Solriamfetol (Sunosi): Another Option for the Treatment of Adult ADHD?

A variety of medications are FDA-approved for the treatment of attention-deficit/hyperactivity disorder (ADHD) in adults, including psychostimulants, atomoxetine (Strattera), and viloxazine (Qelbree).  A recent pilot, pioneering clinical trial published by Craig Surman, MD Director of the Adult ADHD Research Program at Mass General Hospital, and colleagues, demonstrates that the wakefulness promoting medication solriamfetol may also be an effective alternative for managing ADHD in adults. 

Solriamfetol (marketed as Sunosi) is FDA-approved for the treatment of excessive daytime sleepiness in patients with narcolepsy or obstructive sleep apnea. Solriamfetol is thought to promote wakefulness by increasing levels of dopamine and norepinephrine; more specifically, solriamfetol is a selective dopamine-norepinephrine reuptake inhibitor that binds to dopamine and norepinephrine transporters at the synapse and prevents the reuptake of these neurotransmitters. 

In a randomized controlled trial, 60 adults with DSM-5 ADHD received either solriamfetol (75 or 150 mg) or placebo for 6 weeks. Participants were assessed using the Adult ADHD Investigator Symptom Rating Scale (AISRS).  

• • Compared to individuals receiving placebo, a greater proportion of individuals treated with solriamfetol experienced a treatment response (CGI scores indicating much or very much improved and AISRS scores reduced ≥ 25%: 45% vs 6.9%, P = .0020). 
  • Individuals treated with solriamfetol noted greater improvements in total AISRS scores by week 3 through week 6 (P = .0012; week 6 effect size = 1.09).  
  • There was no significant association between solriamfetol and changes in sleep parameters measured using the Pittsburgh Sleep Quality Index (PSQI). 
  • Solriamfetol was well tolerated, with no significant effect compared to placebo on mean heart rate, systolic blood pressure, or diastolic blood pressure.  
  • Adverse events most commonly occurring in individuals receiving solriamfetol treatment included decreased appetite, headache, gastrointestinal symptoms, insomnia, and increased energy. 

Another Option for the Treatment of Adult ADHD 

While stimulants are widely used and highly effective for the treatment of ADHD, some patients with ADHD may not tolerate or adequately respond to currently available treatments for ADHD.  The current study indicates that the wakefulness-promoting medication solriamfetol may be a safe and effective alternative for the treatment of ADHD in adults. Larger studies are required to replicate these findings and to determine optimal dosing strategies. 

Solriamfetol is not considered a traditional stimulant, but does block reuptake of dopamine and norepinephrine, whcih is a core mechanism of action of stimulants. The FDA classifies solriamfetol as a schedule IV substance, because it is expected to have lower potential for abuse than traditional stimulants.   

It is estimated that 4% of adults in the US have symptoms consistent with a diagnosis of ADHD; however, only a fraction of adults with ADHD receive treatment for this disorder. With a recent increase in the number of adult patients diagnosed with and seeking care for ADHD, having a wide range of pharmacologic interventions is essential so that we can address the specific needs of individual patients.  Non-stimulant alternatives like solriamfetol may have certain advantages, offering treatment options with a lower potential for abuse and pharmacologic properties that may help to address comorbid psychiatric illness in adults. 

Additional contributors to this research include Daniel M. Walsh, Nora Horick, Maura DiSalvo, Chloe Hutt Vater, and Daniel Kaufman.

Surman CBH, Walsh DM, Horick N, DiSalvo M, Vater CH, Kaufman D. Solriamfetol for Attention-Deficit/Hyperactivity Disorder in Adults: A Double-Blind Placebo-Controlled Pilot Study. J Clin Psychiatry. 2023 Oct 9; 84(6):23m14934.