Opinion
Video
Solriamfetol for Treatment of EDS in Patients With OSA
Author(s):
Panelists discuss how solriamfetol distinguishes itself from existing wake-promoting medications through its dual dopamine-norepinephrine reuptake inhibition, with patients reporting they "feel better" on it beyond just improved wakefulness, while emphasizing careful dose titration to minimize adverse effects like anxiety and cardiovascular changes.
Video content above is prompted by the following:
Solriamfetol entered a competitive market with 2 established medications (modafinil and armodafinil) but successfully distinguished itself through superior clinical efficacy. The panelists report that patients consistently find solriamfetol more effective for maintaining wakefulness, with clinical trial data supporting improved performance on Maintenance of Wakefulness Tests and significantly better Epworth Sleepiness Scale scores, particularly at higher doses (150 mg). Beyond traditional sleepiness metrics, patients frequently report subjective improvements in how they feel overall, addressing cognitive fog and general well-being issues that extend beyond simple drowsiness.
The mechanism of action appears crucial to solriamfetol's enhanced effectiveness. While modafinil and armodafinil work through complex, somewhat unclear pathways involving dopamine availability, GABA suppression, and glutaminergic influences, solriamfetol functions as a direct dopamine and norepinephrine reuptake inhibitor. This targeted dual-neurotransmitter approach may better address the varied neurological impacts of obstructive sleep apnea, whether affecting the reticular activating system, frontal lobe function, or subcortical regions. Patients switching from established medications to solriamfetol frequently express preference for the new treatment, often stating they "like the way this feels better."
The adverse effect profile centers primarily around anxiety management, occurring in 4% to6% of patients but representing the most significant treatment obstacle. The panelists emphasize careful dose titration to prevent anxiety-related discontinuation, noting that premature dose escalation can lead to patient rejection of an otherwise effective medication. Additional side effects include nausea, headaches, tremulousness, and increased blood pressure (3- to 5-point systolic increase), though the 12-week clinical trial data shows most adverse effects diminish over time. Cardiovascular monitoring becomes essential, particularly in patients with existing hypertension, requiring multidisciplinary discussions with cardiologists to weigh sleepiness-related safety risks against potential blood pressure increases.
Newsletter
Keep your finger on the pulse of neurology—subscribe to NeurologyLive for expert interviews, new data, and breakthrough treatment updates.
