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Management of Narcolepsy and Excessive Daytime Sleepiness - Episode 11

Solriamfetol: Recently FDA Approved for Narcolepsy

Michael J. Thorpy, MD: There’s another medication that’s been FDA approved in the past 12 months: solriamfetol, which is a dual-acting dopamine and norepinephrine reuptake inhibitor. Alon, do you have experience with this new medication?

Alon Y. Avidan, MD, MPH: I don’t particularly have experience with it. I haven’t prescribed it before, but it does have an interesting mechanism of action. It is noradrenergic and dopaminergic without really creating an amphetamine-type effect. It targets the structures in the brain that are promoting wakefulness. So in my mind, it has the unique ability to promote a level of alertness that you would see with the psychostimulants but without the sympathomimetic adverse effects.

Michael J. Thorpy, MD: I think the studies were quite impressive, Russ, in terms of the effectiveness of this agent.

Russell Rosenberg, PhD, DABSM: Yes. With the self-report measures like the Epworth Sleepiness Scale that we talked about earlier, as well as another test called the Maintenance of Wakefulness Test, which is sort of the flipside of the Multiple Sleep Latency Test, where we put patients in a dimly lit room, boring situation, and ask them to try to stay awake. Patients who are pathologically sleepy have great difficulty staying alert. And so this drug did show pretty impressive results on those tests.

It’s a Schedule IV drug, so it’s not like pitolisant in the sense of scheduling. We’ve been using this term toolbox, and I think it’s another good tool to consider. And as we spoke about earlier, we need to manage polypharmacy in patients, so this would be an option to think about.

Michael J. Thorpy, MD: Is this drug available for children?

Kiran Maski, MD, MPH: It is not, but I’ve had some experience with it. I think an advantage is that it’s long acting, just like pitolisant. That is always helpful. I think in the clinical trial there was a slight increase in heart rate and blood pressure, so it does have to be followed.

Michael J. Thorpy, MD: Right, yeah. Hopefully this will be another drug that will be studied in children and shown to be helpful.