking Sunosi while nursing, the healthcare provider might monitor the nursing baby for the following side effects:
AgitationPoor feedingTrouble sleepingWeight changes
Also, please consider calling 877-283-6220 to enroll yourself in the pregnancy exposure registry.
Kidney function does affect the dosing of Sunosi. Based on your kidney function, your healthcare provider can adjust your medication dose. If you have end-stage renal disease (ESRD), however, the manufacturer does not recommend Sunosi for you.
Missed Dose
If you ever skip your Sunosi dose for the day, you might experience excessive daytime sleepiness. If you forget a dose, try to take it as soon as you remember. However, if it is already within nine hours of your scheduled bedtime, just wait until your next dose. If you take Sunosi too close to bedtime, then you might have trouble sleeping.
Do not double up or take more than one dose at a time.
Overdose: What Happens If I Take Too Much Sunosi?
If you accidentally take multiple Sunosi doses at one time, please seek medical attention.
Precautions
What Are Reasons I Shouldn’t Take Sunosi?
If any of the following applies to you, taking Sunosi is not advisable:
If someone collapses or isn’t breathing after taking Sunosi, call 911 immediately.
This medicine does not take the place of getting enough sleep. It should not be used for occasional sleepiness that has not been diagnosed as narcolepsy or sleep apnea. Ask your doctor for advice about good sleep habits.
Do not use this medicine if you are using or have used an MAO inhibitor (MAOI), such as isocarboxazid (Marplan®), linezolid (Zyvox®), phenelzine (Nardil®), selegiline (Eldepryl®), tranylcypromine (Parnate®) within the past 14 days.
Your blood pressure might get too high while you are using this medicine. It may also increase your heat rate. This may cause headaches, dizziness, lightheadedness, fainting, or blurred vision. You might need to measure your blood pressure at home. If you think your blood pressure is too high, call your doctor right away.
This medicine may cause some people to be agitated, irritable, or display other abnormal behaviors. Make sure the doctor knows if you have trouble sleeping, get upset easily, have a big increase in energy, or start to act reckless. Also tell the doctor if you have sudden or strong feelings, such as feeling nervous, angry, restless, violent, or scared. If you or your caregiver notice any of these side effects, tell your doctor right away.
Do not take other medicines unless they have been discussed with your doctor. This includes prescription or nonprescription (over-the-counter [OTC]) medicines and herbal or vitamin supplements.
Kidney concerns: It is not recommended to take Sunosi if you have end-stage kidney disease. Monoamine oxidase inhibitor (MAOI) use: Due to a drug interaction that causes severe high blood pressure, the healthcare provider will not give you a prescription for Sunosi if you have taken a medication in the MAOI class within the last 14 days.
What Other Medications Interact With Sunosi?
In addition to MAOIs, due to drug interactions, take the following medications with caution:
Medications that raise blood pressure or heart rate: Sunosi can possibly lead to high blood pressure and fast heart rate. Therefore, use caution with other medications that have similar side effects of raising blood pressure and heart rate. Dopaminergic medications: Dopaminergics mimic dopamine. Since Sunosi raises existing dopamine levels in the brain, taking dopaminergic medications with Sunosi might result in too much dopamine activity.
Before starting Sunosi, talk to your healthcare provider about all medications you take.
What Medications Are Similar?
Although there are other medications that affect dopamine and norepinephrine in the brain, Sunosi is the only medication in the DNRI drug class that helps improve wakefulness in people with OSA and narcolepsy.
Experts generally recommend medications as second-line or add-on therapy options for OSA. Using a CPAP machine is a common treatment choice for OSA. However, if excessive daytime sleepiness is still an issue after a month of CPAP use, then Sunosi can be a potential add-on option.
Sunosi is also not the first treatment choice for narcolepsy. Modafinil (brand name Provigil)—a brain stimulant that is thought to work by raising dopamine levels—is often the initial option. However, a 2019 study suggests that the differences in side effects are minimal between Sunosi and modafinil. Although further research is necessary, Sunosi might become another first-choice treatment option for narcolepsy in the future—depending on more data.
In addition to modafinil, the two other similar medications to help decrease excessive daytime sleepiness in people with narcolepsy are:
Amphetamine-like stimulants: If modafinil is not effective, then the next possible medication option is an amphetamine-like stimulant, such as methylphenidate. Similar to Sunosi, this type of brain stimulant is thought to work by raising dopamine and norepinephrine. Compared to Sunosi and modafinil, however, amphetamine-like stimulants tend to have more side effects and a higher likelihood of SUD. Sodium oxybate: In addition to improving wakefulness, sodium oxybate might help people with cataplexy—another potential symptom of narcolepsy. Sodium oxybate’s active component is gamma-hydroxybutyrate (GHB). GHB is the breakdown product of gamma-aminobutyric acid (GABA)—a naturally occurring chemical in the brain. This medication is thought to work by mimicking GABA in parts of the brain that have dopamine and norepinephrine.
Since all of these medications influence similar brain chemicals, they are not usually taken together. If you have any questions, please talk with your healthcare provider.
How Can I Stay Healthy While Taking Sunosi?
While taking Sunosi for OSA or narcolepsy, lifestyle changes are important.
Recommendations for OSA include:
Avoiding alcohol and sleep-inducing medications Losing weight Quitting smoking
As for narcolepsy, medications will help with symptoms. However, the following lifestyle changes will further improve the quality of nighttime sleep and decrease excessive daytime sleepiness:
Avoiding alcohol and caffeine Getting regular exercise Having regularly scheduled naps and bedtime Quitting smoking Skipping large meals
In addition to the above lifestyle changes, having a strong social support network is essential. Consider taking the first step by sharing that you have a medical condition. As your loved ones become more aware of OSA or narcolepsy, they can provide you with the encouragement and support that you need.
Please also stay in touch with your healthcare provider. If you experience side effects while taking Sunosi, please let them know to prevent serious side effects, worsening mood conditions, and SUD.
