Names and pronunciation
(sol′ri-am′fe-tol) Sunosi
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Drug reference
(sol′ri-am′fe-tol) Sunosi
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Func. class.: Narcolepsy agent
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Chem. class.: Dopamine norepineph- rine reuptake inhibitor Controlled Substance Schedule IV
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ACTION: Unknown, action may be due to its inhibitor of a dopamine and norepi- S nephrine reuptake
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USES: Excessive daytime sleepiness due to narcolepsy or obstructive sleep apnea
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CONTRAINDICATIONS: Hyper- sensitivity, MAOIs Precautions: Alcoholism, bipolar disorder, cardiac disease, breastfeeding, diabetes mellitus, geriatrics, heart failure, hepatic disease, hypertension, MI, pregnancy, renal dis- ease, schizophrenia, stroke, substance abuse, valvular heart disease, ventricular dysfunction
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SIDE EFFECTS CNS: Insomnia, anxiety, headache, dizziness CV: Palpitations, chest discomfort GI: Anorexia, nausea, dry mouth, con- stipation, abdominal pain INTEG: Hyperhidrosis
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INTERACTIONS Increased: hypertensive reaction— MAOIs; do not use within 14 days Use caution when using dopaminergic agents or drugs that increase B/P or heart rate
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DOSAGE AND ROUTES Narcolepsy Adults: PO 75 mg daily on awakening; may increase to 150 mg after ≥3 days; max 150 mg/day Obstructive sleep apnea • Adults: PO 37.5 mg daily on awaken- ing; double the dose at intervals of at least 3 days if needed; max 150 mg/day Renal dose Adult: PO 37.5 mg/day; may increase to 75 mg/day after ≥7 days
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Available forms: Tablet 75, 150 mg
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Administer: • Without regard to food • Take on awakening; avoid within 9 hr of bedtime
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Assess: • Narcolepsy: assess for trouble staying awake baseline and after 1 wk, 2 wk • B/P and heart rate baseline and peri- odically; hypertension should be treated before starting this product • Psychiatric symptoms: assess for symptoms baseline and periodically; those with renal disease may be at higher risk • Abuse: assess for those with a recent history of drug abuse, especially alco- hol, amphetamines, cocaine, methyl- phenidate; watch for drug-seeking be- haviors
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Evaluate: • Therapeutic response: ability to stay awake
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CLINICAL CONSIDERATIONS
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Patient and caregiver information: • To discuss all Rx, OTC, herbs, and supplements taken and if taking an MAOI • That if a dose is missed, skip missed dose and administer the next dose the following day in the morning on wakening • To report to healthcare provider if in- ability to stay awake continues or if you develop anxiety, agitation, irritability, problems sleeping • Pregnancy/breastfeeding: identify if pregnancy is planned to suspected, en- courage to enroll in the pregnancy regis- try if she becomes pregnant; to enroll or obtain information from the registry, on- line at www.SunosiPregnancyRegistry.com or by calling 1-877-283-6220; present in breast milk
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PHARMACOKINETICS Protein binding <20%, minimally metab- olized; half-life 7.1 hr, increased in renal disease; excreted 95% unchanged, peak 1.2-3 hr
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• Adults: PO 37.5 mg daily on awaken- ing; double the dose at intervals of at least 3 days if needed; max 150 mg/day Renal dose Adult: PO 37.5 mg/day; may increase to 75 mg/day after ≥7 days
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