and solriamfetol both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.droxidopaMonitor Closely (1)droxidopa and solriamfetol both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.ephedrineMonitor Closely (1)ephedrine and solriamfetol both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.epinephrineMonitor Closely (1)epinephrine and solriamfetol both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.epinephrine racemicMonitor Closely (1)epinephrine racemic and solriamfetol both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.fenoldopamMonitor Closely (1)fenoldopam and solriamfetol both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.formoterolMonitor Closely (1)formoterol and solriamfetol both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.indacaterol, inhaledMonitor Closely (1)indacaterol, inhaled and solriamfetol both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.isocarboxazidContraindicated (1)isocarboxazid will increase the level or effect of solriamfetol by sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Contraindicated. Do no use solriamfetol during and/or within 14 days of discontinuing MAOI treatment. MAOIs irreversibly inhibit the enzyme monamine oxidase, an enzyme involved in the degradation of various monoamines, including dopamine and norepinephrine. Solriamfetol increases synaptic dopamine and norepinephrine.lasmiditanMonitor Closely (1)lasmiditan, solriamfetol. Either increases effects of the other by sedation. Use Caution/Monitor. Coadministration of lasmiditan and other CNS depressant drugs, including alcohol have not been evaluated in clinical studies. Lasmiditan may cause sedation, as well as other cognitive and/or neuropsychiatric adverse reactions.levalbuterolMonitor Closely (1)levalbuterol and solriamfetol both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.levodopaMonitor Closely (1)levodopa and solriamfetol both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.levodopa inhaledMonitor Closely (2)levodopa inhaled and solriamfetol both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor. levodopa inhaled, solriamfetol. dopaminergic effects. Use Caution/Monitor. Monitor for increased hypertensive effect of solriamfetol if coadministered with dopamine agonists.linezolidContraindicated (1)linezolid will increase the level or effect of solriamfetol by sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Contraindicated. Do no use solriamfetol during and/or within 14 days of discontinuing MAOI treatment. MAOIs irreversibly inhibit the enzyme monamine oxidase, an enzyme involved in the degradation of various monoamines, including dopamine and norepinephrine. Solriamfetol increases synaptic dopamine and norepinephrine.metaproterenolMonitor Closely (1)metaproterenol and solriamfetol both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.methamphetamineMonitor Closely (1)methamphetamine and solriamfetol both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.methylphenidateMonitor Closely (1)methylphenidate and solriamfetol both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.midodrineMonitor Closely (1)midodrine and solriamfetol both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.modafinilMonitor Closely (1)modafinil and solriamfetol both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.naphazolineMonitor Closely (1)naphazoline and solriamfetol both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.nicotine gumMonitor Closely (1)nicotine gum and solriamfetol both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.nicotine inhaledMonitor Closely (1)nicotine inhaled and solriamfetol both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.nicotine intranasalMonitor Closely (1)nicotine intranasal and solriamfetol both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.nicotine lozengeMonitor Closely (1)nicotine lozenge and solriamfetol both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.nicotine transdermalMonitor Closely (1)nicotine transdermal and solriamfetol both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.norepinephrineMonitor Closely (1)norepinephrine and solriamfetol both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.phendimetrazineMonitor Closely (1)phendimetrazine and solriamfetol both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.phenelzineContraindicated (1)phenelzine will increase the level or effect of solriamfetol by sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Contraindicated. Do no use solriamfetol during and/or within 14 days of discontinuing MAOI treatment. MAOIs irreversibly inhibit the enzyme monamine oxidase, an enzyme involved in the degradation of various monoamines, including dopamine and norepinephrine. Solriamfetol increases synaptic dopamine and norepinephrine.phentermineMonitor Closely (1)phentermine and