Why This Matters
Solriamfetol is FDA-approved for excessive daytime sleepiness in narcolepsy and obstructive sleep apnea—but could it have a role in adult ADHD?
With recent positive Phase III results in adult ADHD, it’s starting to generate real interest.
What the Research Shows
Solriamfetol is a dopamine and norepinephrine reuptake inhibitor (DNRI):
Blocks dopamine and norepinephrine reuptake (relatively low affinity)
No significant monoamine release
Minimal off-target receptor activity
Schedule IV (lower abuse potential than traditional stimulants)
FDA-approved for excessive daytime sleepiness in Narcolepsy and Obstructive Sleep Apnea
Not FDA-approved for ADHD as of this writing
Key Adult ADHD Study (Phase II; 2023, N = 60):
Response rate: 45% vs. 6.9%
Effect size: 1.09 (vs. ~0.4–0.6 for current non-stimulants)
Improvements in executive function
Effects independent of sleepiness
Important caveat: effect sizes from small pilot studies often decrease in larger trials.
Phase III (2025; N ≈ 500):
In development; full results not yet published
Early topline suggests benefit; full dataset not yet released
Placebo response was higher (vs Phase II), which may attenuate drug–placebo separation
Common side effects:
≥10 percentage points over placebo: Decreased appetite, insomnia, headache, GI symptoms, increased energy, and cardiovascular/neurologic effects
FDA labeling also notes dose-dependent BP/HR increases, palpitations, and anxiety
How It’s Different
Less potent than stimulants (pharmacologically):
vs. amphetamines: no monoamine release
vs. Methylphenidate: lower DAT/NET affinity and more selective profile
Potentially more effective than traditional non-stimulants:
Early effect size: 1.09 (vs. ~0.4–0.6)
Caveat: based on a single, small study (phase II)
vs. Bupropion:
More pharmacologically selective (minimal off-target effects)
No active metabolites
Cleaner translation from pharmacology → clinical effect
Where It May Fit
Monotherapy for stimulant-intolerant patients
Potential higher-efficacy non-stimulant option
ADHD + sleep disorder overlap
My Take
This is one of the more interesting developments in ADHD treatment.
The signal is strong—but still early:
Small phase II trial; phase III trial completed for adults, full results pending
Short duration
No head-to-head comparisons
What stands out:
High selectivity
Low abuse potential
Large early effect size (phase II)
If Phase III data can hold, this could fill a meaningful gap.
For now: Promising—but not ready for routine use.
If you're seeking evaluation or treatment for adult ADHD in the Bay Area, learn more about our approach here.
Sources
Ferahkaya H, Bilgic A. Potential Treatments for Attention-Deficit/Hyperactivity Disorder: A Focus on Phase III Trials. Expert Opinion on Pharmacotherapy. 2025. doi:10.1080/14656566.2025.2566257. PMID: 40986064. [1]
Surman CBH, Walsh DM, Horick N, et al. Solriamfetol for Attention-Deficit/Hyperactivity Disorder in Adults: A Double-Blind Placebo-Controlled Pilot Study. The Journal of Clinical Psychiatry. 2023;84(6):23m14934. doi:10.4088/JCP.23m14934. PMID: 37819836. ClinicalTrials.gov: NCT04839562
https://www.fiercepharma.com/pharma/axsome-touts-success-phase-3-trial-sunosi-adhd