Solriamfetol Does Not Interact with Oral Contraceptive Pills
Solriamfetol (option c) does not interact with oral contraceptive pills, while both modafinil and pitolisant reduce the effectiveness of oral contraception. 1, 2
Evidence for Each Medication
Modafinil (Option a) - DOES Interact
- Modafinil explicitly reduces the effectiveness of oral contraception, as stated in the 2021 American Academy of Sleep Medicine guidelines 1
- This interaction occurs through hepatic enzyme induction, similar to other enzyme-inducing drugs that impair contraceptive efficacy 1
- Women taking modafinil should use alternative or additional contraceptive methods 1
Pitolisant (Option b) - DOES Interact
- Pitolisant reduces the effectiveness of hormonal contraceptives through CYP3A4 induction 2
- The American Academy of Sleep Medicine specifically warns that pitolisant may reduce oral contraceptive effectiveness 1
- Alternative non-hormonal contraceptive methods should be used during pitolisant treatment and for at least 21 days after discontinuation 2
Solriamfetol (Option c) - Does NOT Interact
- No interaction with oral contraceptives is documented in the 2021 American Academy of Sleep Medicine guidelines for solriamfetol 1
- The comprehensive safety profile for solriamfetol lists common adverse events (headache, decreased appetite, insomnia, nausea, chest discomfort) but makes no mention of contraceptive interactions 1
- Unlike modafinil and pitolisant, solriamfetol's remarks section contains no warnings about reduced oral contraceptive effectiveness 1
Clinical Significance
The distinction between these medications is critical for women of childbearing potential requiring treatment for narcolepsy or other hypersomnolence disorders 1. While all three medications may cause fetal harm based on animal data, only modafinil and pitolisant create the additional risk of contraceptive failure 1, 2.
Answer: c. solriamfetol