How do I safely wean off Sunosi (solriamfetol)?

Weaning Off Sunosi (Solriamfetol)

There are no specific tapering protocols established for discontinuing Sunosi (solriamfetol), and the medication can generally be stopped abruptly without a gradual taper. 1, 2

Key Considerations for Discontinuation

No Withdrawal Syndrome Expected

• Solriamfetol is a selective dopamine and norepinephrine reuptake inhibitor, not a controlled substance with typical physical dependence characteristics 2
• Unlike opioids or benzodiazepines that require gradual tapering protocols to prevent withdrawal symptoms 3, 4, solriamfetol does not have documented withdrawal syndromes requiring structured weaning
• The medication's adverse events typically occur within 2 weeks of treatment initiation and mostly resolve within 2 weeks, suggesting rapid physiologic adaptation 1

Practical Discontinuation Approach

• Abrupt discontinuation is acceptable - Real-world data shows physicians commonly discontinue wake-promoting agents abruptly when transitioning patients between medications 5
• In clinical practice, 94% of physicians abruptly discontinued prior wake-promoting agents when switching to solriamfetol, indicating this approach is standard and well-tolerated 5

What to Monitor After Stopping

• Return of excessive daytime sleepiness - The primary concern is recurrence of the underlying symptom (excessive sleepiness from narcolepsy or obstructive sleep apnea) rather than withdrawal symptoms 1, 6
• Sleepiness typically returns within days as the medication's wake-promoting effects wear off 6
• Ensure the underlying sleep disorder (OSA or narcolepsy) is adequately managed with primary treatments before or after discontinuation 6

Important Caveats

This is NOT Like Other Medications

• Do not apply tapering protocols designed for opioids 3, benzodiazepines 4, or antidepressants 7 to solriamfetol - these medications have entirely different pharmacology and withdrawal profiles
• The gradual dose reduction strategies (10-20% reductions every 24-48 hours) used for sedatives do not apply here 3, 4

Clinical Context Matters

• If discontinuing due to adverse effects (headache, nausea, decreased appetite, anxiety), these typically resolve within 2 weeks of stopping 1
• If discontinuing due to lack of efficacy, ensure alternative wake-promoting strategies are in place before stopping 5
• Patients should maintain adherence to primary OSA treatment (CPAP/BiPAP) throughout and after discontinuation 6, 8