solriamfetol both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.phenylephrineMonitor Closely (1)phenylephrine and solriamfetol both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.phenylephrine POMonitor Closely (1)phenylephrine PO and solriamfetol both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.pirbuterolMonitor Closely (1)pirbuterol and solriamfetol both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.pramipexoleMonitor Closely (1)pramipexole and solriamfetol both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.procarbazineContraindicated (1)procarbazine will increase the level or effect of solriamfetol by sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Contraindicated. Do no use solriamfetol during and/or within 14 days of discontinuing MAOI treatment. MAOIs irreversibly inhibit the enzyme monamine oxidase, an enzyme involved in the degradation of various monoamines, including dopamine and norepinephrine. Solriamfetol increases synaptic dopamine and norepinephrine.pseudoephedrineMonitor Closely (1)pseudoephedrine and solriamfetol both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.rasagilineContraindicated (1)rasagiline will increase the level or effect of solriamfetol by sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Contraindicated. Do no use solriamfetol during and/or within 14 days of discontinuing MAOI treatment. MAOIs irreversibly inhibit the enzyme monamine oxidase, an enzyme involved in the degradation of various monoamines, including dopamine and norepinephrine. Solriamfetol increases synaptic dopamine and norepinephrine.ropiniroleMonitor Closely (1)ropinirole and solriamfetol both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.rotigotineMonitor Closely (1)rotigotine and solriamfetol both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.safinamideContraindicated (1)safinamide will increase the level or effect of solriamfetol by sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Contraindicated. Do no use solriamfetol during and/or within 14 days of discontinuing MAOI treatment. MAOIs irreversibly inhibit the enzyme monamine oxidase, an enzyme involved in the degradation of various monoamines, including dopamine and norepinephrine. Solriamfetol increases synaptic dopamine and norepinephrine.salmeterolMonitor Closely (1)salmeterol and solriamfetol both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.selegilineContraindicated (1)selegiline will increase the level or effect of solriamfetol by sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Contraindicated. Do no use solriamfetol during and/or within 14 days of discontinuing MAOI treatment. MAOIs irreversibly inhibit the enzyme monamine oxidase, an enzyme involved in the degradation of various monoamines, including dopamine and norepinephrine. Solriamfetol increases synaptic dopamine and norepinephrine.selegiline transdermalContraindicated (1)selegiline transdermal will increase the level or effect of solriamfetol by sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Contraindicated. Do no use solriamfetol during and/or within 14 days of discontinuing MAOI treatment. MAOIs irreversibly inhibit the enzyme monamine oxidase, an enzyme involved in the degradation of various monoamines, including dopamine and norepinephrine. Solriamfetol increases synaptic dopamine and norepinephrine.serdexmethylphenidate/dexmethylphenidateMonitor Closely (1)serdexmethylphenidate/dexmethylphenidate and solriamfetol both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.terbutalineMonitor Closely (1)terbutaline and solriamfetol both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.tranylcypromineContraindicated (1)tranylcypromine will increase the level or effect of solriamfetol by sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Contraindicated. Do no use solriamfetol during and/or within 14 days of discontinuing MAOI treatment. MAOIs irreversibly inhibit the enzyme monamine oxidase, an enzyme involved in the degradation of various monoamines, including dopamine and norepinephrine. Solriamfetol increases synaptic dopamine and norepinephrine.umeclidinium bromide/vilanterol inhaledMonitor Closely (1)umeclidinium bromide/vilanterol inhaled and solriamfetol both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.vilanterol/fluticasone furoate inhaledMonitor Closely (1)vilanterol/fluticasone furoate inhaled and solriamfetol both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.yohimbineMonitor Closely (1)yohimbine and solriamfetol both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor. >10% (Narcolepsy) Headache (16%) 1-10% (Narcolepsy) Decreased appetite (9%) Nausea (7%) Anxiety (6%) Insomnia (5%) Dry mouth (4%) Constipation (3%) Palpitations (2%) Constipation (1%) <2% Psychiatric disorders: Agitation, bruxism, irritability