Pharmacists’ Guide to Solriamfetol for Excessive Daytime Sleepiness in Narcolepsy and OSA

Winter opens the discussion by highlighting that millions of Americans with narcolepsy and OSA suffer from undertreated EDS. He sets the stage for understanding the unmet need that solriamfetol addresses.

Winter opens the discussion by highlighting that millions of Americans with narcolepsy and OSA suffer from undertreated EDS. He sets the stage for understanding the unmet need that solriamfetol addresses.

Winter explains solriamfetol's distinct pharmacological profile as a dopamine-norepinephrine reuptake inhibitor—the first and only agent in its class approved specifically for EDS—and discusses why this mechanism matters clinically compared to other available wakefulness-promoting options.

Winter breaks down the TONES clinical trial program, discussing ESS and Maintenance of Wakefulness Test end points. He covers how these benchmarks translate into what patients actually experience as functional improvements in their daily lives—helping pharmacists understand the real-world significance of the trial data.

Winter examines the TONES 5 randomized-withdrawal trial, discussing how sustained efficacy over 6 months factors into clinical decision-making and patient adherence in a chronic condition like EDS.

Maroney outlines the key safety considerations pharmacists and clinicians should weigh when prescribing solriamfetol for EDS in narcolepsy or OSA. She highlights the drug's favorable interaction profile—since it isn't a substrate for major CYP enzymes, unlike modafinil, armodafinil, and pitolisant—making it a practical option for patients managing comorbidities on polypharmacy regimens.

Maroney discusses practical strategies for navigating coverage determinations and prior authorizations for patients prescribed solriamfetol. Current data show roughly 95% of commercially insured patients already have access to the drug, suggesting access barriers, while real, are often surmountable

Winter explores how solriamfetol's emerging pipeline (ADHD, binge eating disorder, major depressive disorder, shift work disorder) may reshape the future of CNS pharmacology and the pharmacist's evolving role in this space.

Finally, Winter and Maroney synthesize the most critical practical lessons for pharmacy professionals and health care providers caring for patients with EDS in narcolepsy and OSA. They provide the essential roadmap pharmacists need to optimize outcomes for patients with EDS—from initial identification through long-term therapy management.