Respiratory, thoracic, and mediastinal disorders: Cough Skin and subcutaneous tissue disorders: Hyperhidrosis General disorders and administration site conditions: Feeling jittery, thirst, chest discomfort, chest pain Investigations: Weight decreased 1-10% (OSA) Nausea (8%) Decreased appetite (6%) Anxiety (4%) Diarrhea (4%) Irritability (3%) Palpitations (3%) Abdominal pain (3%) Feeling jittery (3%) Dizziness (2%) Chest discomfort (2%) Hyperhidrosis (2%) <2% Psychiatric disorders: Bruxism, restlessness Nervous system disorders: Disturbances in attention, tremor Respiratory, thoracic, and mediastinal disorders: Cough, dyspnea Gastrointestinal disorders: Constipation, vomiting Investigations: Weight decreased Postmarketing Reports Hypersensitivity (rash erythematous, rash [unspecified], and urticaria) Contraindications Coadministration with MAO inhibitors or within 14 days after discontinuing MAO inhibitor Cautions Blood pressure and heart rate increase Increases systolic blood pressure, diastolic blood pressure, and heart rate in a dose-dependent fashion Assess blood pressure and control hypertension before initiating treatment Monitor blood pressure regularly during treatment and treat new-onset hypertension and exacerbations of preexisting hypertension Caution in patients at higher risk of major adverse cardiovascular events (MACE), particularly patients with known cardiovascular and cerebrovascular disease, preexisting hypertension, and advanced age If increases in blood pressure or heart rate cannot be managed with dose reduction or other appropriate medical intervention, consider discontinuation of therapy Psychiatric symptoms Psychiatric adverse reactions observed during clinical trials, including anxiety, insomnia, and irritability Caution in patients with history of psychosis or bipolar disorders, as these patients were not evaluated in clinical trials Patients with moderate or severe renal impairment may be at a higher risk of psychiatric symptoms because of the prolonged half-life Observe patient for the possible emergence or exacerbation of psychiatric symptoms; reduce dose or consider discontinuing drug if psychiatric symptoms develop Drug interaction overview Drugs that increase blood pressure/heart rate: Caution; coadministration might result in pharmacodynamic interactions Dopaminergic drugs: Caution; coadministration might result in pharmacodynamic interactions MAO inhibitors Contraindicated; do not use concomitantly or within 14 days after discontinuing MAO inhibitor Coadministration of MAO inhibitors and noradrenergic drugs may increase risk of hypertensive reaction Potential outcomes include death, stroke, myocardial infarction, aortic dissection, ophthalmological complications, eclampsia, pulmonary edema, and renal failure Pregnancy Available data from case reports are not sufficient to determine drug-associated risks of major birth defects, miscarriage, or adverse maternal or fetal outcome Pregnancy registry Healthcare providers are encouraged to register pregnant patients, or pregnant women may enroll themselves in the registry by calling 1-877-283-6220 or online at www.SunosiPregnancyRegistry.com Animal studies Administration during organogenesis caused maternal and fetal toxicities in rats and rabbits at doses ≥4 and 5 times and was teratogenic at doses 19 and ≥5 times, respectively, the maximum recommended human dose (MRHD) of 150 mg based on mg/m² Administration to pregnant rats during pregnancy and lactation at doses ≥7 times the MRHD based on mg/m² resulted in maternal toxicity and adverse effects on fertility, growth, and development in offspring Lactation Available data from a lactation study in 6 women indicate that this drug is present in human milk; the daily infant dose is 0.112 mg/kg (based on nominal infant weight of 6 kg) and relative infant dose (RID) is approximately 5.5% of maternal weight-adjusted dosage; data are insufficient to determine effects of this drug on breastfed infant or effects on milk production Solriamfetol is present in rat milk; when a drug is present in animal milk, it is likely that the drug will be present in human milk Clinical considerations: Monitor breastfed infants for adverse effects (eg, agitation, insomnia, anorexia, reduced weight gain) The development and health benefits of breastfeeding should be considered along with the mother’s clinical need for the drug and any potential adverse effects on the breastfed child or from the underlying maternal conditionPregnancy Categories A: Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk. B: May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk. C: Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done. D: Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk. X: Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist. NA: Information not available. Mechanism